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Personal variability in blood sugar "comfort"

Discussion in 'Ask A Question' started by Erin, May 15, 2021.

  1. Erin

    Erin Type 2 · Well-Known Member

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    Hello everyone,

    Do some people here find that not everyone feels comfortable with the same recommended blood sugar range. My experience for the past 14 yrs. or so being diabetic, has been that I become very hypoglycemic at 4.1 and can tolerate a high as 18 with few adverse effects. I do manage to stay within 5.5 and 11 on average with some work. A strange phenomenon I have had with "tingling" and "tremor" has more often been with the lower numbers than the high ones, maybe eliminating the possibility of neuropathy, particularly as my yearly A1C has been below 7 for most years.. I would like to read of your experiences.
     
  2. searley

    searley Type 1 · Moderator
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    I used to be quite in controlled.. so couldn’t tell that I had a bg of more than 30.. but would feel hypo at about 5.6

    Now I have a pump.. I start feeling low at about 4.5. But can tell if I above 14ish
     
  3. lucylocket61

    lucylocket61 Type 2 · Expert

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    I am not concerned with my comfort levels, I am concerned with my spikes leading to long term harm.
     
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  4. KennyA

    KennyA Type 2 (in remission!) · Well-Known Member

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    I wonder if part of this issue is that the "A1c diabetic level" was a fairly recent compromise agreement so that every country signing up agreed that an A1c of 50 was diabetes, and that a lower A1c wasn't? My experience has been of having around ten or twelve years of diabetic symptoms, but no diagnosis of diabetes because my A1c wasn't high enough (then) for a diagnosis. This has continued after my BG returned to "normal" levels - I had a couple of new short-term symptoms last year and still have the night sweats and tingling feet on occasion. At the same time I know diagnosed T2s with much higher BGs than mine who report zero symptoms. My conclusion is that the medics are focused on a number derived from testing and do not look at the patient in front of them.
     
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  5. Erin

    Erin Type 2 · Well-Known Member

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    Thank you Searley, that's good feedback.
     
  6. Erin

    Erin Type 2 · Well-Known Member

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    lucylocket61, you sound like a medical conservative; but you know, some respect may be due to a comfort level which may actually be an alarm, e.g. hypo leading to unconsciousness; tx for reading;
     
  7. Erin

    Erin Type 2 · Well-Known Member

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    Very interesting Kenny A; I am frequently inquisitive about "bureaucratic" guidelines which have now become the easy way out in medicine and clinical trials. But that may be too much reading and too much time on my fingers. :)
     
  8. chrisbug

    chrisbug Type 1 · Well-Known Member

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    Hi,
    My high symptoms start at about
    9.5 mmol/L, but I find it difficult to explain the symptoms, lethargic (mainly in the legs) and feeling really sluggish.
    My hypo symptoms have only ever been hand tremors and kick in with any certainty at 4.0 mmol /L.
    In the past my control was so very close to the wire, and I am now trying to raise my BG in the hope that my awareness will improve.
    Yesterday (according to my Libre) I had a first of 100% in target and an average of 7.1 mmol/L, which is most definitely not the norm.
     
  9. VashtiB

    VashtiB Type 2 · Moderator
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    Hello,

    I agree that there is variability in the approaches taken by different people. I personally like my levels to stay below 6 and like them as low as possible. As a person with type 2 diabetes and on no medication other than metformin it is highly highly unlikely that I will get a hypo so I don't need to worry about that and neither do a lot of people with type 2 diabetes.

    I worry about possible complications from high blood sugar levels. So that is something that keeps me motivated. I am also an all or nothing person so I find it easier to keep my carb intake very low rather than a level of say 100 grams of carbs a day. This is the balance that works for me. Everyone has to find their own balance. If the balance that you have works for you and you have untaken sufficient research so that you are comfortable with your balance then that is great.

    So for me my personal comfort level is with lower levels than yours but that is fine. we are all different so we should expect different ways of approaching this. My biggest concern on this forum is to be supportive of people in their journey to find their balance and maintaining it. My views on my personal levels of comfort may change in the future but at the present time I find that it works for me and my life usually feels good.
     
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  10. lucylocket61

    lucylocket61 Type 2 · Expert

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    I don't know what you mean by a medical conservative, but you were talking about being comfortable with high readings. Hence my response.
     
  11. muzza3

    muzza3 Type 2 · Well-Known Member

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    Hi @Erin

    I agree that BG levels of comfort or concern are very much a personal thing developed from our own experiences, medication etc.

    Personally as a Type 2 with no medication and normal levels I am comfortable from 4 to 7.9.
     
  12. woollygal

    woollygal Type 2 · Well-Known Member

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    Yes.
    For the majority of times I cannot stand being in the 4s. I get shivers and very cold and the longer I’m in them the longer it takes to get rid of symptoms. Sometimes it gets me in the low 5s.
    4s are supposed to be fine but I just don’t feel good in them.
    For work I will always start a lesson (driving instructor) when I’m in mid 6s. So I don’t drop into the 4s in a lesson.
     
  13. KK123

    KK123 Type 1 · Well-Known Member

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    Hi Erin, I do get what you mean overall, one size does not necessarily fit all, but 'tolerating an 18' is puzzling, do you mean you still feel ok if you hit an 18? When I was diagnosed my hb1ac was 16%/151mmol, equating to an average reading of over 22 for at least a 3 month period. I felt absolutely fine on diagnosis apart from feeling thirsty and losing weight I couldn't afford to lose which is what sent me to the Drs. I think from that perspective I too was tolerating it but I shudder to think of the damage that may have been done over the preceding months, I ended up in hospital on the verge of DKA. Obviously a one off 18 is different to prolonged very high readings but how would anyone really know whether that had had an adverse effect or not, the effects of very high numbers tend to accumulate over time.

    I think they declare these blood glucose ranges because I suppose they have to work towards what they believe is the 'average' range a non diabetic would have with a little bit added for those whose bodies are diabetically 'flawed'. Otherwise what yardstick would they use? It's not perfect of course. My levels seem to persist with a level of around 6, it goes down into the 4s often (fasting) and up into the 8s often (after food) but left entirely to its own devices it stubbornly remains on 6. Even if I use extra insulin it will go into the 4s and then 2 hours later it's sitting at 6, I think that's its comfort zone and when I asked a Consultant about it, they said not to forget that insulin is just one hormone working in tandem with others so if you overload one of them or force it into reacting extremely, it affects all the others too. I used to think forcing it to sit in the 4s like a non diabetic was a good thing, even though it took a mammoth effort and left me in hypo territory constantly, now I know that anything between 4 and 8 for ME is good enough. x
     
  14. EllieM

    EllieM Type 1 · Moderator
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    Are we talking about levels people are comfortable to aim for or levels at which they get symptoms?

    I think the former is a personal preference which has a lot of individual factors (eg potential bad hypos, need to keep tight levels because of complications, ability to control levels, etc). My T2 dad is 90, and his doctor is happy for him to have much higher levels than many of the T2s on here aim for, just because he's prone to falls and a hypo could be really really bad for him.

    As regards the symptoms, that also varies a lot. I used to have a T1 work colleague who swore he got hyper symptoms at 8, whereas at the time I could go into the high teens without noticing much. And hypo awareness can be enormously important for insulin users, whether T1 or T2 (or T3c). Mine is not that great, though I haven't lost it completely. The last time I had a bad (trip to hospital) hypo was a couple of years ago, and my endo told me to keep my levels between 6 and 12 to restore my awareness. (Which worked, but it still isn't as good as it was 40 or 50 years ago). Though I aim lower now, I can only afford to do that because I self fund a dexcom.
     
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  15. HSSS

    HSSS Type 2 · Expert

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    What’s a medical conservative in this context please?

    Very rarely will a type 2 have a hypo let alone one that leads to unconsciousness unless on certain medication to control the diabetes. So this is an important factor to consider.

    Like all physiological levels there is a normal range taken as an average of many people. These will be a variety of more and less perfect to borderline unhealthy specimens usually too. Some will naturally fall at one end of the scale or other and possibly a little outside and it be their personal normal. So yes I suspect a small amount of variance in what is a good natural normal.

    That all said is comfort about the here and now immediate physical sensations “. In which case as I’m not on medication I am not concerned about hypos. If I hit an 8 or 9 I definitely know it. I get very sleepy and sluggish. It’s rare I do go to those numbers though.

    Or is comfort the level I’m happy to be at for the long term implications? In which case my answer is under 7 pretty much all the time (measured before and 2hrs after eating) and ideally when fasted as close to the 4’s as I can manage. (I sadly don’t manage that but that’s what I’d be happiest with)
     
    #15 HSSS, May 16, 2021 at 10:55 AM
    Last edited: May 16, 2021
  16. KennyA

    KennyA Type 2 (in remission!) · Well-Known Member

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    If I recall correctly this was a decision taken by an international group of physicians: I think the UK's representative was Professor Sir George Alberti. I don't think it was a particularly patient-centered process - it did allow for large-scale comparisons to be made across countries that up until then had had their individual ways of diagnosing T2 diabetes. They simply all agreed that they would all recognize an A1c reading of 49/50 as diabetes. That in itself isn't the problem - the problem lies in medic systems then assuming that if your test score is not at 49/50, you can't possibly have any diabetic symptoms because you officially haven't (yet) got diabetes.
     
  17. Erin

    Erin Type 2 · Well-Known Member

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    Well, yes these guidelines are probably a result of statistical findings on the whole; but there may be variables in blood sugar tolerance such as age, diet, exercise, general health and personal tolerance. When I mentioned going up to 18, which I avoid, but it sometimes happens, I meant that it does not feel as bad and on the "comfort" spectrum is not as disabling as a hypo, which for me as the years have gone by, is now even at 4.0. The argument seems to be that hyperglycemia in the long run has serious diabetic effects-- question: what is the long run? But the hypos too, can have an immediate adverse effect on the brain esp. if repetitious, and dangerous if occurring in your sleep for example. So, yes, it is a balancing act which requires some transparency in studying different groups of individuals.
     
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  18. Erin

    Erin Type 2 · Well-Known Member

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    "like all physiological levels" that generality may be the problem in giving more weight to an occasional hyperglycemic number than a hypo. Physiological levels may vary from patient condition to patient condition. For example, I was able to tolerate 3.0 in my early diabetic years but even my dr. was concerned that I would exceed those for more than twice a week. I think they are more harmful than hyper numbers. You are not on medication? Wow! Oh yes, I should have added than insulin AND diabetic meds may risk a hypo now and then. I have been lucky to wake up sometimes nervous and sweating and confirming that these symptoms are caused by a hypo, checking my meter. But I am concerned about sleeping through something like that which may get too low.
     
  19. HSSS

    HSSS Type 2 · Expert

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    Lots of us type 2 in here manage with no or minimal meds as we eat low carb, thus if we don’t push the levels up in the first place we don’t need to bring them back down. This means not only do we have the benefit of fewer hypers we don’t risk hypos either.

    Not sure I get your point about generalising about physiological levels (they pretty much all have a range sometime small sometime larger) or why that adds weight to the damage a hyper does. Hypers do damage when repeated and long term. Hypos obviously have a much more serious short term risk. Long term I guess the biggest danger would be losing hypo awareness? They are different risks and thus hard to compare
     
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  20. lucylocket61

    lucylocket61 Type 2 · Expert

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    @Erin Hypers do damage, just not as fast as hypos. Do a search on here for more information.

    I am type 2, diet only controlled for over 9 years now. I low carb to control my levels. For some reason I hypo down to 2 occasionally, but know what to do now about the hypos and am aware of them coming on so can treat them quickly. I am on no diabetic medication.
     
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