Group 7-day waking average?

[New-journey]

Morning all.🙂 A pesky 11.1 here. I have to accept that I'm coming down with this horrible bug that all my little pupils have had...come on flu jab, do your job!😉

How are your mums doing, Amigo and NJ?

Oh No, hope you feel better soon. Thanks and Mum is ok , still no date for new valve operation.
5.2 for me today and going to make appointment for first diabetic review as feeling brave.

 

[Bubbsie]

Oh No, hope you feel better soon. Thanks and Mum is ok , still no date for new valve operation.
5.2 for me today and going to make appointment for first diabetic review as feeling brave.

Good for you NJ...think I've said somewhere here before this morning...good news about your mum...although disappointing no date set yet...hopefully that will be resolved soon...good luck with your review...great numbers...can you get your HbA1c test results online before your review...that is so helpful when review comes around.

 

[New-journey]

If that's too low then the entire non-diabetic population are in trouble, given that I think it's bl***y good! 🙂 I suspect they want to give you the 'too many hypos' inquisition and can't believe you're achieving it through your efforts in losing weight and eating healthily 🙂

It's a brilliant result and seems most of us under 6 get 'told off' for being too low as they are terrified of our hypos. I hope they ask you how you have managed to get such a good result and them pass on the information to others.

 

[New-journey]

Good for you NJ...think I've said somewhere here before this morning...good news about your mum...although disappointing no date set yet...hopefully that will be resolved soon...good luck with your review...great numbers...can you get your HbA1c test results online before your review...that is so helpful when review comes around.

Thanks! Yes, I will ring up and get them, I am expecting it to be the same or even a little lower so trouble ahead! I will probably be asking for support here so I am fully prepared.
I am thinking of you and hope all goes well today.

 

[Bubbsie]

Yes, I will ring up and get them, I am expecting it to be the same or even a little lower so trouble ahead! I am thinking of you and hope all goes well today.

Thanks NJ...why are you expecting trouble...your last one at 5.5 sound great...possibly along the same lines as Hazel?...be interesting to hear the result of HbA1c and your review.

 

[Owen]

Exactly Alan. I have been reducing my doseage of insulin, as and when appropriate.

As I no longer drive, hypos (seldom) I can live with.

I believe that by the end of this year, I could be insulin free, but I want to be in charge of that. It has taken a lot of work to get to this stage and I I do not want a jobsworth telling me what to do

Its not the risk of hypo's so much than the added risk of CAD. Even though a Hypoglycaemic event does add extra stress to the cardiac and neurological system. Regular low readings and insulin combined add a risk of an MI, particularly in the wee hours. I am currently experiencing this problem, hence my reluctance to publish BM readings and create peer pressure for others to achieve too low a BM. I was on a ALS course recently where this was raised as an issue and gave me better explanation as to why too tight a control is not so good for the heart. It is like everything else, finding a good balance is the key. (Pumps do not have the same effect as MDI on the heart).

 

[Owen]

If that's too low then the entire non-diabetic population are in trouble, given that I think it's bl***y good! 🙂 I suspect they want to give you the 'too many hypos' inquisition and can't believe you're achieving it through your efforts in losing weight and eating healthily 🙂

Sorry Alan, but the entire non diabetic population have autonomic control of their metabolic systems and rarely have the risk of a hypo. 80% of mortality in diabetes is through cardiac failure. Diabetes does have co-morbidities with CAD , therefore there is a valid argument for diabetics to stop chasing extreme low BM.

 

[Owen]

Post Script, keeping your BM below 8 is more than adequate to reduce the risk of complications.

 

[Ljc]

I've been unwell Recovering, but hardly had any sleep for the past three nights Still, at least got to hear some interesting stories on the World Service at 3am 🙄 😉

@Northerner I'd hoped you had fully recovered now, sorry to hear it's still a work in progress. Lack of sleep ugg.

 

[Northerner]

Its not the risk of hypo's so much than the added risk of CAD. Even though a Hypoglycaemic event does add extra stress to the cardiac and neurological system. Regular low readings and insulin combined add a risk of an MI, particularly in the wee hours. I am currently experiencing this problem, hence my reluctance to publish BM readings and create peer pressure for others to achieve too low a BM. I was on a ALS course recently where this was raised as an issue and gave me better explanation as to why too tight a control is not so good for the heart. It is like everything else, finding a good balance is the key. (Pumps do not have the same effect as MDI on the heart).

I take your point @Owen. In Hazel's case though the improvement in HbA1c is coming through improvements in her overall health and control, to the extent that she is frequently having to reduce her insulin precisely to avoid hypos. So rather than aiming for low levels by risking a lot of hypos, she's aiming to reduce the likelihood of experiencing any at all when she reaches her goal of zero insulin doses 🙂 Certainly, if you achieve a low HbA1c through too many hypos then your control is not good and needs attention 🙂

 

[New-journey]

Its not the risk of hypo's so much than the added risk of CAD. Even though a Hypoglycaemic event does add extra stress to the cardiac and neurological system. Regular low readings and insulin combined add a risk of an MI, particularly in the wee hours. I am currently experiencing this problem, hence my reluctance to publish BM readings and create peer pressure for others to achieve too low a BM. I was on a ALS course recently where this was raised as an issue and gave me better explanation as to why too tight a control is not so good for the heart. It is like everything else, finding a good balance is the key. (Pumps do not have the same effect as MDI on the heart).

I am not sure what this means and it sounds important. How tight is too tight and what is a good balance? What is regular low readings? Sorry so many questions but haven't heard this before.

 

[Amigo]

4.8 this morning - seeing DSN on Friday.

They called me as they reckon my HbA1c of 5.9% (40) is too low

Will see what she has to say then

It's crazy that they're concerned you are managing to keep within non diabetic levels Hazel. Don't they want people to succeeed? It's the meds that a need a look at, not your efforts. The weight loss has changed your diabetic profile and they need to keep up with your success. They do know you're not type 1 presumably and 40 is an excellent Hb for a type 2. I suppose in fairness, it's hypos they're concerned about with the insulin. (The other posts on this came in whilst I was typing).

I'm 6.5 this morning...rough few days. @Bloden thanks for your kind enquiry. Mum is still in hospital, she has pneumonia and pulmonary oedema. We thought we might lose her on Sunday but she's rallied a lot and I have to remain hopeful.

 

[Amigo]

Sorry Alan, but the entire non diabetic population have autonomic control of their metabolic systems and rarely have the risk of a hypo. 80% of mortality in diabetes is through cardiac failure. Diabetes does have co-morbidities with CAD , therefore there is a valid argument for diabetics to stop chasing extreme low BM.

I'm struggling with this explanation Owen to be honest. It seems to contradict a lot of what I've read. Presumably you're primarily talking about the medicated diabetic population here not non diabetics. I'm not on medication and don't suffer hypos but a lot of the medical advice would have me around 4 5 on waking and not in the 6 & 7's.
The situation would presumably be different in terms of cardiac risk for diabetics not subject to the control of medication because their 'autonomic control of their metabolic systems' is still functioning to some extent?

 

[Hazel]

Amigo - such a worry about your Mam

Sending you both much love xx

 

[Robin]

Post Script, keeping your BM below 8 is more than adequate to reduce the risk of complications.

So why did NICE decide that 6.5 was the relevant figure? I get really confused over what I should be doing. My GP said she thought my HbA1c at 47(6.4) was a bit high last time I saw her. (I assume she'd confused non-D levels with D targets. I didn't quibble, as at the time I was trying to get her to look at a dodgy mole at my medication review, thus breaking the sacred rule of one condition one appointment)
On 'tight' control, perhaps 'close' control would be a better term to use. I think it's better if I test, tweak, scratch my head and think about eliminating those night time lows, than be told to go to bed gaily on 7.5, wake at 6.5, assume all is hunky dory and never discover I hit 3.5 in the middle of the night, which is what my DSN would be happy with.

 

[Owen]

I'm struggling with this explanation Owen to be honest. It seems to contradict a lot of what I've read. Presumably you're primarily talking about the medicated diabetic population here not non diabetics. I'm not on medication and don't suffer hypos but a lot of the medical advice would have me around 4 5 on waking and not in the 6 & 7's.
The situation would presumably be different in terms of cardiac risk for diabetics not subject to the control of medication because their 'autonomic control of their metabolic systems' is still functioning to some extent?

Primarily type 1 and insulin using type 2. Every time you are below 5 mmol, there is an increased demand on the heart to ensure the brain gets its hit of glucose. By using insulin we are trying stop too much glucose from clogging up the system but in doing so we are adding this pressure to the heart. Hypoglycaemia especially during the night adds even more risk to cardiac arrest. In addition to this when hypo's go below 3 mmol, there is a very real threat of irreversible brain damage or convulsions.
Diet controlled BM does not generally cause any of these problems.
Pumps are less of an issue as they cause less hypoglycaemic events.

All too often and myself included, we try to achieve normal BM through Insulin or blood sugar reducing drugs. We are diabetic, we are not normal. Unfortunately we are also supressing the delivery of glucose which is essential for homeostasis. We cannot sustain this tight a control without causing hypo's. Second to this, the average population are not at as high a risk of MI as are diabetics. So they can happily run their blood sugar lower.

There was a study involving type 1' having CGM and continuous ECG monitoring. The ones with tight control all showed arrhythmias or similar events during the night time when they were less aware of their BM and less able to correct it.

At the end of the day, people can shoot me down over this. I have personal experience of attending diabetics during the night in cardiac arrest. They do not fair well. Less than 10% of pre-hospital cardiac arrests survive and those that do often have severe cerebral impairment.

With all this said and done, I would rather sit above 5 and below 8. Less risk of cardiac arrest and also less risk of complications.

Hypoglycaemia is a severe medical emergency! Not a challenge to achieve.

 

[Owen]

I am not sure what this means and it sounds important. How tight is too tight and what is a good balance? What is regular low readings? Sorry so many questions but haven't heard this before.

I think the DVLA guidelines of five to drive are reasonably sensible. If I attend a hypo emergency, then an infusion of 10% glucose is generally used until the PT is stable above 5. I am also monitoring them on a 12 lead ECG as well as SpO2 and other vital signs until they are steady with a GCS above 8. Some of my colleagues are quite brutal about hypoglycaemia being an avoidable event.

 

[Amigo]

Primarily type 1 and insulin using type 2. Every time you are below 5 mmol, there is an increased demand on the heart to ensure the brain gets its hit of glucose. By using insulin we are trying stop too much glucose from clogging up the system but in doing so we are adding this pressure to the heart. Hypoglycaemia especially during the night adds even more risk to cardiac arrest. In addition to this when hypo's go below 3 mmol, there is a very real threat of irreversible brain damage or convulsions.
Diet controlled BM does not generally cause any of these problems.
Pumps are less of an issue as they cause less hypoglycaemic events.

All too often and myself included, we try to achieve normal BM through Insulin or blood sugar reducing drugs. We are diabetic, we are not normal. Unfortunately we are also supressing the delivery of glucose which is essential for homeostasis. We cannot sustain this tight a control without causing hypo's. Second to this, the average population are not at as high a risk of MI as are diabetics. So they can happily run their blood sugar lower.

There was a study involving type 1' having CGM and continuous ECG monitoring. The ones with tight control all showed arrhythmias or similar events during the night time when they were less aware of their BM and less able to correct it.

At the end of the day, people can shoot me down over this. I have personal experience of attending diabetics during the night in cardiac arrest. They do not fair well. Less than 10% of pre-hospital cardiac arrests survive and those that do often have severe cerebral impairment.

With all this said and done, I would rather sit above 5 and below 8. Less risk of cardiac arrest and also less risk of complications.

Hypoglycaemia is a severe medical emergency! Not a challenge to achieve.

Thanks Owen for the full explanation, that clarifies what you were saying. Thankfully, hypoglycaemia isn't something that I personally experience but I know high b/p compounds my cardiac risk if I run too high for too long or have sudden spikes. Not being on medication, there's never been mention of similar risks from low figures but I see the medication effect is the crucial factor.

 

[Northerner]

Primarily type 1 and insulin using type 2. Every time you are below 5 mmol, there is an increased demand on the heart to ensure the brain gets its hit of glucose. By using insulin we are trying stop too much glucose from clogging up the system but in doing so we are adding this pressure to the heart. Hypoglycaemia especially during the night adds even more risk to cardiac arrest. In addition to this when hypo's go below 3 mmol, there is a very real threat of irreversible brain damage or convulsions.
Diet controlled BM does not generally cause any of these problems.
Pumps are less of an issue as they cause less hypoglycaemic events.

All too often and myself included, we try to achieve normal BM through Insulin or blood sugar reducing drugs. We are diabetic, we are not normal. Unfortunately we are also supressing the delivery of glucose which is essential for homeostasis. We cannot sustain this tight a control without causing hypo's. Second to this, the average population are not at as high a risk of MI as are diabetics. So they can happily run their blood sugar lower.

There was a study involving type 1' having CGM and continuous ECG monitoring. The ones with tight control all showed arrhythmias or similar events during the night time when they were less aware of their BM and less able to correct it.

At the end of the day, people can shoot me down over this. I have personal experience of attending diabetics during the night in cardiac arrest. They do not fair well. Less than 10% of pre-hospital cardiac arrests survive and those that do often have severe cerebral impairment.

With all this said and done, I would rather sit above 5 and below 8. Less risk of cardiac arrest and also less risk of complications.

Hypoglycaemia is a severe medical emergency! Not a challenge to achieve.

I'd be interested if you could point me to any sources for research leading to these conclusions @Owen. I'm surprised I've never come across this, given the amount of stuff I have read over the past 8 years.

 

[Northerner]

Good morning 🙂 7.2 for me today 🙂