When Should You Feel a Hypo?

Hi @empink - i don't think there is a 'norm' as such, there's lots of factors that can affect hypo awareness, so the speed at which you drop, if you've been running high for a period beforehand, circumstances, so if tired, exercising, and we are all different, I am pretty sensitive to hypos so will start to feel low at around 4.2, however have found on the rare occasion that I've not felt it until I've been at 3.2. The important point is to keep good hypo awareness so if you feel that your sensitivity is getting worse then speak to your DSN as you may need some assistance in improving it.

I usually start to feel hypo when mine drop below 5mmol. I think it varies from person to person and how sensitive you are.
If you're starting to loose awareness then I would speak to your DSN.
Also, always make sure you test before driving (if you drive) to make sure you're not starting to drop before you set off.

For me its abut 3.0 but it has been lower if I'm golfing and it drops very gradually. I usually know I'm low when a skull a shot into a lake!

I Agee with Juicyj (again), speak with your DSN if you think you're losing hypo awareness.

We're all different and the important thing is to learn your own signs. For me, if the drop's rapid it can begin when I'm 5.5, which is 'normal'. I also find that the symptoms can vary. It's as if there's a sharing out, my body asking whose turn is it this time. So sometimes my rational self seems fine but my legs aren't working like they should be; other times I'm wittering on like a ventriloquist's puppet that's gained an independent life, and then the next time I can be zoned out on a pretty leaf. But the main thing is to be aware that as soon as the slightest hint that all's not well hits your consciousness you take action to get back to sensible functioning as soon as possible and stop whatever you're doing until you're ok.

The consensus is that below 5.0 then you should be eating a glucotab or jelly baby to maintain balance, and you should be 5.5 before operating machinery without fear of disaster.

It's usually considered to be an issue if you don't feel a hypo until you are lower than 3.5, and if you don't feel at lower than 3.0, then you're already in the realm where your brain is impaired due to the lack of glucose in your blood. At the levels you're at @empink, then you should be speaking to your DSN.

@Fairygodmother - I'd completely disagree with your statement:

Fairygodmother said:

The consensus is that below 5.0 then you should be eating a glucotab or jelly baby to maintain balance

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As it just isn't the case. In relation to driving and handling heavy machinery, then there are guidelines that one should be above 5 mmol/l, but if you are sat at a desk all day, then there's no need to be worrying below five, especially if you are able to manage your levels well.

The recommendations with regard to treating below five relates much more to people that swing up and down a lot, but that's a different point.

tim2000s said:

As it just isn't the case. In relation to driving and handling heavy machinery, then there are guidelines that one should be above 5 mmol/l, but if you are sat at a desk all day, then there's no need to be worrying below five, especially if you are able to manage your levels well.
The recommendations with regard to treating below five relates much more to people that swing up and down a lot, but that's a different point.

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That's what I think too. The magic number 5 is just a guideline. My diabetes saying is: "you're either on your way up or on your way down". If so when you hit 5.0 you don't have a lot of cushion left even though you're probably mentating perfectly even at 3.0 People can't tell I'm low at 3.0 even though I generally can tell.

I used to get signs of hypo at 4. I've been using Freestyle Libre with much better control but although checking regularly, I do not get warning signs like before. It is sometimes as low as 2.9 and no signs. Why is this?

With me it's the 4s but I generally test myself a few more times after that to figure out if my BGs are dropping or just leveling out. Usually they're just leveling out so I take no action and try to keep my levels in the 4s for as long as possible but there are times - usually brought on by exercise where I will test 15 minutes after my previous test and it becomes obvious that my BG levels are still dropping. That's when I counteract it with a snack, but let me tell you - for most of us there is a delay between where your levels are at and when your brain says - "okay I'm feeling better now". This causes over-compensation which just makes you feel worse in the long run.
For me it took a while to figure out how to best handle low BGs without causing it to go very high, you basically have to ignore your instincts and validate where things are by testing again.

Cit said:

I used to get signs of hypo at 4. I've been using Freestyle Libre with much better control but although checking regularly, I do not get warning signs like before. It is sometimes as low as 2.9 and no signs. Why is this?

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Probably because the Freestyle Libre isn't that accurate like fingerstick is. It's kind of a POS for a number of people who post here. I noticed that our FDA approved a Freestyle device last week here but it isn't the one they use in the UK.

I think ideally you should feel low somewhere between 3.5-4.5 (allowing for meter inaccuracies). I can usually feel hypos around 4, but sometimes higher if I am on my way down.

TheBigNewt said:

Probably because the Freestyle Libre isn't that accurate like fingerstick is. It's kind of a POS for a number of people who post here. I noticed that our FDA approved a Freestyle device last week here but it isn't the one they use in the UK.

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Yes, it is. It's the same sensor and technology. The difference is that Abbott submitted a different case to the FDA including approval for bolusing without fingerpricks, in order to try and replace finger prick testing. So instead of a one hour warm up there's a twelve hour one (the data collected from the European roll out showed that the first twelve hours are less accurate vs finger pricks) meaning that when it starts you can use it to bolus off. It also stops after 10 days. I assume this is an accuracy thing related to the previous point.

But it's very much the same device, just with different software settings in the sensor and alerts to do fingerpricks in the reader.

Thanks. So when you say "it stops after 10 days" I take that to mean you have to change the sensor every 10 days no matter how long it will actually last. I read some people get theirs to last longer, and some Dexcom sensors last a really long time too.

Besides the feelings of hypo's and when you feel them... please be aware that the severity of the drop can impact of how you react and when you may actually "feel" it.

Quicker drops can and you may not feel them until under 3.0. If the drops are gentler you may well feel them above 3.0 and nearer to 4.0.

empink said:

Hi guys, quick question for you on a Saturday arvo!

Just wondering when you should start to feel hypo symptoms? It's quite rare I feel anything above 3.5 (sometimes false hypos at around 4.5 if I've been quite high that day). Today was 2.9 which is closer to when I usually realise and I've been as low as 2.2 before without twigging something was going on.

Just curious as to what the 'Norm' (if there is such a thing in this T1 word!) is?

Many thanks in advance for your help!! xx

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Hi Empink. I am asymptomatic to hypoglyceamia. My diabetic team tell me this is quite common in long term diabetes. I have type 1 for 45 years. I do think it varies widely though and probably depends on your usual levels. Good luck

clanders said:

Hi Empink. I am asymptomatic to hypoglyceamia. My diabetic team tell me this is quite common in long term diabetes. I have type 1 for 45 years. I do think it varies widely though and probably depends on your usual levels. Good luck

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Precisely. And what most people consider to be the hallmark sign of hypoglycemia, confusion and inability to function mentally (as well as physically) depends on how your brain functions with lower glucose concentrations. But we measure glucose in the bloodstream not the brain tissue. And we can adapt to lower levels of glucose than the average person. But sooner or later if the sugar keeps dropping it will win. Every time.

clanders said:

Hi Empink. I am asymptomatic to hypoglyceamia. My diabetic team tell me this is quite common in long term diabetes. I have type 1 for 45 years. I do think it varies widely though and probably depends on your usual levels. Good luck

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After 51 years I'm still very hypo aware, thankfully. At about 4, I recognise the signs but as you say it probably does depend on your usual levels.

Have been using Libre for 2 yrs and have found my awareness to be improving.
I am lucky in that Libre gives me very similar readings to blood so can use it to learn. Now I recognise small symptoms even subconsciously.
I awake at night in the 4 s,. If dropping quickly at around 5.0, if slowly nearer 4.0. This is similar to daytime awareness but actually quicker/earlier. Daytime is more like 4.5 (fast) and 3.5 (slow) when I can be certain without checking with Libre - but I find I have actually checked(scanned) without realising that I have felt the symptoms, if that makes sense.
I have found the lag time (time difference between ISF readings and blood) is shorter when going down than when rising; which I believe is the algorithms they have developed to reduce lag and is confirmed by trials. About 5 minutes lag on avaerage but 0 lag when falling and almost 15 minutes when rising. Quite important when working out how much glucose is needed to raise levels without massive rebound.
If falling slowly I will start at around 4.0 with only a 1/4 glucotab, around 1gm of fast acting carb. If falling fast then up to 1 tab (4 gm ) . Then check in 15 minutes and redose if/as needed.
Can now level it out at around 6 without shooting up to the teens
So much information from Libre opening up a new world. I would never have dared run so low before without much greater glucose dose and certain hyper following. The old days of 2-4 glucotabs for a hypo have gone thankfully!

On top of the blood/ISF lag, I believe there is a brain/blood lag. It takes about 5-10 minutes for brain symptoms to follow other physical symptoms. An interesting topic.

Normally I 'feel' hypo around 3.5 , but last night I was checking as I was about to go to sleep as I do every night, and was shocked to discover I was 1.8!! Zero symptoms, so I rechecked and it was correct. So glad I checked, but it really worried me that I hadn't had the typical shakes/tongue tingling etc. Hopefully that was a one off

I feel the feel the affects when my B G falls below 4:00. My legs start to feel weak and that's my sign to test.