Is this too many hypos?

[mum2westiesGill]

6/7 - 1 hypo
10/7 - 1 hypo
12/7 - 1 hypo

30/6 - 1 hypo
29/6 - 1 hypo
28/6 - 1 hypo
27/6 - 1 hypo.......this was a terrible month for hypos and also when I started on my reductions of Tresiba

 

[trophywench]

You know these hypos Gill - how low were they? And, did any of them require assistance from anyone else, other than eg you asking your husband to pass you your hypo remedy which is nearer to him than you at that exact moment?

 

[Kaylz]

My worry is that you've mentioned your slightly hypo unaware and are just catching them by chance

 

[mum2westiesGill]

My worry is that you've mentioned your slightly hypo unaware and are just catching them by chance

That's true - some I feel and some I don't

 

[mum2westiesGill]

You know these hypos Gill - how low were they? And, did any of them require assistance from anyone else, other than eg you asking your husband to pass you your hypo remedy which is nearer to him than you at that exact moment?

6/7 - 1 hypo - 3.7 - didn't feel hypo
10/7 - 1 hypo - 3.9 - didn't mark down how I felt
12/7 - 1 hypo - 3.7 - didn't feel hypo

30/6 - 1 hypo - 3.6 - didn't mark down how I felt
29/6 - 1 hypo - 3.3 - didn't mark down how I felt
28/6 - 1 hypo - 3.3 - didn't mark down how I felt
27/6 - 1 hypo - 3.4 - didn't mark down how I felt

none required assistance I'm glad to say

 

[Matchless]

I dont really call those figures hypo they are just low that i take some sugar and sit down for a while when they get to 2.5 is hypo for me but every one is different.it sounds like you mmay need to tweek your basal settings or less bolus with your meals .

 

[AJLang]

Gill I agree with Kaylz, those figures are definitely hypos and if I was going that low, especially without symptoms I would be very worried. It's not just the effect of each hypo but how together they can impact on losing hypo awareness. Do you know why these hypos are happening?

 

[Inka]

If you can strive to keep your blood sugar above 5 or so* for a few weeks, it will really help your hypo awareness and sharpen it up @mum2westiesGill I do that routinely now - ie eat a few carbs if I’m in the 4s, even a 1/4 of a biscuit or whatever, and it really helps.

(*some people have a higher minimum eg 6 -it depends on your situation)

 

[pm133]

I dont really call those figures hypo they are just low that i take some sugar and sit down for a while when they get to 2.5 is hypo for me but every one is different.it sounds like you mmay need to tweek your basal settings or less bolus with your meals .

Anything below 4.0 is considered a hypo I believe.
You can't drive when that happens.

 

[Kaylz]

Gill they are most certainly hypo's and as @pm133 says anything below 4.0 is (4 is the floor and all that), I know you use a bolus calculator but if above your target range it would suggest the dose based on your carbs, your target is 5-8 I think? So if you were say above 5 by even 0.2mmol and having 50 grams of carbs it would suggest you take a 5u dose, how would you feel to override that and decrease it to 4.5u if you were at that level to bring you up a bit by the time the bolus has worn off? That is if you are capable of dosing in half unit increments?

You really need to gain that hypo awareness back which means trying to run a little higher for a bit xx

 

[rebrascora]

It is probably not helpful for me to make this comment in respect of Gill because her hypo awareness is impaired, but might be useful to other people to know the whole range of what might be considered normal....
.... I drop below 4 on my Libre for short spells on an almost daily basis, sometimes more than once. Some of those would not be below 4 if I did a finger prick and some would but they are almost exclusively in the 3s with a very occasional high 2. I believe DAFNE considers below 3.6 a hypo, so there is no real agreement on what a hypo actually is and (edited to add.... some) long term diabetics actually only consider it a "hypo" if they need assistance.... so there is a fairly broad spectrum of views on the subject anyway. For me, Libre definitely reads lower than a finger prick test and therefore sometimes indicates that I am below 4 or even 3 when I am not, so if I was finger pricking and not using Libre I would probably clock up less hypos.... but then I might clock up more because Libre helps me head off quite a few!!

The nature of your particular diabetes will dictate to a certain extent how frequently you hypo as changes in basal needs can make it tricky particularly on MDI. Some people are fairly stable with their basal needs so will be less likely to hypo and others, perhaps with a less routine lifestyle, will see more variability in their basal needs and therefore potentially have more hypos. The important thing is to look at each hypo and try to figure out why it happened and work out what action you can take to try to prevent it happening again in those circumstances but that doesn't mean you are doing anything wrong is you have more hypos than someone else.
Thankfully, so far I have not needed any assistance in dealing with a hypo and I hope that I never will but none of us can guarantee that. Insulin is funny stuff and our bodies don't always react in a predictable manner and none of us are infallible.
My Libre currently shows 6 "Low Glucose events" in the last 7 days, 10 in the last 14 days and 79 readings below 3.9 in the last 90 days. My consultant has full access to my Libre results and I have just had a review with him and he is very happy with my diabetes management and has sent word to my GP that I have "overall excellent control" along with my blood test results. Of course it is important to minimize hypos but don't feel like you have failed if you are getting quite a few. The important thing is what action you take as a result of those that you do have. For me knowledge is power and this forum and my DAFNE course and particularly Libre have given me the knowledge to be confident in making the necessary adjustments to my basal doses particularly, to address the low and high BG levels that my lifestyle, body rhythms and basal insulin limitations throws up. It's all a balancing act.

 

[martindt1606]

Gill - When i did DAFNE we were told that 2-3 mild hypos per week should be considered normal. This would be anything between 4.0 and 3.5. I think 2.8 was the severe level although that presents another issue as some monitors revert to LO.

PM133 - I hope you are not driving with blood glucose levels of 4.0. You should be above 5.0

 

[martindt1606]

As an aside.... Neuroendocrine Cancer UK asked me what the signs of a Hypo were. In the last couple of weeks there was a thread asking for people to say what signs they had, I collated these for Neuroendocrine Cancer. There were over 50 which I didn't think would be too educational in a table. So I turned the list into this:


Thanks to those of you who contributed.

 

[AJLang]

My DAFNE training stated below 4.0 was hypo. The Libre can read below 4.0 when you’re not hypo but that’s why the guidance is to cross-check with a finger prick. At least recently there seemed to be an increased consensus from diabetic consultants to aim to avoid all hypos as much as possible because of the cumulative affect on the brain, risks associated with hypos etc. The latest guidance appears to be no more than 3% of your time under 4.0 as shown on the Libre.

 

[silentsquirrel]

Gill - When i did DAFNE we were told that 2-3 mild hypos per week should be considered normal. This would be anything between 4.0 and 3.5. I think 2.8 was the severe level although that presents another issue as some monitors revert to LO.

PM133 - I hope you are not driving with blood glucose levels of 4.0. You should be above 5.0

DVLA regs allow driving between 4 and 5 so long as you eat a carby snack.
Some prefer not to drive below 5, but that is their choice.

 

[nonethewiser]

Since switching to libre 2 hypo's few & far between, like to keep above 4.5 to preserve hypo awareness, running low levels is sure way to lose them, thats fact.