How low is OK to go?

Morning, all!

I know everyone is different, but between the hospital’s idea of low, the CGM’s idea of low, and what I see hear as people’s experiences… I’m trying to figure out what is my real/warning level low and what is an ok goal bg number.

While in the hospital, the teams would panic and overload me with juices and milk if I went to 80. That started my nervousness about “going low.”

On the Dexcom, there are different settings that allow you to select your own baseline.

I’ve over compensated nearly every time in reaction to those BEEEEEEeeeeps and have then sent my bg skyrocketing. I’m learning not to do that anymore. Still a work in progress. (As I’m writing, the beeeeeppp is beeping at me and I’m trying not to react…)

But, now I’m curious as my bg becomes better understood? managed? that maybe when it gets to 70 or 80 and is holding stable, that I shouldn’t be worried and lunging for my raisins.

To be clear, I don’t feel low… however, I’m also not that self-aware. So… it’s a complicated balance between learning that self-awareness while allowing my machine overlords (just some SkyNet joking) to beep at me.

What do other folks do? How did you decide what works for you??

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I have 70 as my line. Anything under 70 is low. But if my CGM is holding steady, I sometimes wait out numbers in the 60s because often my body will pull me out and all will be well without treatment. It all depends upon time of day or night, when I last ate and bolused, as well as how much insulin I have on board. However, with the CIQ, the IOB number is constantly being changed by the pump so I no longer pay much attention to it. The low thing is very individual and reactions should be based upon past experiences.

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The low thing is highly variable for everyone based on where their average BG runs. For the person that runs BG’s between 180 and 250, they would be going low probably in the 130 range, For someone that has average BG values in the 60 to 100 range, they can easily go down to 50 and remain there steady without being low. It is all about the delta between where the BG averages and where it is now. The same person can be in either range depending on their lifestyle, and where their BG currently averages.

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I agree that people’s low levels do vary. Over time (T1D 37 years), I’ve discovered that my body produces physical symptoms of hypoglycemia starting at 65 mg/dL. My heart rate goes up and I start to sweat on my forehead and upper lip.

It’s good that you’ve already observed that the professional class over-reacts to even a hint of a hypo. Their concern is warranted but their timing sucks. If you follow their sentiment, you will spend too much time on the glucose roller-coaster. This added variability, by the way, is likely a main driver of severe hypoglycemia episodes (< 54 mg/dL).

It’s good to read that you are using a CGM. It is a great teacher about how your body’s glucose metabolism works, if you’re willing to pay attention.

When it’s time to treat a low, I take into consideration my IOB (insulin on board) number when deciding how many glucose tabs I will take. I definitely don’t use the standard 15/15 (take 15 grams of glucose and wait 15 minutes, test again, and repeat, if necessary) rule. I can often treat an impending hypo with 1/2 of a glucose tab providing my BG variability and my IOB are both low.

It’s good practice to learn your body’s low signals and always fingerstick if your CGM says low yet your body does not confirm. I’ve been burned more than once treating a phantom hypo and then needing to treat the inevitable hyper!

For me, cruising sideways with a CGM number in the high 60s for extended periods is not an emergency but a mark of good glucose management. For my values and system to work and be safe, it needs glucose variability, as indicated by standard deviation (SD) and coefficient of variation (CV), to reside at lower levels. My SD is often around 20 mg/dL and CV (SD/average) about 22%.

When glucose variability is low, any impending hypo happens more slowly. It gives you the luxury of time to respond. Your warning levels in your CGM then do not need to be set high enough to compensate for hypos at the end of a screaming white knuckle descent. Once your glucose variability is under control, you can set your CGM alarm levels closer to your hypo symptom threshold.

By the way, I would not recommend raisins for hypo treatment. Your body has to work to access the glucose it craves. While it’s doing that work, it still sends strong signals to your brain, “More sugar!” I only use glucose tabs to treat since they are a specific quantity and if I need speed, I’ll chase them with a glass of water.

You are asking good questions. Your curiosity will serve you well in living with your diabetes! Good luck.

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It’s under 60 for me. I won’t take carbs unless it’s lower. Unless I’m exercising then I eat carb as I go.

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A real hypo is under 50 for a male and under 45 for a female. Treating anything under your number you consider low, 70 or 80, is to give a buffer and allow for strip error. To get it under control. So you don’t have a real hypo.

Fwiw @Mika hospitals use 80 as a low threshold number because of Medicare. Hospital Medicare reimbursement rates are tied to many variables, one of which is hypo events for both Medicare and non-Medicare patients alike at their respective facilities.

You can search on the Medicare website and get data regarding hospital rates of hypos, what percentage of patients were readmitted post surgery, even death rates by procedure (for major procedure like hip\knee replacement, etc).

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Why is there a difference for gender?

For me, whether or not I treat a low depends somewhat on the circumstances. If I’m in the 60’s or high 50’s, and I’m just about to eat a meal, I don’t treat the low separately but, rather, just reduce my meal bolus.

On the other hand, having once gone so low while driving that I ended up off the road and an ambulance being called, if I’m even at 70 or the high 60’s, I treat before getting in the car…and I absolutely NEVER get in the car without checking my BG first.

In other circumstances, i.e, at work, at home, and not just before a meal, I would treat (carefully) if I’m at 65 or below.

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Thanks, all great learnings…

I should’ve factored in the delta, baseline and overall variability-yes, that’s what was missing.

After a few panic sessions with the double- down yellow, and it’s evil twin double-up yellow, I learned early on to test strip when the Dexcom was acting cray cray.

Based on what folks have said, I don’t think I’ve had a real hypo—except for while exercising when I’ve noticed it.

They’ve been a pokey, gentle dips down.

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Glucose tabs are the way for me. Eating or drinking any other food seems to be the road to over treating, causing a hyper. I seldom use more that 2 - 8g, usually 1 -4g. I found out about water speeding the effect by wanting to wash the glucose off my teeth. Yeah, that really works.

I make my own fuel drink with 1 and 1/3 oz corn syrup (40g glucose) contents of two caps of electolytes diluted with strong coffee and a 1/4 teaspoon of instant espresso. The Hammer flask I use holds 5 oz with each oz being close to 8g carbs. This is a great (not so tasty) and cheap way to keep BG up on long bike rides. I seldom use more than an oz or 2.

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I don’t know. It would be a metabolic thing.

@Luis3
How do you know that u r getting
1 oz in the the Hammer Flask at a time?

It depends on many things. If I’m sitting around the house and get an alert for 78 but feel OK I might not get up and do anything about it.

If I’m outside cutting the grass if I get down to 100 I might get some gatorade because there is a lot more chance of dropping low fast while doing something physical/exercise.

My Dexcom I set my day time alarm at 85 to 160 and night time 75 to 140. I only alert at 85 in the daytime because I never know when I’ll be doing something physical so don’t want to wait too long to get an alert about getting low. I don’t consider 85 low, just a good margin for me to react if I’m going low fast.

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This flask is sold by Hammer Nutrition for using their gels sold in bulk. 5, 1 oz marks are on one side. Also, the grip bumps are 1 oz as well. I bought mine at my local bike shop, but Hammer will supply one with a bottle of their gel. It has a bite valve just like a bidon (bicycle water bottle) that makes in easy to use.

The problem I had was how to have easy access on the bicycle. I came up with a way using a plastic conduit clamp and heavy duty self-stick Velcro. I don’t have a picture of it, but can take on later if you wish.

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Thanks for the info.

Kinda context-dependent question. What counts as “severe hypo” for the purposes of medical records and things like whether your insurance will pay for an insulin pump is a set number, presumably the ones @jack16 cites. But what feels like a severe low can vary widely depending on how tight your overall control is. This can be physical impairments, not just the subjective sensations. My knees used to start locking up when I’d get into the 70s, but these days I don’t feel anything at that level unless I’m dropping rapidly. For me, my eyesight starts to go when I’m <60—that “flashbulb” effect—and I don’t care what Medicare says, that’s a scary thing to have happen and counts as “severe” to me. I have also seen the technical definition stated as “a low requiring assistance to treat” or words to that effect. If I can’t see, yeah, I’m gonna need assistance. That’s really rare for me now but it does occasionally happen.

As for treating 'em without roller-coastering, the main problem is how to placate the hunger monster when you know you’ve had enough carbs but the ravening beast is still screaming. Eat, eat eat, eat now or die foolish human! For me the answer is peanut butter, a big tablespoon full with a little honey on top. The honey supplies the carbs, and the peanut butter, which is bulky, takes an effort to eat, and pretty low carb, gums up the works, satisfying the urge to cram food in your face until the sensation fades. You can’t eat that stuff fast, and it can help you resist scarfing the entire quart of Edy’s you were supposed to save for your kid’s birthday.

Here’s a question: I’ve come to realize that as soon as my BG turns around and starts up again, the sensations stop almost immediately even if my BG is actually still in the “low” range, however you define it. Curious if anyone else experiences that.

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I don’t feel low symptoms unless it’s a fast drop or I’m down in the in 50’s. I think most likely because I keep pretty tight control with an A1C of 5.1. I don’t feel a 75 as being to low and unless I’m dropping I’m fine with it. But yea, the medical community freaks out about a 75. When I was in the hospital I just had surgery so of course I didnt eat much after but they still insisted on giving me the same amount of insulin and of course I went low to about 65. Their response was to keep me above 300 the rest of the time. A lot of these doctors and nurses are clueless when it comes to all this.

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Next time be prepared with your diabetes doctor instructions that you should administer your own insulin, or have say in amount they administer.

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Oh I tried and they wouldn’t have none of it. They’re the ‘professionals’ after all and we know nothing.

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