Nightmare diabetes appointment

[Brunneria]

Well, the dip in the BG last night was only to 3.8 so not too worried about that. Tonight I'm a bit worried - first glass of wine since being back on Insuman and I remember how wine + Insuman used to drop me pretty low, so I've cut the dose from 6.5 units to 6 units but I'm a bit worried I should have cut it further. I guess I'll see during the night - decided to set an alarm for an overnight test tonight.

Smidge

I can't comment on your doses or anything, but I just wanted to say that I hope this works out for you.
You are certainly doing everything you can to keep on top of it.

 

[LucySW]

Good luck Smidge.

 

[Susiespearish]

What do you all make of this latest on hypos and cardiovascular issues? I don't have any other details e.g. at what level they are considering hypo etc, but I thought given the discussions about normal BGs and hypos we've been having on this thread, it might be of interest.

http://www2.le.ac.uk/news/blog/2014...od-glucose-and-cardiovascular-events-revealed

Smidge

My consultant was involved in that trial .Hence his new advice to never go below 6 at any time .I already have heart problems .

Am I missing something here because it seems obvious that doctors would be far more concerned with hypos than raised bloods.You wake up dead with a really bad hypo compared to "possible" complications if the BG's remain raised for a significant period of months /years. I would expect my doctors to worry as no matter how well controlled you are just as you can spike for no reason you can hypo whilst sleeping .

 

[eddie1968]

I'm not to fond of low BGs either, like to be about 6. About a month ago I woke up in the middle of the night with a headache, trembling and sweating. I was starving. Checked BG and it was 2.3 mmol/l. Panicked drunk some sweet tea and ate. Woke up to a 7.5 though. Scary stuff !

 

[LucySW]

The question that someone raised earlier is an interesting one. It was whether tighter control led to more hypos.

I think there are a couple of ways to look at it. One is that a lower Hba1c number statistically would suggest more hypos.
The second is that a tighter level of control doesn't have to, however it is a tighter level of control at all levels and therefore suggests significant lifestyle impacts.

Yes, that's the million-dollar one. It's always stated that a lower HbA1c must increase hypos.

So let's have a look at it. If that statement is true, then it's because either (a) a low A1c necessarily lessens hypo awareness, or (b) you can't have a low A1c without hypos, or both.

But (b) isn't true. As Smidge pointed out, A1c numbers aren't a mean, they're incremental: we acquire the glycosylated hemoglobin when we have lots of glucose bumping about in the blood, and only then. And we don't lose glycosylated cells/whatever after a hypo: we don't lose them at all till they die off. You could have as many hypos as you like (as it were), and it wouldn't knock a point off your A1c score. So hypos wouldn't show up in A1c at all, and you can't read hypos off an A1c measurement.

As to (a), it's true that people who have had lots of hypos lose hypo awareness. And that's very serious.

But that's because their adrenalin warning system has been desensitised by the hypos. Their bodies no longer respond to the cues.

So that doesn't make (a) true either. Why should people who haven't had lots of hypos lose hypo awareness? What other reasons would there be?

It actually looks as if hypos and A1cs have nothing to do with one another.

So we're left with the key Q: can very low BS leading to hypos be avoided, like high BS, by careful management including low and consistent carbs?

Regardless of whether that would be horrible in lifestyle terms - a separate question that each of us makes up our mind about at any given time.

 

[Scardoc]

Yes, that's the million-dollar one. It's always stated that a lower HbA1c must increase hypos.

So let's have a look at it. If that statement is true, then it's because either (a) a low A1c necessarily lessens hypo awareness, or (b) you can't have a low A1c without hypos, or both.

But (b) isn't true. As Smidge pointed out, A1c numbers aren't a mean, they're incremental: we acquire the glycosylated hemoglobin when we have lots of glucose bumping about in the blood, and only then. And we don't lose glycosylated cells/whatever after a hypo: we don't lose them at all till they die off. You could have as many hypos as you like (as it were), and it wouldn't knock a point off your A1c score. So hypos wouldn't show up in A1c at all, and you can't read hypos off an A1c measurement.

I don’t believe that a T1 diabetic can have a low HbA1c without hypo’s….generally speaking and allowing for the ever present exceptions to the rule. I mainly base this on my own experiences. For the first 5 years of being diabetic my HbA1c’s were between 5.8% and 6.3%. I was always advised to try and increase them towards 6.5%. I know I was in the mind set of “lower is better” and experiencing mild hypo’s on a fairly regular basis. I also lost some awareness.
Over the last 2 years my results crept up and peaked at 7. I have attributed this to the insulin not being as efficient through injecting in the same places too often. I’ve started rotating better and finding new sites and have seen my last too results dropping back to 6.5%. The main time I used to hypo would be before meals and this has not been an issue in recent times.
So, to the point. If insulin efficiency was my problem then the increased HbA1c’s were likely due to my BG levels being higher for longer. This makes sense to me. Remember, high BG levels causes glucose molecules to attach to haemoglobin, but glycation occurs when there is a prolonged period of high BG levels. In a “normal” person, the body would deal with the high BG levels efficiently, resulting in a “normal” HbA1c.
If, BG levels are consistently too low then the amount of glycation taking place will be lower than normal and thus would result in a low HbA1c reading. In a T1, consistently low BG levels would be very indicative of hypo’s. It’s ok saying that an HbA1c of 4.9% is not effected by hypos but it also indicates that over the last four weeks there has been very little glucose in the blood. So, either you have unbelievably good control and can replicate the human body fantastically, or, the BG levels are dropping too low.

 

[smidge]

Why should people who haven't had lots of hypos lose hypo awareness? What other reasons would there be?

It's interesting isn't it? Personally, I would question whether having a high proportion of 'normal' BGs really means you lose hypo awareness or whether actually, you return to having a 'normal' hypo awareness - i.e. the hypo awareness of a non-diabetic - i.e. very little (and we know that non diabetics do dip down into the 2s sometimes without them actually knowing it). Now, there is certainly an argument that insulin-dependent diabetics need hypo awareness, but that's a different question. Does the hypo awareness weaken because that is actually the natural condition for those with 'normal' BG levels?

I'm not saying this is the case, just asking whether people think it's a plausible theory - or are their other reasons.

Smidge

 

[smidge]

My consultant was involved in that trial .Hence his new advice to never go below 6 at any time .I already have heart problems .

Am I missing something here because it seems obvious that doctors would be far more concerned with hypos than raised bloods.You wake up dead with a really bad hypo compared to "possible" complications if the BG's remain raised for a significant period of months /years. I would expect my doctors to worry as no matter how well controlled you are just as you can spike for no reason you can hypo whilst sleeping .

That's interesting Susie. I'd love to have a better insight into that research. My consultant did mention it to me in a throw-away comment earlier in the year, but he didn't elaborate. I think with all these things, the devil is in the detail, so i'd love to see a proper analysis of the findings.

In terms of dying from hypos - I don't actually know how great a risk that is. It's pretty scary, but it might be only a tiny proportion of diabetics and under specific conditions - we just don't seem to have the data to make an informed judgement about it. @phoenix found and posted some links when I last asked about this, but they were old studies, people on older insulins etc etc. For something that seems to worry very many of us, there seeems remarkably little recent research or disclosure of statistics. The likelihood of complications from high BGs is a near-certainty, so balancing these risks is something that is of critical importance - and yet we simply don't have the information upon which to make a sound judgement.

Smidge

 

[AndBreathe]

It's interesting isn't it? Personally, I would question whether having a high proportion of 'normal' BGs really means you lose hypo awareness or whether actually, you return to having a 'normal' hypo awareness - i.e. the hypo awareness of a non-diabetic - i.e. very little (and we know that non diabetics do dip down into the 2s sometimes without them actually knowing it). Now, there is certainly an argument that insulin-dependent diabetics need hypo awareness, but that's a different question. Does the hypo awareness weaken because that is actually the natural condition for those with 'normal' BG levels?

I'm not saying this is the case, just asking whether people think it's a plausible theory - or are their other reasons.

Smidge

I'm not a T1, so forgive my interjection, but I think many non-diabetic people would know they were low, when in the 2s (or even very low 3s), but because they have no reason to know this, or understand what it could mean (to a diabetic person), they interpret that empty, sometimes trembly, feeling as ravenous hunger, and get on and eat. I would suggest this situation mainly arises in non-diabetic when they need to refuel, rather than randomly, as can happen in those with dodgy physiology.

At my lowest verified finger prick test (2.something I can't recall from the top on my head) I wanted to consume the contents of the fridge. At figures down into the low 3s, I just have a cup of tea, or if food is imminent, I just salivate waiting for my food to be ready! I'm so pleased my system appears to have largely "got with the programme" these days!!

Just my 2p worth.

 

[phoenix]

Dead in bed happens. It is rare fortunately but it has now been documented as occurring during hypoglycaemia using CGM
http://www.ncbi.nlm.nih.gov/pubmed/19833577
This one http://diabetes.diabetesjournals.org/content/63/5/1457.full discusses 'silent' nocturnal hypos and cardiac arrhythmia. (this is not a very cheerful pre Christmas subject ) I think it highlights one of the reasons why doctors are wary of very low HbA1cs. Without a cgm you may have un recognised nocturnal hypos.It also seems that the best indicator of low levels at night is low levels in the morning (Somogyi, if it exists is rare)Those of us who wake to 'normal' levels tend to have lower HbA1cs and that invites the question; what happens during the night? )

edited link

 

[LucySW]

Dead in bed happens. It is rare fortunately but it has now been documented as occurring during hypoglycaemia using CGM
http://www.ncbi.nlm.nih.gov/pubmed/198335

Wrong link?

 

[noblehead]

It's interesting isn't it? Personally, I would question whether having a high proportion of 'normal' BGs really means you lose hypo awareness or whether actually, you return to having a 'normal' hypo awareness - i.e. the hypo awareness of a non-diabetic - i.e. very little (and we know that non diabetics do dip down into the 2s sometimes without them actually knowing it). Now, there is certainly an argument that insulin-dependent diabetics need hypo awareness, but that's a different question. Does the hypo awareness weaken because that is actually the natural condition for those with 'normal' BG levels?

I'm not saying this is the case, just asking whether people think it's a plausible theory - or are their other reasons.

Smidge

But dipping down into the 2's in a non-diabetic isn't dangerous Smidge in most cases, however with an insulin dependant diabetic with IOB there's no control over what might happen, that is why it is not encouraged and should be avoided.

 

[LucySW]

Yes. Because non-diabetics' livers will save them (but ours won't).

 

[noblehead]

Yes. Because non-diabetics' livers will save them.

Precisely Lucy, but above all else the impact of long-term low bg levels on the brain are still unknown, also the DVLA state that anyone who drives on the roads must be hypo aware, so the loss of ones hypo awareness symptoms has other consequences besides the risks to ones safety.

 

[phoenix]

Wrong link?

Yes, I have corrected it ,it seems that I lost some numbers on the way.

 

[Ian DP]

Dead in bed happens. It is rare fortunately but it has now been documented as occurring during hypoglycaemia using CGM
http://www.ncbi.nlm.nih.gov/pubmed/19833577

I don't follow. Surely an insulin pump stops hypos.... His BG level was under 2.0, but on an insulin pump.

 

[elaine77]

LADAs can have tight control without hypos though. Since being on insulin my levels are between 4 and 6 almost constantly and I've had maybe one slight hypo at 2.9 and that's it so far and it wasn't through the night. My liver is still compensating too as I have went to bed lower than I should have and woke up higher. I'm on mixed insulin too so not much a day.

Shame I can't enjoy the good levels though due to the stupid weight gain :'(

 

[donnellysdogs]

Ok people.

Let me give you a scenario.

A person has a level of 5.1 before having a very rare chinese with horrendous carbs in it.

This person does a big bolus for the chinese.

This person within 30 minutes is puling her guts up, seriously, really badly. Everything ate comes back up including the snack she had 3 hours earlier, what would you do?

This person was me on Sunday.

I knew I had to get glucose in me urgently as I had insulin still working from 3 hours earlier, I knew I had 14 units of bolus in me.

I gave myself a glucogon injection, a bottle of glucose gel, sweets and milk and sugar which all came back up again.

I knew I was going to go low, I tried to stop it, but the only thing I had working in me was one glugagon injection... Not enough and the coma came on very rapidly and nothing could stop it.

I slipped in to a coma. A very serious coma.

My hubby phoned ambulance as I was totally unconscious. They said to him to stay on phone and to check my breathing at all times, telling him exactly what to do.

When the 1st responders came out I was lifeless and the first thing they gave me was oxygen up the nose. Y oxygen levels had dropped dangerously low and this was there first priority.

One of them was relaying further details to ambulance. Ambulance when arrived minutes later gave me another glucagon injection and I started to come round. I recovered.

This was all due to bad food of some description but you need to be aware that circumstances like this happen.

I was aware that I needed to get glucose quickly. I was aware that I was hypo and there was nothing more that we could do. I had fortinately a glucagon injection and liquid glucose at home, but it wasn't enough..

For all people that keep their levels low, you must have glucose gel and a glucose injection at home and thankgod I had my hubby at home on his one day off and was with me.
I knew that I was in trouble but the soeed that the coma came on in this instance was too quick for me to call an ambulance.. I told my hubby to but by the time you think about injection, gel being sick etc there is not enough time.... I would have been in worse dire straights if I did not have the injection, the gel (lucozade tablets would have been useless) and my partner with me. I wouldn't have been able to get to the phone, let alone unlock the front door to let them in!!!

This is why you must have back up glucose in gel form, at least...

I run my levels between 5 and 7. I knew I was in trouble and there was nothing I could do about it.

You must have people aware what to do with glucose gel and injections.

Be aware that despite being at a reasonable level at 5.1 if I had been a tad higher then that 1st injection and glucogel may have stopped me going unconscious...

I hope that everybody else that tries to keep their levels under non diabetic bg levels and are on insulin will consider their lives and circumstances and what they have in the fridge like injection and gel before they pursue lower levels.

 

[donnellysdogs]

Also further details on diabetics knowing when they are in the 2's.

Another ongoing scenario at the moment.

I have an anorexic young female friend in a eating disorder unit currently.

When she was first admitted her levels were all under 3 for 3 weeks.

She did not have a clue that her texts were like she was drunk, her talking was like she was brain dead. She didn't have a clue that this was not normal.

She is a very academically qualified clever young lady. Nobody prior to her being admitted to the unit realised that her blood glucose levels were so low that it was affecting her brain functioning. She did not realuse at all.

Ot took three weeks of horrendously high eating of carbs (80% of her food was carbs) and fruit juices to get her bg levels raised consistently.

Her brain was acting exactly like mine does when I drop low. No different at all.. And she any nobody else realised that this was the cause of her brain functioning badly academically or on txts or speaking.

When I go like this, I know and, my friends and family know instantly.

So.. No. Non diabetics do not realise.
I realised because I have the knowledge of hypo's and testing my bloods etc.

Another person (her dad) also has low blood level incidences and after I tested him after complaining of being dizzy up a ladder then He actually gave up going on to roofs and up ladders as part of his job and also carries choc bars with him. He knew he was getting dizzy and feeling like he was drunk but actually didn't have a clue why. He had also been to a GP who did not consider that it was because he was having low blood glucose levels.

Non diabetics who may well be having symptoms of hypo's do not know the causes and GP's would not know unless they were there and tested at that specific time of the low levels occuring.

These people are just as unsafe doing things with liw levels as diabetics are, its just that they do not get it considered that their levels are low OR have to report them to the dvla.

 

[Emmotha]

Ok people.

Let me give you a scenario.

A person has a level of 5.1 before having a very rare chinese with horrendous carbs in it.

This person does a big bolus for the chinese.

This person within 30 minutes is puling her guts up, seriously, really badly. Everything ate comes back up including the snack she had 3 hours earlier, what would you do?

This person was me on Sunday.

I knew I had to get glucose in me urgently as I had insulin still working from 3 hours earlier, I knew I had 14 units of bolus in me.

I gave myself a glucogon injection, a bottle of glucose gel, sweets and milk and sugar which all came back up again.

I knew I was going to go low, I tried to stop it, but the only thing I had working in me was one glugagon injection... Not enough and the coma came on very rapidly and nothing could stop it.

I slipped in to a coma. A very serious coma.

My hubby phoned ambulance as I was totally unconscious. They said to him to stay on phone and to check my breathing at all times, telling him exactly what to do.

When the 1st responders came out I was lifeless and the first thing they gave me was oxygen up the nose. Y oxygen levels had dropped dangerously low and this was there first priority.

One of them was relaying further details to ambulance. Ambulance when arrived minutes later gave me another glucagon injection and I started to come round. I recovered.

This was all due to bad food of some description but you need to be aware that circumstances like this happen.

I was aware that I needed to get glucose quickly. I was aware that I was hypo and there was nothing more that we could do. I had fortinately a glucagon injection and liquid glucose at home, but it wasn't enough..

For all people that keep their levels low, you must have glucose gel and a glucose injection at home and thankgod I had my hubby at home on his one day off and was with me.
I knew that I was in trouble but the soeed that the coma came on in this instance was too quick for me to call an ambulance.. I told my hubby to but by the time you think about injection, gel being sick etc there is not enough time.... I would have been in worse dire straights if I did not have the injection, the gel (lucozade tablets would have been useless) and my partner with me. I wouldn't have been able to get to the phone, let alone unlock the front door to let them in!!!

This is why you must have back up glucose in gel form, at least...

I run my levels between 5 and 7. I knew I was in trouble and there was nothing I could do about it.

You must have people aware what to do with glucose gel and injections.

Be aware that despite being at a reasonable level at 5.1 if I had been a tad higher then that 1st injection and glucogel may have stopped me going unconscious...

I hope that everybody else that tries to keep their levels under non diabetic bg levels and are on insulin will consider their lives and circumstances and what they have in the fridge like injection and gel before they pursue lower levels.

Omg r u ok now?