Hypo levels - a strange question

[Lauras87]

I'm going through everything I was given with my new meter & from the dietician.

Something I'm struggling to get my head round is, the dietician said a diabetic blood sugars should be 3.5mmol to 7mmol.

I was told when I was first diagnosed & all the material I have states anything under 4mmol is a hypo.

She also said dont follow up with long acting carbs.

Am I right or is the dietician?

I'm just questioning all I know now

 

[brett]

Also told under 4 is hypo, hence 4 is the floor expression. Although many people are ok at 3.5, best not to get there as if levels are dropping quickly would have less time before you would be in serious trouble. I would stick to 4 at a min although I prefer to stay 5+.apart from before bed when I like to be 7~8.

 

[Pumper_Sue]

Hi Laura,
once you reach 3.9 or 4 then treat as a low blood sugar.
This allows you room for any further drop. Being on insulin you do not want to run any lower due to the risk of becoming hypo unaware.

There's an old saying of....... fours the floor. Obviously not as in you will end up on the floor but the floor level before you treat. 🙂

 

[Lauras87]

Hi Laura,
once you reach 3.9 or 4 then treat as a low blood sugar.
This allows you room for any further drop. Being on insulin you do not want to run any lower due to the risk of becoming hypo unaware.

There's an old saying of....... fours the floor. Obviously not as in you will end up on the floor but the floor level before you treat. 🙂

That's what I do even at 3.9 but she said not to treat til under 3.5.
I think she is wrong as when I was diagnosed I was told dont eat chocolate, sweets, have sugar in coffee etc where as I'm told I now can eat what I like as long as I take the insulin to compensate

 

[AlisonM]

I was also told that 'four is the floor' but not to treat aggressively anything over 3.5 as I could end up going too far in the opposite direction. So anything over 3.5 and I might decapitate a single jelly baby, below that and it'll be half a dozen of them. Anywhere below three and it's chip butty or banana toastie time. I tend not to treat with drinks as they bring my bloods up OK, but they won't stay up and, if I eat something as well, I go too high.

 

[Lauras87]

I was also told that 'four is the floor' but not to treat aggressively anything over 3.5 as I could end up going too far in the opposite direction. So anything over 3.5 and I might decapitate a single jelly baby, below that and it'll be half a dozen of them. Anywhere below three and it's chip butty or banana toastie time. I tend not to treat with drinks as they bring my bloods up OK, but they won't stay up and, if I eat something as well, I go too high.

I couldn't pick 1 jelly baby! My hypo kit (a plastic bag with 3 jelly babies in has my 3 fav ones in)

I was just wondering if anyone else had been told this?

To live my life how I have for 10 years to get all this new info is confusing the hell out of me

 

[Pumper_Sue]

Have you heard of the 15 min rule Laura?
Hypo... treat with 15 fast acting carbs wait 15 mins and retest if not coming up re treat?

I've only ever used 10 carbs to treat a hypo unless active then I use 15.

IMHO 3.5 is to low to wait to treat a hypo if you are on insulin. Just not worth the risk.

 

[Lauras87]

Have you heard of the 15 min rule Laura?
Hypo... treat with 15 fast acting carbs wait 15 mins and retest if not coming up re treat?

I've only ever used 10 carbs to treat a hypo unless active then I use 15.

IMHO 3.5 is to low to wait to treat a hypo if you are on insulin. Just not worth the risk.

Yeah that's what I do now.

I've worked to the rule of keeping my bloods between 4 - 7 mmol as thats what i was told was normal sugar levels but what she said is confusing me.

I'm going to keep doing it how I do it now but just wondered if this was a new break through on sugar levels

 

[AlisonM]

Laura, if it wasn't for this place, and all the folk in here who live with the Big D every day, I wouldn't have a clue. I've learned so much and now filter everything I'm told elsewhere through here. Most of the professonals I see are geared towards T1 or T2 and don't know what to do with me as I don't fit in their worldview. Plus, we all seem to react differently to similar situations so I think it's a case of finding what works for you and building on that.

 

[Persil]

I was also told "four is the floor", but like Alison M, if I'm at a 4, I just eat a couple of sweets to try to stop my levels from dropping below 4. When below 4, however, I've been told to follow the 15 rule: 15g fast acting carbs followed by 15g long acting carbs, unless my next meal is within the hour following. In that case, I skip the long acting carbs knowing I'm going to be eating a meal fairly soon.

 

[Tina63]

Dare I utter the phrase "She is only a dietician?" I am sure a dietician treats other conditions as well as diabetes. With my son, his hypo symptoms are so apparent even just around the 4 mark, so if he did leave it much longer he would be incapable of dealing with it himself, a state I would rather he doesn't get into. We too were told 4 is the floor. 5 to drive. Stick with what you know. It has served you well for 10 years, so why go messing with it now? She doesn't need to know........

 

[brett]

Dare I utter the phrase "She is only a dietician?" I am sure a dietician treats other conditions as well as diabetes. With my son, his hypo symptoms are so apparent even just around the 4 mark, so if he did leave it much longer he would be incapable of dealing with it himself, a state I would rather he doesn't get into. We too were told 4 is the floor. 5 to drive. Stick with what you know. It has served you well for 10 years, so why go messing with it now? She doesn't need to know........

Totally agree with you butthink she does need to know as shes giving c**p advice and could put others in danger

 

[Northerner]

I think a lot depends on how well you know yourself. I treat 3.5-3.9 as a 'low' BG, anything below 3.5 as a hypo. I would usually take into consideration how long it has been since I injected, so if I have a 3.7 (for example) after two hours I know that I still have a lot of insulin glugging around in me, so will use more carbs to treat than if I was 3.7 after 4-5 hours.

I believe that 'normal' BG for a non-diabetic person is 3.3-6.0 - our range is slightly broader, and with a 'safety margin' at the lower end, because our methods of control are much cruder (even with fancy pumps! 😉)

 

[Lauras87]

Dare I utter the phrase "She is only a dietician?" .

I did think that myself as some of the stuff she said, I didn't agree with.
I've never seen a dietician as a confirmed T1, they thought I was T2 when I saw one so the info I got was different & I'm self taught for carb counting

I believe that 'normal' BG for a non-diabetic person is 3.3-6.0 - our range is slightly broader, and with a 'safety margin' at the lower end, because our methods of control are much cruder (even with fancy pumps! 😉)

Thank you for that northerner, I feel a bit better with you saying that. I'm 3.8 now & had a haribo sweet while I make my lunch even tho I'm not hungry

 

[everydayupsanddowns]

I think I read somewhere that cognitive impairment kicks in at 3.5ish, and I believe pregnant t1s are often given a target range that goes below 4 to aim for fewer spikes after meals and less time with high BG generally.

I've changed my opinion in the last 12 months or so and don't get so hung up on the 3.5-3.9 ones, though I can clearly see that the more of them I am having he more extra ones I get.

Not to follow up with starchy carbs is also more up to date advice, but like everything - you will have to do what works for you. I stopped 'following up' about 2 years after Dx because I could see that that extra slice of toast or whatever *always* meant I was in double figures after recovery.

As Northie says, each hypo treatment really has to be individually tailored to the circumstances at the time, level of activity/active insulin/severity of low/what's happening next etc etc

 

[trophywench]

Ah well, T2s usually aren't on insulin.

Let's get this straight shall we?

To be actually CLINICALLY hypo, ie your brain is affected - that ALWAYS happens below 3.3 and it's desperate by that time if you ARE on insulin, and you already know why!

A LOT of hospitals now actually use 3.7 as the cut-off point because that gives you 10% margin for error. And if anyone happened to be pregnant, they would be told that anyway by most 'good' clinics these days.

However, to maintain your hypo symptoms long term - esp if you are a driver, operate machinery, look after kids etc etc etc, it isn't really a brilliant idea to be floating along with that low a BG generally. And that's why, 4 is the floor comes in.

Of COURSE you can eat what you want when you want to and just jab for it, Laura, that's precisely what dafne (and of course DAFNE, LOL) are all about isn't it? Whether that's really a good idea for you or not though, is a totally different matter of course. Cos if you make a complete pig of yourself, it sometimes becomes a habit - but occasionally - like eg Xmas day - it doesn't cause lasting harm. But I have cake mid-afternoon, a couple of times a week - just not every day. I can afford to weight-wise and I don't eat a whole Victoria sponge or anything!

Plus of course when you DO eat more than a certain amount, dose calculations don't work out in the simple way that lower carb meals or snacks do - so you may need to have more bolus than usually, split dose or do an extended bolus if you can cos you have a pump. It's a process of trial and error for what foods or amount of carbs, your body requires you to do this.

You do need to do some carb counting training before getting a pump, because you don't seem to have all this imprinted on your brain, which you will need to if you are gonna make a pump work for you as well as all of us want it to. This applies to everyone - not just you! And it certainly helps more than 'a lot' when you are on MDI too.

 

[Lauras87]

Ah well, T2s usually aren't on insulin.

Let's get this straight shall we?

To be actually CLINICALLY hypo, ie your brain is affected - that ALWAYS happens below 3.3 and it's desperate by that time if you ARE on insulin, and you already know why!

A LOT of hospitals now actually use 3.7 as the cut-off point because that gives you 10% margin for error. And if anyone happened to be pregnant, they would be told that anyway by most 'good' clinics these days.

However, to maintain your hypo symptoms long term - esp if you are a driver, operate machinery, look after kids etc etc etc, it isn't really a brilliant idea to be floating along with that low a BG generally. And that's why, 4 is the floor comes in.

Of COURSE you can eat what you want when you want to and just jab for it, Laura, that's precisely what dafne (and of course DAFNE, LOL) are all about isn't it? Whether that's really a good idea for you or not though, is a totally different matter of course. Cos if you make a complete pig of yourself, it sometimes becomes a habit - but occasionally - like eg Xmas day - it doesn't cause lasting harm. But I have cake mid-afternoon, a couple of times a week - just not every day. I can afford to weight-wise and I don't eat a whole Victoria sponge or anything!

Plus of course when you DO eat more than a certain amount, dose calculations don't work out in the simple way that lower carb meals or snacks do - so you may need to have more bolus than usually, split dose or do an extended bolus if you can cos you have a pump. It's a process of trial and error for what foods or amount of carbs, your body requires you to do this.

You do need to do some carb counting training before getting a pump, because you don't seem to have all this imprinted on your brain, which you will need to if you are gonna make a pump work for you as well as all of us want it to. This applies to everyone - not just you! And it certainly helps more than 'a lot' when you are on MDI too.

I'm going on a DAFNE course in June, work are annoyed that I'm having 5 days off for it but I'd be happier to have done it especially with going on the pump.

I had a crash carb counting course on Wednesday as the dietician wasn't happy I'd not been shown properly (sadly I didn't know I had to count milk & I can drink it for something to do so am studying the carbs & cals book I got given so I can be on top form come pump day)

 

[Vix]

I agree with the majority - 4 on the floor, 5 fine to drive 😉 But having said that my hypos still confuse me as I can be 3.7 and feel terrible and then be 2.1 and only just realise that my sugars are low! I have to say that I haven't seen a dietician as a T1 for basal/bolus and the first one I saw when I was diagnosed treated me like a 2 year old who couldn't add 1+1 so I'm doing a very condensed version of the DAPHNE too starting next month.... Hope that you find the course useful before your pump Laura! I have to say that I am still learning so much about diabetes but sometimes my instinct seems to serve me best when hypos are concerned xx

 

[trophywench]

I'd agree with the fact that when your BGs drop suddenly, I feel them a LOT more than if they just meander down very slowly. Same with rises, if I pig out and they shoot up, I feel a lot worse than if they rise slowly.

But with hypos if it drops suddenly and violently - then I probably have to hit them harder (and flippin quicker!) with the glucose than when they go slow. In which case I'm probably still in the high 3s.