Hypo now 3.5 mmol/l

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Tdm

Tdm

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According to dafne course.

They say hypo is 3.5mmol/l or below

What do you think?
 
Tdm said:
According to dafne course.

They say hypo is 3.5mmol/l or below

What do you think?
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My Libre records anything below 4.0 as below target, and I’m only supposed to be below target a maximum of 3% of the time.
I think non-diabetic people do have ‘normal' blood glucose of 3.5, but because meters and CGMs do not have 100% accuracy, there is a 'leeway' built in. I also find that taking 4 as the point at which you should really stop and treat a hypo, it gives you a cushion if you’re dropping fast, to get the jelly babies in before you start really feeling major hypo symptoms.
 
Yes, a true hypo is 3.5 or below, because non diabetics can naturally drop that low, BUT we ( as insulin dependent diabetics) need to preserve our hypo awareness (if we have any... I know yours is limited @Tdm) so we treat anything below 4 as a hypo, but it isn't unnatural for human beings to drop below 4 it is just that being insulin dependent we generally think of and refer to hypos as anything below 4, to keep ourselves safer.
 
Does it the scientific definition of a hypo matter?
The important question is “at what BG do you take action to raise it?”
For some people, this will be 4.0, some may be 5.5, some may want to fly (but not drive according to DVLA) by the seat of their pants and wait until they are in the upper 3s.

As for what is the lowest BG for someone without diabetes, my partner felt very unwell when he did a long tough cycle ride with proper fuelling. He “bonked” below 2.9.

I usually treat at 5.0 with my trend going down but, with a pump, the first treatment is basal suspension. I try to avoid lower than 4.0,because that is what DVLA requires, even though I don’t drive every day.
 
I have the same understanding as @rebrascora. @Tdm, I’m curious - were they suggesting you don’t treat until you’re 3.5? I’ve been told to treat anything under 4.
 
When I was diagnosed about a million years ago (well, 30 but it seems an awful long time!), my consultant told me that technically below 3.5 is a hypo but that I should consider anything below 4 a hypo for practical purposes. This is to allow a buffer zone; because the meters aren’t 100% precise; and to enable prompt treatment to avoid nasty hypos and maintain hypo awareness.

I try to stay 5 or above and nudge my blood sugar up slightly with a tiny amount of carbs (or insulin suspension when appropriate). For driving, I try to stay in the 6s and 7s.
 
I think 3.5 is the level at which cognitive function starts to become impaired. 4.0 is an ‘alert’ level - but definitely one at which action should be taken (because of the inaccuracy of the devices if nothing else!

It’s interesting that the International consensus on Time In Range measures 4-10.

I wonder if that advice is consistent across all DAFNE educators. I’d be slightly surprised if it was.
 
Inka said:
my consultant told me that technically below 3.5 is a hypo but that I should consider anything below 4 a hypo for practical purposes
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Since I’ve been carefully guarding my warning signs I’ve been treating 4.8-5.2 as my early warning level!
 
They did mention 3.5 being the threshold for hypo at my DAFNE 4 years ago but they were not suggesting you wait until you get to that level to treat but that you treat anything below 4.
 
rebrascora said:
They did mention 3.5 being the threshold for hypo at my DAFNE 4 years ago but they were not suggesting you wait until you get to that level to treat but that you treat anything below 4.
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Yes delaying treatment at 3.6 just seems crazy!

Even moreso if people are using Libre/Dex which is “you were 3.6 and dropping 5-10 minutes ago”!!
 
I agree with the consensus, due, as you say, to inaccuracies in meters, cgms being behind, and as a buffer.
They did say to treat below as 'out of target range' but only go full throttle, hypo tratment with the 15g of quick acting carbs, test again 15 minutes etc etc once 3.5 or less. Which, to be honest, is kind of what i do, so for a 3.9 i may have less than 15g if i think it will work, depending on how quickly i am falling. Not that i would recomend that to others.
My aim is not to go below 4, as then its easier to stay above 3.5.
Also, as said, its best to stay above 4 at all times to keep hypo awareness.
 
I meant to say

...they said to treat below 4 as 'out of target'
 
I wonder if part of this is to dispel some of the fear of hypos. We do have some people who are so anxious about hypos that they are frightened to let their levels come down into the normal range and perhaps it helps for them to know that normal people come down to these levels between 3.5 and 4 without any ill effects and that they are part of the normal range the human body functions within. The important thing for us is to preserve our awareness as much as possible at this level because it is our "safety net". Sometimes the fear of hypos can be much more debilitating than a hypo itself.
everydayupsanddowns said:
Even moreso if people are using Libre/Dex which is “you were 3.6 and dropping 5-10 minutes ago”!!
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I don't think this is accurate for Libre because the algorithm predicts by extrapolation of previous readings, so if you were dropping fast but then slowed down, Libre will often show you lower than you actually are at that moment in time. There is a delay between BG and interstitial fluid but supposedly not between Libre readings and BG. Plus Libre tends to read lower than BG for many people, when levels are steady and in range but more so at lower levels. I was steady at 3.8 this morning on Libre but BG was 4.6. (I didn't want to eat any more because breakfast was still digesting so I hung on and it just levelled out..... so then I did eat a few more carbs.) This is a very regular trend for me that Libre will consistently read lower but I appreciate that other people might find the opposite.
 
rebrascora said:
I don't think this is accurate for Libre because the algorithm predicts by extrapolation of previous readings, so if you were dropping fast but then slowed down, Libre will often show you lower than you actually are at that moment in time. There is a delay between BG and interstitial fluid but supposedly not between Libre readings and BG.
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Yes I realise that Abbott attempted to close the gap (and sometimes Libre overshoots as a result), but interstitial lag can only be second-guessed so far can’t it?

Abbott try to close the gap to under 3 minutes (claimed here for the Pro: https://pro.freestyle.abbott/ie-en/...ems/why-sensor-based-glucose-monitoring.html#)

But some studies measure it at more like 2.5 - 5 minutes for Libre 2, like here:
pubmed.ncbi.nlm.nih.gov

Accuracy of a 14-Day Factory-Calibrated Continuous Glucose Monitoring System With Advanced Algorithm in Pediatric and Adult Population With Diabetes - PubMed

The System demonstrated improved analytical accuracy performance across the dynamic range during the 14-day sensor wear period as compared to the previous-generation device.NCT#: NCT03607448 and NCT03820050.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
 
I am not sure how it can scientifically be calculated because the algorithm overpredicts when levels are changing direction and or the rate of change is changing and if your levels are stable then there shouldn't be any lag, so the only time when you could measure it is when you have a steady uniform rate of change. But that lag will only be valid when you have that steady uniform rise or fall in levels and most of the time we don't get that because levels wander up and down all the time. I can live with 2 or 3 mins difference but in my experience even when it takes me 2-3 mins to get my meter out and do a finger prick test, Libre is always lower than FP a few mins later, even when dropping.
 
everydayupsanddowns said:
I think 3.5 is the level at which cognitive function starts to become impaired. 4.0 is an ‘alert’ level - but definitely one at which action should be taken (because of the inaccuracy of the devices if nothing else!

It’s interesting that the International consensus on Time In Range measures 4-10.

I wonder if that advice is consistent across all DAFNE educators. I’d be slightly surprised if it was.
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I think the threshold of 3.5=hypo is written into the DAFNE course book which I understood was a definitive document for consistency in DAFNE training. Of course I don't know whether that figure has been forever with DAFNE or is a recent change.
 
It was mettioned in the material that we jaf that 3.5 was a hypo and you could have a slowr acting carb if between 3.5 and 4 you have a slower acting carb like a biscuit but that wasnt encouraged by nurse.

Saying this has reminded how I use to be though see 3.9 on a metter when first dianoisges "I need jelly babies" see a 4.1 "ill have a biscuit". Same with corrections my team told me not to correct below 10 but I could with 10 and above and I took it way to literally I would correct a 10.1 but not a 9.9(I know I know) I don't see those numbers as any different anymore.
 
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I think grading your response based on your level is a good idea and I certainly do that, but I would always have fast acting carbs below 4 and if I am low 4s and dropping I will still have a JB rather than slower acting carbs. I very rarely have biscuits in the house, but a slower acting alternative to a JB would be a prune (5g carbs) or a dried fig (7-8g carbs). I can be 4.5 with a vertical downward arrow and 2 JBs well chewed will turn it around before I hit the red line. If I am 4.3-5 and level and I want to drive then I will have a dried fig. You just get to know what is about the right amount and type of carbs for the right situation. There are even rare occasions when a JB gets bitten in two (cruel I know 🙄) because 5g is too much, if my levels just need a quick but small nudge.
 
rebrascora said:
I think grading your response based on your level is a good idea and I certainly do that, but I would always have fast acting carbs below 4 and if I am low 4s and dropping I will still have a JB rather than slower acting carbs. I very rarely have biscuits in the house, but a slower acting alternative to a JB would be a prune (5g carbs) or a dried fig (7-8g carbs). I can be 4.5 with a vertical downward arrow and 2 JBs well chewed will turn it around before I hit the red line. If I am 4.3-5 and level and I want to drive then I will have a dried fig. You just get to know what is about the right amount and type of carbs for the right situation. There are even rare occasions when a JB gets bitten in two (cruel I know 🙄) because 5g is too much, if my levels just need a quick but small nudge.
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Yeah my comment was more about how I treated the metters to be aboustlly right and 100% When really there wa no difference between a 3.9 and 4.1
 
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