Low blood sugar tolerance

Not really normal.

Impaired awareness is really when you fail to recognise hypo's until they are below 3.4. Doesnt really matter whether you are still able to treat yourself, you are deemed as being hypo unaware and its not good for keeping driving or being safe.

tom58 said:

After taking insulin for many years is it possible to become more tolerant of low blood sugars?

If my BS falls below 2.5 I'm aware of it but still remain relatively competent. Not until I fall below 2.0 do I become noticeably impaired and can still take corrective action as low as 1.5. Is this normal?

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IMHO that is completely normal. I got hypo playing golf yesterday afternoon. Hit a great tee shot and totally gaffed the wedge and chip shot, realized I was low, ate something, drove cart to bathroom, BS was 2.0 and that was 5-10 minute later.

Hi, Iv noticed that the more hypos I have (especially when asleep) I can’t tell I’m having a hypo until I’m under 2.0...and Iv been at 1.0 and was still able to take action in ensuring my sugar levels come up x

tom58 said:

I don't consider myself hypo unaware because I feel uneasy when below 4.0. But there are always times when our BSs inconveniently fall, like TBN when playing golf. My question is do we gradually get used to lows below 2.0 and can you train yourself to endure them whilst still remaining conscious?

When I was first a diabetic I would conk out frequently. A&E became so fed up with me they once gave me a shot of i/v glucose and told the ambulance to take me home whilst I was still dead to the world. I can't remember the exact details because it's over fifty years ago but I'm certain I wasn't that ridiculously low. Happily hypo comas don't happen now and the last one was over ten years ago.

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Yes we do get used to being low especially if it happens gradually like when I was golfing. I too have awakened with paramedics standing over me injecting D50. But I have learned how to not have that happen anymore when I'm asleep thank God. Whatever you do don't mention hypo unawareness to your medical team or they might jerk your driver's license. Just test before you drive like you're supposed to.

Listening to Fung yesterday he was saying that prolonged lows are as bad as prolonged highs but he didn't elaborate.

tom58 said:

I don't consider myself hypo unaware because I feel uneasy when below 4.0. But there are always times when our BSs inconveniently fall, like TBN when playing golf. My question is do we gradually get used to lows below 2.0 and can you train yourself to endure them whilst still remaining conscious?

When I was first a diabetic I would conk out frequently. A&E became so fed up with me they once gave me a shot of i/v glucose and told the ambulance to take me home whilst I was still dead to the world. I can't remember the exact details because it's over fifty years ago but I'm certain I wasn't that ridiculously low. Happily hypo comas don't happen now and the last one was over ten years ago.

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Hi @tom58 your question doesn't seem to be about impaired awareness of hypoglycaemia. If you are aware when you are under 4, you don't have impaired awareness.

Rather, your question is about ability to function when hypo. I think there probably is, to some extent, a tolerance to hypoglycaemia in that you can retain an ability to function at suprisingly low levels and part of what allows that to happen is exposure to those level. But, and this is a big but under 3 your brain isn't functioning properly, you will have impaired reaction times, impaired speed and accuracy, even if while you are down there you think you are functioning just fine you won't, in reality actually be able to function just fine, and while you are down there your brain won't really be able to form proper memories of what's going on. Don't be fooled by thinking you are fine under 2, that's your hypoglycaemic brain playing tricks on you.

@tom58, to answer your question shortly then the answer is unfortunately 'YES'. We can as diabetics compared to 'normal' people manipulate our bg to be lower than what a full functioning body would regulate it to. When on intensive therapy (which I think these days majority of type ones are) then we can in our dedication to drive the HbA1c as low as possible also in the process make our body more used to low bg levels. As we as active diabetics cannot avoid the hypos from time to time. When doing so consistently for longer periods of times, the body system will then adapt and take that as 'the new norm'. Your counter reaction will then not start until a much lower bg level. You may then even at times be advised to raise your bg levels slightly by your endo, as your risks by lows are indeed greater than when going above the max advisable bg level for short periods of times. Been there myself, when I previously thought that the holy grail of T1 control was to get your HbA1c value below 6.5. ;o)

That's not normal - you should ideally be feeling hypos somewhere around 3.5-4.5 (allowing for meter inaccuracy). Recently I haven't had any hypos because I've been able to treat in time, but I can generally feel it around this level. I'm sure that my functioning is impaired <4, if only due to anxiety, but once I was 2.9 while studying and successfully solved a maths problem for a postgrad course I was taking Other people can often notice things about me that I don't notice when I'm low - for example, my voice is much higher. Consider talking to your doctor about hypo unawareness, it is very dangerous!