Hypo - What Number?

[Satan’s little helper]

Finger pricks are generally accurate for me personally at those figures. As I have said, 5 times in a year I have had hypos so not that concerned, was just curious at other peoples "full on hypo number". My last HbA1c was 38 which is that of a non diabetic so I can't really complain.

Firstly, I think your HbA1c is impressive. What I have noticed over the years with bunching up blood tests every 5 minutes with a detected hypo, is the low can go a little lower before the rise on treating? Similar can happen with the libre graph though the lag can last much longer before it rises way after my symptoms subside & even my meter telling me I’m back in the 5s.

 

[everydayupsanddowns]

I partially mangled my hypo awareness with years of overnight lows (thanks Lantus) in the 3s for hours, and by “preferring to run on the low side” because dips below 4.0 were quick and easy to treat, and I was very worried about complications.

Thankfully I’ve managed to repair my awareness by focussing on staying above 4.0 and treating anything in the high 4s in the way I would have treated 3.9 and below.

Predictive low glucose suspend has massively helped too.

I keep a close eye on my Time In Range, and aim to keep time spent below 4.0 to an absolute minimum. Even 1% below range could equate to a 15 minute period of low BG every single day!

Low BG associates with risk of cardiac arrythmia (and death), so far from running low being ‘preferable’ as I used to see it, I now recognise low level hypos / low BG as a complication of diabetes. The very thing I was trying to avoid!

 

[Inka]

Absolutely this @everydayupsanddowns I too thought ‘lower was better’ and it was ok as long as you kept an eye on things, but it was what I read online about subtle (or not so subtle) cognitive difficulties and heart arrhythmias that made me realise that that wasn’t true. Also, after 20 odd years of Type 1, I felt a ‘softening’ of my hypo symptoms. It was subtle but once I spotted it, it caused me concern. Now, 30 years after diagnosis, my hypo symptoms are still sharp and I always try to stay above 4.8/5 ish as a matter of routine.

Just like weight, lower isn’t better, and if you run too low, you risk developing other problems and affecting your life for the worst. I actually asked my consultant about complications when my HbA1C rose slightly. I asked if someone with an HbA1C of 45 was more at risk of complications than someone with an HbA1C of 45. She said No. Although good control is important, like maintaining a healthy BMI, the healthy zone isn’t at the very bottom - because it brings other risks. That is, a BMI of 21 is good, but a BMI of 16 isn’t ‘extra good’ - it’s more dangerous and it’s unnecessary as it won’t bring better health than a BMI of 21.

It’s the same with HbA1Cs @sharp00782 I remember the urge to ‘get the best score’ and to force it lower, but that’s not necessary; not healthy; and will impair your hypo awareness, as you’ve found. You also mentioned not eating enough carbs to treat a hypo (ie you didn’t eat enough to bring your blood sugar up enough). That’s another risk that we face: restricted eating and eating disorders. Those can creep up on you and are best nipped in the bud.

 

[Satan’s little helper]

Absolutely this @everydayupsanddowns I too thought ‘lower was better’ and it was ok as long as you kept an eye on things, but it was what I read online about subtle (or not so subtle) cognitive difficulties and heart arrhythmias that made me realise that that wasn’t true. Also, after 20 odd years of Type 1, I felt a ‘softening’ of my hypo symptoms. It was subtle but once I spotted it, it caused me concern. Now, 30 years after diagnosis, my hypo symptoms are still sharp and I always try to stay above 4.8/5 ish as a matter of routine.

Just like weight, lower isn’t better, and if you run too low, you risk developing other problems and affecting your life for the worst. I actually asked my consultant about complications when my HbA1C rose slightly. I asked if someone with an HbA1C of 45 was more at risk of complications than someone with an HbA1C of 45. She said No. Although good control is important, like maintaining a healthy BMI, the healthy zone isn’t at the very bottom - because it brings other risks. That is, a BMI of 21 is good, but a BMI of 16 isn’t ‘extra good’ - it’s more dangerous and it’s unnecessary as it won’t bring better health than a BMI of 21.

It’s the same with HbA1Cs @sharp00782 I remember the urge to ‘get the best score’ and to force it lower, but that’s not necessary; not healthy; and will impair your hypo awareness, as you’ve found. You also mentioned not eating enough carbs to treat a hypo (ie you didn’t eat enough to bring your blood sugar up enough). That’s another risk that we face: restricted eating and eating disorders. Those can creep up on you and are best nipped in the bud.

Did you inform the DVLA when you discovered loss of hypo awairness?

 

[Inka]

Did you inform the DVLA when you discovered loss of hypo awairness?

No, because, as I said, I didn’t lose my awareness. I still felt the hypos in the low 4s but there was a subtle blunting of the signs. So subtle that I only realised when I read someone else mentioning it as a consequence of long-term Type 1. I asked my consultant about it and she confirmed my hypo awareness was spot on and not impaired.

Why? Are you concerned about your awareness? I suggest you speak to your consultant 🙂

 

[helli]

Did you inform the DVLA when you discovered loss of hypo awairness?

To be fair @Inka did not write that she lost hypo awareness. There is a huge difference between a "subtle softening of symptoms" and losing awareness.

 

[Satan’s little helper]

No, because, as I said, I didn’t lose my awareness. I still felt the hypos in the low 4s but there was a subtle blunting of the signs. So subtle that I only realised when I read someone else mentioning it as a consequence of long-term Type 1. I asked my consultant about it and she confirmed my hypo awareness was spot on and not impaired.

Why? Are you concerned about your awareness? I suggest you speak to your consultant 🙂

No problems with hypo awareness as I’ve stated above. (Without trying to sound too cocky. With the initial topic regarding levels of awareness.) Though I do concur with the safety issues of a road user & the possibility of unknown cognitive impairment. I wouldn’t want to hastily diagnose pushing a complete online stranger into making an unnecessary life & potential financial changing decision dropping the privilege to drive for what just might be a case of a recent batch of under-reading sensors.

 

[Lucyr]

I wouldn’t want to hastily diagnose pushing a complete online stranger into making an unnecessary life & potential financial changing decision dropping the privilege to drive for what just might be a case of a recent batch of under-reading sensors.

I don’t think that needs to be a concern, since all hypos should be being checked with a fingerprick reading, and OP stated they felt perfectly fine with no symptoms whatsoever at 2.9. That’s quite different to someone else saying they were still identifying bgs when they dropped into the 4s, their symptoms just weren’t quite as distinctive as they had been previously.

 

[rebrascora]

I wonder if people newly diagnosed who use CGM from the start, will miss out on identifying the subtle early signs of a hypo because they just look at their phone or reader instead of feeling more vulnerable and therefore having to be on the look out for those subtle early sensory signs, which tip you off to an impending hypo but might be easy to miss if you didn't know about them. About 4-5 months into my diagnosis I had a few whoppers probably due to honeymoon and physical activity, which really rattled me. I am mostly working or walking on my own so it was a bit scary and perhaps that makes you really start to focus and look out for those early tell tale signs, hence me regularly "consciously" checking my peripheral vision for sharpness, particularly when I am out walking alone. I tend to do that over looking at my phone or reader. If I feel a bit of a tummy flip I check my levels. 9/10 times I will be hypo within 15-20 mins of that sensation, but if I hadn't had a hypo after it in the past I wouldn't necessarily know that was what it was signalling. I think that feeling and then an alarm going off and eating a jelly baby or whatever, doesn't stick in the mind like that feeling preempting a nasty hypo, which is a much more memorable event and therefore easier to learn from. All the times my alarm goes off at 4.5 and I eat a JB or a dried fig or date.... I don't remember those times or what happened before them because they were non events, ie. everyday occurrences, so nothing to stick in the mind, whereas not having CGM and ending up having a hypo after those mild warming signs sharpens the focus and makes you realise those sensations were a tip off that you can learn from.
Not sure if that makes sense to anyone else...

 

[Inka]

I wouldn’t want to hastily diagnose pushing a complete online stranger into making an unnecessary life & potential financial changing decision dropping the privilege to drive for what just might be a case of a recent batch of under-reading sensors.

Which is why I checked if they fingerpricked, and suggested they talk to their team. I see driving not as a privilege but as a responsibility. I don’t believe you can be “too honest” on a form that’s asking factual questions about a medical condition that might affect driving.

 

[everydayupsanddowns]

Did you inform the DVLA when you discovered loss of hypo awairness?

Like others, I didn’t completely lose awareness, but I was aware it was becoming impaired.

I have always had, and continue to have, full and frank conversations with my consultants about the levels at which I will always feel symptoms and they are happy to recommend me to continue to drive on that basis.

 

[Satan’s little helper]

Like others, I didn’t completely lose awareness, but I was aware it was becoming impaired.

I have always had, and continue to have, full and frank conversations with my consultants about the levels at which I will always feel symptoms and they are happy to recommend me to continue to drive on that basis.

At a recent appointment with my consultant where I focused on pushing for a pump, (2nd or 3rd year running.) he asserted I was doing fine on MDI. Then mentioned whilst looking at statistics, I don’t seem to get hypos. Of course I do. I can see how he & my GP have no issues with me behind the wheel.
As an aside, “ Members are only permitted to share their own experiences.” Which is how I conduct myself. “Members are not qualified to give medical advice.” Hence the aforementioned. “Additionally, everyone manages their health differently.” This point (hopefully) is my good faith pledge when interacting with other users. “Please be respectful of other people's opinions about their own diabetes management.” To @sharp00782 . You have my deepest empathic apologies. I didn’t get to enquire if you actually drive? 😉