Very low blood sugar but still OK

Shannon27 · Jan 28, 2020

tom58 said:
I'm very very aware when my blood sugar is low but I can still function nearly normally.
Whenever I mention this to professionals they all immediately says that is because I've become hypo unaware and they will never countenance any other explanation.

For years I've kept my HbA1c consistently between 5 and 6 and have gradually learnt to live with the effects of less blood sugar. Sometimes that level may fall below 2 but I can still think rationally enough to eat. It has been over twelve years since I've had a diabetic hypo coma and needed someone else to help.

Despite what diabetic specialists say I believe that it is possible to train your brain to become used to being low on blood sugar, even though it may take a very long time. Has any other fellow T1 had a similar experience?

Yes i totally agree with you! When i go low or hypo, i can still function. I get hypo signs and feel a bit rubbish but i can carry on with my job. It's been 5 years since my last fit/hypo coma thing which my boyfriend helped me with.
As for training the brain, i haven't done it with being low but it definitely happens when you're consistently high for a while! I was ill over christmas and had high blood sugars for about 2 weeks, when they came down to normal i was getting hypo symptoms at 6.3. I think your brain gets used to the high (or low sugar) environment. However, personally i feel like constant low sugar is a lot more dangerous, as the brain isn't getting enough fuel.

Juicyj · Jan 28, 2020

If you mean to switch to auto pilot when hypo then I’ve done this many times so continued to finish the task in hand before swallowing the glucose, I lack complete common sense which shows how the brain can respond but do I think this is ok - no I’d rather treat the hypo as quickly as possible so I didn’t take so long to recover afterwards and incur a tasty liver dump too which can take hours to manage afterwards.

tim2000s · Jan 28, 2020

Just to add in my two penneth.

There are a whole bunch of studies of hypo aware t1s, hypo unaware t1s and non-diabetic people that have had their glucose levels reduced in a clinical setting and given a variety of cognitive tasks to do.

All have had the same issues. When clinically hypo, they're unable to do the tasks to the same level as when not, and what's interesting (as determined by Gold et al [https://scholar.google.com/scholar_...cation_year=1995&pages=501-511&pmid=8587958&] the guy who developed the hypo awareness test) is that those who are hypo unaware (and therefore more likely to spend more time at substantially lower levels) tend to have more acute cognitive dysfunction that lasts for longer as a result of time at lower levels. This is relevant in this case as you are deliberately running lower for longer.

Those people expressing that low level hypos do not affect their cognitive ability are basically kidding themselves. You might not observe any difference in your ability but an outsider would be likely to, and all of the clinical evidence that has been gathered and reviewed runs counter to what you are saying.

Jaylee · Jan 28, 2020

tim2000s said:
Just to add in my two penneth.

There are a whole bunch of studies of hypo aware t1s, hypo unaware t1s and non-diabetic people that have had their glucose levels reduced in a clinical setting and given a variety of cognitive tasks to do.

All have had the same issues. When clinically hypo, they're unable to do the tasks to the same level as when not, and what's interesting (as determined by Gold et al [https://scholar.google.com/scholar_...cation_year=1995&pages=501-511&pmid=8587958&] the guy who developed the hypo awareness test) is that those who are hypo unaware (and therefore more likely to spend more time at substantially lower levels) tend to have more acute cognitive dysfunction that lasts for longer as a result of time at lower levels. This is relevant in this case as you are deliberately running lower for longer.

Those people expressing that low level hypos do not affect their cognitive ability are basically kidding themselves. You might not observe any difference in your ability but an outsider would be likely to, and all of the clinical evidence that has been gathered and reviewed runs counter to what you are saying.

I wouldn't disagree with any of this Tim.

But i feel the subject matter is about holding one's composure to the best of one's ability on detecting & treating a low..
I certainly wouldn't wanna run on empty any longer than need be..

porl69 · Jan 28, 2020

Train your brain for lows a definite NO. Adapting over time too your lows the YES. I have been hypo unaware for years now and only get the feeling of a hypo in the low 2's which is not good. I can still cope between 2.5 - 4 BUT I am a lot slower and have to think a lot before I do anything!

tim2000s · Jan 28, 2020

Jaylee said:
I wouldn't disagree with any of this Tim.

But i feel the subject matter is about holding one's composure to the best of one's ability on detecting & treating a low..
I certainly wouldn't wanna run on empty any longer than need be..

I think my point was that while you might feel you can train your brain to run on lower blood sugars, all the evidence suggests that that's not quite what's happening as you are able to tolerate them to fix yourself okay, but doing anything that requires proper cognitive ability remains affected.

Glucobabu · Jan 28, 2020

tom58 said:
A stern telling of from two moderators... must try harder

I have NOT lost hypo awareness. I know perfectly well when I'm low. Usually I eat something quickly but there are times when that is not possible and I go very low.

What I'm trying to say is that fifty years ago I would have been completely incapacitated by a BS of 2. Today I'm still OK in the sense that I'm aware of my state and am able to do something about it. That is why I think the brain might learn to tolerate lower blood sugar levels over time, if only as an act of self preservation.

Of course one shouldn't be complacent about this. Of course one should stop all activity and get nourishment. I get it... In fact I got it a long time ago. But if I ever try to discuss this phenomenon all I ever end up with is well intentioned lectures. That is why I started this thread; to see if anyone else has had the same experience.

Yes I have had very similar experience to yours and have always been told that I have lost hypo awareness due to overly tight BG control. However I have to agree with the moderators in that going too low is indeed problematic with your ability to function normally. Others around you will invariably pick up when you are not acting normally even if you are kidding yourself otherwise!

EllieM · Jan 28, 2020

tim2000s said:
All have had the same issues. When clinically hypo, they're unable to do the tasks to the same level as when not, and what's interesting (as determined by Gold et al [https://scholar.google.com/scholar_...cation_year=1995&pages=501-511&pmid=8587958&] the guy who developed the hypo awareness test) is that those who are hypo unaware (and therefore more likely to spend more time at substantially lower levels) tend to have more acute cognitive dysfunction that lasts for longer as a result of time at lower levels. This is relevant in this case as you are deliberately running lower for longer.

Very interesting article, and certainly pretty convincing that running low is a bad idea. But how low is an acute hypoglycemic episode? We're taught that below 4 is hypo, but I know that non diabetics can have blood sugars in the mid to high 3s before meals. Does cognitive decline happen at a fixed point for everyone, is it a gradual process, does it vary by time of day and activity for one individual person?

Jaylee · Jan 28, 2020

tim2000s said:
I think my point was that while you might feel you can train your brain to run on lower blood sugars, all the evidence suggests that that's not quite what's happening as you are able to tolerate them to fix yourself okay, but doing anything that requires proper cognitive ability remains affected.

Thanks Tim,

I feel you maybe confusing me with the OP of this thread.
It's for me since childhood a "rewiring" of the thought process during a low with one focus on the objective, (in short.) to detect & souly treat it.
A "rewiring" in the sense to accept what will remedy the situation & remove the emotions normally triggered & associated as a "smoke screen" hindering progression.

I would concur that during a hypo the cognitive function of the brain is not functioning at normal capacity.
Your fascinating link regarding 20 subjects in a controlled environment looking at & tracking numbers on a screen is only one aspect exploring the workings of the brain under such conditions. Indevidual subjects don't always prioritise certain areas of the brain & vocational skill sets may differ too. We don't all have the reflexes of a fighter pilot.

It's quite simple with me. I detect a low coming on physically around the 4.4 to 3.8 then switch off that power tool or inform my wife that, that intended shopping trip will need to wait a while.. Logic. I may also drop a little lower on further testing, before I rise? (then there is manking sure thre won't be a recurrent sucessive low.)
There has never been any jibbering wreck with someone forcing me to eat in this neck of the woods.

Interestingly, I have never been told by an HCP that they feel I have lost hypo awareness..

micksmixxx · Jan 28, 2020

tom58 said:
I'm very very aware when my blood sugar is low but I can still function nearly normally.
Whenever I mention this to professionals they all immediately says that is because I've become hypo unaware and they will never countenance any other explanation.

For years I've kept my HbA1c consistently between 5 and 6 and have gradually learnt to live with the effects of less blood sugar. Sometimes that level may fall below 2 but I can still think rationally enough to eat. It has been over twelve years since I've had a diabetic hypo coma and needed someone else to help.

Despite what diabetic specialists say I believe that it is possible to train your brain to become used to being low on blood sugar, even though it may take a very long time. Has any other fellow T1 had a similar experience?

You MAY feel that you are OK with being able to function with a low blood sugar, tom58, but technically you are NOT OK. I, too, am able to function with a low blood sugar level. In fact, just over a week ago, I was attending a foot clinic appointment when I felt "low". My blood sugar level was 3.6 mmol/l and was treating the same by taking some Dextrose tablets. Unfortutunately, by the time I got home, my blood sugar level had fallen to less than 2.0 mmol/l, so I took some more Dextrose tablets AND ate my lunch. Within a matter of minutes I lost consciousness, which resulted in my wife needing to give me a glucagon injection. This has occurred on several occasions. In fact, several weeks ago I was again attending a hospital appointment and 'came round' to find paramedics treating me. They stayed with me for around about an hour, after also having given me a glucagon injection. This was after having giving me an intravenous glucose injection and me not recovering sufficiently to be able to discharge me home. Sadly, it is now on my record that I was treated in this way, and had insisted that I was 'well enough' to be sent home via a 'normal' ambulance. This has been going on for several years now. and my medical team have been reviewing my medications over this time, even though I was able to function 'well' in my own eyes. Do yourself a favour, my friend, and liten to those around you before something serious happens.

Lots of Love and Light.

Mick
x x x x
x x x

P.S. Please don't be offended, or alarmed, at the 'x's'. It's merely a logo, of sorts, that I've used for more than 40 years now.

Jollymon · Jan 28, 2020

Juicyj said:
If you mean to switch to auto pilot when hypo then I’ve done this many times so continued to finish the task in hand before swallowing the glucose, I lack complete common sense which shows how the brain can respond but do I think this is ok - no I’d rather treat the hypo as quickly as possible so I didn’t take so long to recover afterwards and incur a tasty liver dump too which can take hours to manage afterwards.

you are the 1st person in this forum to also offer that Symogi Effect exists. That nasty liver dump takes me almost 2 days to recover from, so I do not like it when it happens.

teasytux · Jan 28, 2020

Hello Tom58 & all who've replied,

Just to say, experiences talked about are very much familiar!

I'm Type1, 46yrs now & used to get all the traditional signs & symptoms at a young age to my mid teens & mainly lost now. As I've gotten older, eat less carbs (65g daily avg), focused on bm control with an average Hba1c 43 - 45. I have lows caused from gastroparesis & neuropathy where my bm falls to low 2's but I'm fully cognitive & able to treat. I test often with the Libre & catch most lows mid to high 3's with some high 2's thrown in at times. I'm always fully able to treat & cognitive. My consultant gave me a telling off in Nov 2019, saying I have to get my Hba1c higher, to 48-50! I admit my hypo recognition is generally gone but I sometimes get some signs I'm going low.

I am sure I have lost brain cells from hypos, my memory is terrible some days. It's embarrassing when stopping mid sentence as my memory has fogged up & I cannot retrieve the memory, name, word or whatever..I guess age plays some part too! I'd like to do a test of some sort just to see how much I'm affected from past hypos, if such a test exists?

I believe we should test bm much & with the Libre sensor & cgm's, that's much easier now (if you're able to afford or are funded). I've dropped a half unit of hourly basal insulin & changed my insulin to carb sensitivity in an attempt to stop my lows & noticed a drop.. Its the neuropathy though that throws a spanner in the works!

A good topic raised!

Best wishes, Tux

milesrf · Jan 29, 2020

urbanracer said:
NO.

Training your body to accept low blood sugars (as low as 2) is inherently dangerous because you are into the clinically defined hypoglycaemic region and therefore not aware of hypo's.

This makes you unfit to drive (in the UK) and significantly reduces your margin of error.

Some parts of the brain rely on glucose and cannot survive on ketones and proteins so you are essentially risking starving those parts of the brain from the required nutrition.

Note that the liver can convert proteins into glucose more than fast enough to supply the portions of your brain that cannot survive on ketones. I have not heard of any portions of the brain that can use proteins as their source of energy more directly.

Jaylee · Jan 29, 2020

Jollymon said:
you are the 1st person in this forum to also offer that Symogi Effect exists. That nasty liver dump takes me almost 2 days to recover from, so I do not like it when it happens.

I can't speak for @Juicyj 's experince.

Probably not the first.. Hypos have always woken me,
But what I have noticed with recent Libre use. (No not a pressure low? The Libre is placed to avoid to much pushing about.)
I will get a drop, then a rise before anything has been passed down my throat? Or if not. I can treat with 5g of carb then react more like I've eaten 30..?
I feel the liver does help slow decent. Though, I wouldn't trust the liver to what the insulin on board is possibly doing? Or if there happens to be any alcohol consumed..

I can't say it personally takes me 2 days to recover from.. (Though my levels may need a steady hand the rest of the morning.?)

Lynne C J · Feb 4, 2020

tom58 said:
I'm very very aware when my blood sugar is low but I can still function nearly normally.
Whenever I mention this to professionals they all immediately says that is because I've become hypo unaware and they will never countenance any other explanation.

My blood sugars can run low at times especially after or during exercise but I can recognise the symptoms and take action. It's not so much how low my blood sugar is as whether it's a usual low or a nervous system low, they're much more tricky to spot. I think my body has got used to running with a more normal bg than a lot of T1 diabetics. My HbA1C is 42. An endocrinologist Professor inOxford

For years I've kept my HbA1c consistently between 5 and 6 and have gradually learnt to live with the effects of less blood sugar. Sometimes that level may fall below 2 but I can still think rationally enough to eat. It has been over twelve years since I've had a diabetic hypo coma and needed someone else to help.

Despite what diabetic specialists say I believe that it is possible to train your brain to become used to being low on blood sugar, even though it may take a very long time. Has any other fellow T1 had a similar experience?

Terry42 · Feb 4, 2020

tom58 said:
I'm very very aware when my blood sugar is low but I can still function nearly normally.
Whenever I mention this to professionals they all immediately says that is because I've become hypo unaware and they will never countenance any other explanation.

For years I've kept my HbA1c consistently between 5 and 6 and have gradually learnt to live with the effects of less blood sugar. Sometimes that level may fall below 2 but I can still think rationally enough to eat. It has been over twelve years since I've had a diabetic hypo coma and needed someone else to help.

Despite what diabetic specialists say I believe that it is possible to train your brain to become used to being low on blood sugar, even though it may take a very long time. Has any other fellow T1 had a similar experience?

Hi- what medicine are you taking

Teajay · Feb 4, 2020

tom58 said:
I'm very very aware when my blood sugar is low but I can still function nearly normally.
Whenever I mention this to professionals they all immediately says that is because I've become hypo unaware and they will never countenance any other explanation.

For years I've kept my HbA1c consistently between 5 and 6 and have gradually learnt to live with the effects of less blood sugar. Sometimes that level may fall below 2 but I can still think rationally enough to eat. It has been over twelve years since I've had a diabetic hypo coma and needed someone else to help.

Despite what diabetic specialists say I believe that it is possible to train your brain to become used to being low on blood sugar, even though it may take a very long time. Has any other fellow T1 had a similar experience?

Stiller · Feb 4, 2020

Having been T1 for 40 years I have had many occasions with low blood sugars and I have found the body becomes accustomed to this, I realise it’s not a good place to be.
Many times the meter just says Low and I feel fine, but I eat and that’s when I feel terrible as sugars rise !!!

Teajay · Feb 4, 2020

Hi
I can function well even when my levels read low, but I do feel very tired and know I have to eat.( that's my sign of a hypo )
About 20 years ago I was wired up to a monitor for a week which revealed that my levels dropped to coma level every night for six hours. Doctors told me that because my body had probably done this for over 30years I could cope with lows.
I've been type1 for 52years and never been admitted to hospital for diabetes. I monitor my blood on average 20 times a day using Freestyle Libre.
I've not required help with a hypo but do carry glucagon as I occasionally need it.
Janis

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