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What is an acceptable hypo rate

I

Injector1

Active Member
Messages
29
Type of diabetes
Type 1
Treatment type
Insulin
Hi - I've not had a debilitating hypo for some time now and my control is getting much better with the Expert meter. However I do occasionally go below 4mmol especially after unexpected exercise such as chasing sheep that have escaped etc. I sometimes think that my consultant expects zero hypos. What do you think. How many hypos a week - month - year or whatever do you average?
 
This is always a difficult question. It really comes down to what you consider a hypo to be. Clinically a hypo is below around 3.2mmol/l and even non-Diabetics hit less than four sometimes daily. I am therefore totally happy to hit the high threes on a daily basis and have done for years. And more importantly, I am still hypo aware , so know this is happening, after 27 years. More importantly, in that time I've only had two debilitating hypos that required intervention.

I am comfortable with this rate and how it is managed and I think it is unrealistic to expect zero hypos.
 
As usual, I agree with Tim. For me, it's not so much the frequency of hypos, but rather the severity of each one. In the US, we tend to consider anything below 70 mg/dl a hypo which equates to just below 3.9 mmol/l. Personally, I don't consider that anything to worry about whereas a 3.0 would be something I would immediately stop what I doing and address.
 
I have frequent hypos but not debilitating ones. Barely a day goes by without being in the 3s, but I view that as being acceptable for me in my diabetes management. I'm hypo aware, and treat them appropriately, and I view them as small bumps in the road in my ongoing (successful) journey along the realms of tight control.

While I'm on the subject, the nurse at my general practice when I went for my flu jab a week and a half after started on a pump asked me excitedly: 'Has it eliminated all hypos?' Erm no. Because it ain't made of magic.....!
 
I think my healthcare team consider 1-2 a week the norm, however I only have 1 a week, but I only count a hypo if it's below 3.6mmol/l.
 

I haven't had a hypo for a couple of weeks, the last one was in the cold snap in January. Freezing temps tend to lower my BS so I have to be extra careful in cold conditions. Friday evenings are another frequent hypo zone for me, after cycling to and from work all week I guess my leg muscles are sucking me dry of glucose :-0 On average i'd say one hypo a month i.e. when I'm below 3.4 mmol and I get the shakes, sweats and full on confusion.
 
That's a great average - and that's the kind of hypo sensitivity I need to get back to if possible. My 'Expert' meter is set to keep me between 8 and 10 mmol and so far, having adjusted a few settings, it's keeping me in that area. But well done you!
 
Injector1 said:
That's a great average - and that's the kind of hypo sensitivity I need to get back to if possible. My 'Expert' meter is set to keep me between 8 and 10 mmol and so far, having adjusted a few settings, it's keeping me in that area. But well done you!
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Just out of interest why are you aiming for 8 and 10 mmol ? Is this a hypo avoidance strategy or have I misread your post?
 
Wurst said:
Just out of interest why are you aiming for 8 and 10 mmol ? Is this a hypo avoidance strategy or have I misread your post?
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The idea is that if you have repeated lows your hypo awareness is reset to lower and lower levels so that you can get to the stage where unconsciousness is just round the corner before you realise that you are actually hypo. If you can maintain levels well above hypo you can reset that threshold. Interestingly you yourself get extreme symptoms at 3.4 which I believe is not even clinically hypo. So yes it is in a way a hypo avoidance strategy, but for the purpose of regaining awareness.
 


I see, thanks for the clarification. Everyone has their own personal threshold for hypo symptoms. I'd be doing the same if I had lost hypo awareness, how long do you plan to run your sugars between 8 - 10 mmol ?
 
Wurst said:
I see, thanks for the clarification. Everyone has their own personal threshold for hypo symptoms. I'd be doing the same if I had lost hypo awareness, how long do you plan to run your sugars between 8 - 10 mmol ?
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As long as my consultant tells me! At least till I see him in around 6 months.
 
Injector1 said:
As long as my consultant tells me! At least till I see him in around 6 months.
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6 months wow! I thought you only had run a higher BS for a week or two to get your hypo awareness back. I've not yet have to do this fortunately ,so this is news to me.
 
Wurst said:
6 months wow! I thought you only had run a higher BS for a week or two to get your hypo awareness back. I've not yet have to do this fortunately ,so this is news to me.
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Well maybe I'm an extreme case - I believe that some people don't ever get it back It is better now than it was, but it's only since having the 'Expert' meter that I've been able to have consistent tests in the upper single figures. I now know if I'm around 3.5 or below and sometimes higher than that. But nothing like the extreme symptoms that you have at that level - which is what I'd like.
 
Although I have never had a Hypo that's required intervention, I have on numerous occasions I have had sugars as low as 2.3 to which as @TorqPenderloin pointed out previously addressed myself immediately. However over the last 4 weeks I have extensively increased my training program with some very big runs all whilst starting insulin therapy (Basal Only, Bolus from tomorrow fingers crossed), so I have been monitoring my BG levels extensively over the last 4 weeks watching how my body is reacting so have been able to make small adjustments in an attempt to normalise my BG levels. Before exercise I now raise my BG on purpose to between 7-9mmol in anticipation that my BG is going to drop during exercise, And monitoring closely during exercise and again making small adjustments whilst carrying this out... I had a few hypos (<3.9mmol) the first week but I have a handle on this now and a good understanding of how my body is reacting under different circumstances, conditions and intensities. I tried this method in my every day life too and over the last 2 weeks I've had no instances where I have needed to stop and assist myself or the need for anyone else to do so either.

I don't think you can eliminate hypos completely because your always going to be susceptible to them but I believe you can definitely reduce them albeit a little arduous to start with...
 


Think your consultant expects too much...........zero hypo's..........really

Hypo's are impossible to avoid completely and the usual cause is mis-calculating a meal-time bolus and exercise, if you go below 4 occasionally but not below 3.5 then that seems quite normal to me.

I can go 2-3 weeks without a hypo then have a a couple within the space of a day or two, but personally I wouldn't want to be in the 3's everyday and try and keep my bg levels above 4.5mmol/l all of the time (well whenever possible), ideally I like to be above 5 but below 6.5 pre-prandial and below 8.5mmol/l postprandial.

Fortunately I've never had assistance with a hypo in 34 years and I think that's because I don't aim for tight control, still have very good hypo awareness symptoms.
 
I have perhaps done my excellent consultant a dis-service. I'm sure he doesn't expect zero hypos - I just feel torn between trying to avoid hypos with a very irregular lifestyle and trying to get a half decent HBa1C.
 
I don't think I will ever get my hypo awareness back completely as I have been diabetic for a long time and have often had low sugars, sometimes through choice and sometimes through poor control. I will often go into the 3's most days (I am very active and often cycle over 20 miles a day) but I just don't really get concerned by them anymore as they are just a part of my life. I tried to regain the awareness a few times by running them high for a few weeks but frankly it never really seemed to happen.
My consultant moans at me because she says that all the new research suggests that people who have low blood sugars are much more at risk from heart attacks and strokes. I'm sure this is true but then having high blood sugar is also a massive risk for blindness, amputations etc. Face it in another 20 years you'll be told something else about how you'd been doing it wrong.

I do worry about getting confusion etc when low but since I've been on a pump (about 9 months now) my debilitating night time hypo's have all but ceased. I just seem to plod along and function at fairly low levels. A few weeks ago I had a long meeting at work about complex accounting and budget issues with my boss and after it I tested and I knew I was low but had a reading of 2.6. In no way was I feeling impaired and no one in the meeting noticed. I just took some glucose and carried on at work. I don't do it deliberately but I do try and maintain tight control which is hard and ultimately I would prefer my levels to be lower than higher.
 
Yes that was my position too. It's OK if you have the self discipline to correct without over-correcting, because that leads to high HBA1c's I'm finding the Accu-chek Expert meter to be really good. You put in the range that you want to be - say in your case 4.5 - 7.5, you put in your insulin ratio (how many units to 10g carbs) and also your correcting ratio e.g. 1u to 2 mmol. Then the meter works out everything for you and tells you what to inject. It's making me much more confident. However, I wonder, do you drive? If so it might be good to try to hypo awareness back. If you had an accident, even if not your fault and you were low, you would probably lose your licence. I too have been diabetic for a long time (1983).

I have to add this - had a real Duh moment this afternoon. My wife came back and I made a cuppa and decided against fruit cake (what a good boy!) in favour of a digestive. I did a test - was quite high at just over 10, told the Expert that I was going to have 10g - it told me to take 1u - but I was also talking to my wife. It wasn't until I heard click click click... that I realised that I'd dialled up and injected 10u, not one. What an idiot!!! I had the cake after all, and a banana, then later on honey on bread and ice cream. I reckon that will use up the 10u. That's the first time I have made that mistake - hope it'll be the last.
 
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It depends who u talk to... My diabetic Doctor wasn't happy with anything at all under 4 where as my nurse said the high 3s are ok (they were usually just before I was due a snack) x
 
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