Since having been diagnosed with T1D at age 44 six months ago, I have had a mortal fear of passing out, both in public and/or when I am alone. I am in honeymoon and generally on low doses of insulin with tight control over my glucose levels, however this weekend, due to a confluence of factors, I found myself staring at a big '36' on my monitor. I was able to treat it on my own and didn't pass out, which felt like something of a victory. I know every person and circumstance is different, but curious to know what the tipping point is (or is not) for others...?
As a paramedic I have seen people unconscious at 60 and I’ve seen people awake and alert at 20. It’s a crazy thing. Most of the time I think I depends on how used you are to your sugar being low
I don’t think I’ve seen below 30, although there’ve been one or two times that I know I was lower than that. I’ve never passed out because of a low in 17 years, but I’ve come close two times, and if I had to guess I’d say I was around 20-25. I feel my lows no problem, so I don’t really worry about passing out from lows.
As you properly acknowledged right up front, this is a very individual thing. So, with the disclaimer out of the way . . . I have never come close to losing control, or consciousness. Lowest I have ever been is mid 30s, a couple of times.
As a T1 LADA diagnosed at age 46, I have been as low as 30 several times, once while running a marathon. I have never passed out from a low and I have found that if you stay calm you can deal with the lows a lot better. I paniced the first time I had a low and it really messed me up but since I have learnt to treat it as just another diabetes management issue I haven't had any problems.
I'm logging in 20 years of Type 1 as of this spring, and I've never passed out from a low yet. My lowest that I can remember was 28 mg/dl when I was about 12 years old, and I was still pretty functional and able to treat myself, although I definitely felt like crap. I know not everyone can feel their lows, and not everyone is lucky either. I think it really just depends on the person.
I've had diabetes for almost 22 years and have passed out a handful of times (or otherwise been completely non-functional, not knowing where I was or what was happening even though I was "conscious"). I don't know how low I got during these times because no one ever stopped to test me. The one time I did test (immediately after coming around) I was about 3.5 (63 mg/dl), but had dropped from about 19.5 (351 mg/dl) an hour before, which is my theory as to why I passed out at such a "high" number. (I was basically a teenager, argued with my mom about the high number and declared I would "never eat again" so I wouldn't go high, this being in the days when you HAD to eat during NPH's peak ... and, well, I got what I asked for!)
I get readings in the 1s (low 30s mg/dl) a few times a year, usually. As a kid I had readings of 1.2 (21 mg/dl) and LO (too low for the meter to read) and felt fine. As an adult, I get kind of dizzy when I hit the 1 mmol/L range. My lowest recent low was waking up at 1.6 (29 mg/dl) in the middle of the night a few months ago ... a bit too low for comfort!
I haven't passed out since starting on the "modern" insulin regimens of MDI or the pump. But I also always have glucose tablets on my person at all times, because I've had times where I've gone from feeling fine to feeling like I'm about to pass out (and being in the 1 mmol/L range upon testing) in the span of about 30 seconds.
I've gone as low as 26 and have yet to pass out in 8 years of T1. Good control generally means you can feel the lows and thus your chances of passing out are far less.
In 36 years with T1, my meter has said 23 two times, both when I've woke up in the middle of the night. Its been in the 30's more times than I can remember, all middle of the night episodes.
I've never lost conscious from any of these, it actually woke me up :)
I had a One Touch Ultra Smart meter that seemed to read into wider ranges than my other meters and I saw several 7, 8, 12, etc. readings which was extremely disconcerting. That fell out of my bicycle pounch when I rode off. Now I use Ultra Minis that don't seem to go much below the 20s. I don't know what it was when I've passed out.
OneTouch meters aren't supposed to read below 20--they're just supposed to say LO.
I've convinced my Nano to read LO twice (I was trying to see if the saccharin in my eye drops would read on my meter, because it dries sticky on my fingers...yes, it's a waste of strips. And I was bored).
I'd seen the LO before so I was *really* surprised when it said "8" and "12"!
The lowest I've ever been with a meter reading is 50. I've been in the low 50's more times than I can count, mostly during my first year and a half of college. I didn't feel more than a handful of them, so I just tested a LOT, at specific points when I knew I might be low. Sometimes I caught the lows because I could tell I wasn't processing information correctly, but I felt lucid and physically fine. Those lows were the scariest.
There was one time I almost passed out, in the middle of Manhattan, no less. I was too timid to test in public at that point in my life, so I let myself come close to fainting into the subway tracks, followed by a rather scary three-quarters of a mile walk back to school. I didn't test when I got to school because I was about five seconds away from passing out--the only thing in my mind was juice. I've always wondered how low I'd been that day.
I think the OneTouch UltraSmart is sometimes weird about its readings ... (it's only supposed to go up to 600 mg/dl).
Once in high school I tested at 0.6 mmol/L (11 mg/dl) and felt low, but otherwise fine. (It was on a Dex meter, which really *did* go down to 0.6 mmol/L as its lower limit.) I'm sure it must have been an error; I can't imagine being that low and still being conscious.
The monitors are only accurate enough to give you an estimate. I've registered around 20 and felt not that bad. I've gone into shock and lost consciousness probably about 20 times in my life. Mostly as a child. None, since I started the pump. Now, I usually feel pretty bad around 50-60.
After 18 years with T1, I still fear passing out, but it has never happened, so I am slightly more confident. My worst lows have always been the result of exercise. What I would say is, always have with you glucose tabs or something to raise your blood sugar quickly (my new fav is Starburst). Keep them in a drawer at work, in your nightstand, in whatever bag you carry around with you. Always have your emergency kit with you so you can deal with whatever situation comes up.
The lowest I have ever tested is 51. Seems to happen if I take a nap after taking a day dose of insulin. Stashing candy around my room or in my bag is always helpful. Never really tend to think about the candy till I need it for a low.
I have been 14, passed out and 23 awake and doing very well. The issue is how quick the fall. the quicker i fall the more trouble i can have. Slow drops, allow a perosn to mis judge things but awake, sure. i once bought a car and signed the papaers at 36. everyone, including me thought it wqas normal, I have also been unable to think or process at 70. Its the speed not the low that matters, I think.
I think most people can handle lows very well. I have seen 28 mg/dl and did not pass out. The brain needs around 4g of carbs per hour. To get this amount our blood circulation can switch to centralization. In this state the blood flood to our extermities will be reduced. I bet you already have experienced the cold hands and nose in this state.
More significant is the sink rate of the glucose level as others have written. Is it very steep we will have problems to recognize the low before it impacts our ability to reason about our situation. Even this is more uncomfortable than very risky. However it might get serious if the low leads to seizure-like symptoms. Here the brain is running out of fuel and some high and eventually low level functions start to break down. This situation is rare and dangerous and I experienced it once in 25 years with a massive overdose of insulin. Now glucagon is my friend for life and I recommend a glucagon kit for you ;-)
As a bottom line I would treat lows like highs. They are serious and they should not happen too often. Identify the cause and try to act smarter the next time. But of course they do happen often. The more aggressive you are about your control the more you will experience. This is because the difference from normal levels to low levels is just soo small. A little more muscle activity than usual and you are there. So it needs a high frequency of glucose metering and proactive actions to prevent that - please have always glucose tabs at hand!
Please try not to fear that the low will suddenly come over you. You will learn to detect the signs of the low early. Be careful with driving though. To pass out while driving really has the potential for catastrophe. On German undivided rural roads we have speeds of 62 miles per hour (not that uncommon in the USA I think). Veering of into the oncoming traffic can be deadly - even with the best cars available. Over the years I have read about some rare cases here. Still with good control and permission from the endo it is fine to drive commercial trucks. Our authorities do trust T1 diabetics to manage their blood glucose responsibly. I made it a rule for me that I will always test before I will drive my car. I always have glucose at hand and I test more often.
My meter has read 1.1 mmol which is ~20 mg/dl. I was able to get my butt out of bed and get a glass of orange juice. I have had T1D for 38 years and am fairly hypounaware. I do not feel the classic "low" symptoms at all now even when I hit the high 20's and 30's. Thankfully I got a CGM in November which has made avoiding hypos a lot easier. It shows how my blood sugar is trending and alerts when I begin to get low or high. I am attempting to recover my hypo awareness by avoiding hypos like the plague but they still happen.