I want your opinion on this because I´m not sure myself.
Other Qs:
Do you concider a low every blood sugar that needs to be treated?
Is a low also counted as a low when you discover it on it´s way down and treat it before the actual number on your meter is low?
I´ll be grateful for all answers and opinions on this topic as I´m on my way to find peace with and a sane way to treat my diabetes.
If I have any meter reading below 70 mg/dl, I treat it. If it is 69 mg/dl, I treat it. I avoid lows not only to keep from having losing control and hurting myself, but I also am aggressive because being low too often can result in hypo unawareness. I want to remain hypoaware as much as possible.
I'm not sure what you mean by your second question. If you have a CGM and notice a sharp drop, you need to be aware of the potential for a low, but your meter should actually be more up to date. A meter generally measures blood sugars now, while a CGM measures interstitial fluid which reflects blood sugar with a delay of about 15 minutes.
I don't have a number/ week I aim for. I probably run low pretty regularly but feel them coming on, like a mild buzz rather than back in the days when I'd get sweaty and all frazzled. I get a bit frazzled. I have a CGM so it gives plenty of warning.
To me, every low is a different tactical challenge. I hardly ever take 15G of carbs to treat them as probably 90% of the lows I have are more "drifts" into the 60s than the sort of precipitous "dive bombers" going from 120---> 45 in like 1/2 hour because of some sort of calculation error. The drifts, I kind of nudge up, maybe 3-8G of carbs. If I'm at work and it's 45 min until lunch and I'm drifting lower than I want, I'll dip into some carrots early to nudge it up. I use a mix of Smarties (faster dextrose) and Starburst Jelly Beans (gooeyness helps texture of Smarties, plus they are yummy as hell...) and will have 5-6 for the vast majority of my lows. This seems to prevent the "rebounds" or "liver dumps" that are very widely reported in posts/ blogs/ FB/etc. for me.
Since I don't "count" or "keep score" of lows, I don't worry about "counting" this or that number as a low. Really, even when I decide to do nothing (e.g. 75, flat, 1/2 hour until lunchish time...), I'm still making a decision to keep my course steady with my hand on the tiller. We moved a couple of years ago and my doc initially expressed some concern about the "number of lows" but, as long as I feel buzzed, like I can perceive them, I prefer to stay close to that edge rather than running higher. My doc has been nothing but positive lately and I have a fairly high activity level that helps some of my other numbers (heart rate, cholesterol, BP, miles/ week, although that's taking a beating w/ the cold weather and holidays!) and supports this approach.
By second Q I mean testing and finding 90 mg/dl and knowing that you still have more insulin on board than carbs. In those cases I do not wait untill meter shows 65, I treat it with 3-5 gr carbs at 90. Did that make any sense?
This was really, really helpful, acidrock23. Sounds in many ways like me. Guess my Qs stems from reading about and hearing from endos how many lows one should consider acceptable and thereby wondering if I´m overtreating or beeing too obesessed with my diabetes. And then again what is a low when I´m preventing them instead og experiencing them. Is that a sign of me having poorly adjusted insulin doses or is it how it really is beeing a diebetic? I don´t know ´cuas I´m just me, poor material for doing statistics.
For the record and for you helping with how you respond to this discussion, I seldom have those rapid drops that comes out of nowhere.
The clinical definition of a low is any BG less than 70 mg/dl. I treat anything below 70, unless I have a very good reason not too. I think how many lows a week is acceptable depends on the diabetic and their treatment goals. Every diabetic should be aware of the short term (seizure, injury, death) and the long term (hypounawareness, loss of cognative powers) that have been linked to low BGs. I look at high and low BGs as very small damage to my body and do my best to avoid both. If you stop a low before it ever happens then I would not call it a low, I would call it good work.
There are also different lows. A low of 58 is less scary and likely less damaging than a low of 28. Sort of like how a high of 200 is much better than a high of 400. I would say that I test in the 50s maybe every 2 or 3 days, maybe hit the 40s once every 2 weeks. I think this is too much, but I am trying to walk a small tightrope with my target range that mistakes can happen. I also constantly monitor and adjust my basals, ISF and CR to try to avoid lows.
Thanks, Capin101. Useful reply. Fun (or not so fun) fact: In Norway the clinical definition of a low is 61,5 mg/dl or lower.
Interesting. I think that is reasonable as "normies" can routinely test in the 60s (probably as low as 61.5) when fasting. I just don't have any room for error in the 60s so I treat.
I live in Norway in case you think I just threw out bits of knowledge for the sake of throwing :-)
I don't tolerate anything. I want my blood sugar to stay within 100-110 mg/dL
I weigh 104 lbs so 1 gram moves me up 6.5 mg/dL, a half glucose tab moves me up 13 mg/dL. At 87 mg/dL I take a half a glucose tab.
Since I test 6-7x a day, this means I may take a half to a whole glucose tab any time I test if I am below 100.
My goal is to keep the BG as close to 100-110 as I possibly can. Just give me a tiny tiny standard deviation floating around 100, and I am happy.
Now of course, I'm still finishing up Halloween candy, and my kids dumped more tiny Snickers on me, so I'm sometimes dealing with 5 gram lots. My theory always did have a ways to go to equal practice.
I used to treat two or three lows (< 70mg/dl, about 4 mmol/l) every day. When I changed my diet to low carb last year, I also adjusted my basals, I:C ratio, ISF, and lowered the amount of insulin I took. Making all those changes allowed me to cut my lows to two or three per week.
If you ask an endocrinologist this question, they will probably answer zero! They have no idea what it's like to manage BG's in the real world. They're also hyper-sensitive to any legal repercussions from a severe low, at least in the US. In fact, I think that doctors are so fearful of hypos that they would willingly endorse running BG's in the average 150+ mg/dl (about 8 mmol/l)! They'd rather treat long term complications than deal with low BG's.
Where I fault medical practitioners is their inability to counsel and offer practical advice on how to reduce BG variability. Only reduced variability (as measured by standard deviation for example) allows lower averages without hypos. For me the key to this is low carbs (small insulin doses = small mistakes) and finding and keeping appropriate basal rates.
To me a low is anything under 60; some people treat anything under 70. No, I don't treat if I'm not (yet) actually low.
As for how many lows are "too many" there is no exact answer for that. We are all different. Some people are naturally more stable than others. But I start seeing a pattern of daily lows or lows in the same time spot I will make changes in my insulin doses. If you have lows too frequently you put yourself at risk to be hypo unaware.
Many of us in the U.S. use the figure of 60 as well.
"To me, every low is a different tactical challenge. I hardly ever take 15G of carbs to treat them as probably 90% of the lows I have are more "drifts" into the 60s than the sort of precipitous "dive bombers" going from 120---> 45 in like 1/2 hour because of some sort of calculation error. The drifts, I kind of nudge up, maybe 3-8G of carbs."
About the same strategy here. First getting used to the pump, my main goal was not to over correct lows based off of reading and IOB. I try to keep my range between 70 and 100 all day, so I get quite a few "steady drops" into the 60's that I don't feel at all. When I do treat, or I start feeling crappy, I do it in baby steps.
Hi Siri,
in a perfect world the acceptable number of lows during the week would be 0. All lows need to be treated, the number and the treatment are a decisions you will have to determine for your own body. A low is counted when your result is whatever that number you've determined is your low. If you "discover" your bg is on it's way down and treat it before it says low on your meter, that is a good thing and you have avoided a low.
I wish you the best in finding peace and sanity with your diabetes :)
Hi Siri,
I should not have been so flippant. I really do stick with 100-110.
Answering your questions:
How many lows during a week is acceptable? Were I to go lower than 100, I'd simply take whatever number of glucose tablets needed to keep me at 100 and think nothing more about it. Lows happen. I can be off a half a unit and I'll be down to 70. There is nothing I can do but use the amount and type of carbs that I know exactly how many units will handle it. And the fewer the carbs, the better marksmanship I have. I went to 4 meals with fewer carbs in each one just so I would not be dealing with so many units of insulin that I might be off.
Do I consider a low every blood sugar that needs to be treated? Every test I do that results in a lower than 100 gets "treated". A half a glucose tab, 2 grams, will raise me 13. At 87, I take a half a glucose tab. At 93 or so I'll take a one gram candy.
Is a low counted as a low when it's on its way down and treat before it tests low? I don't count "lows" or "highs". I don't blast myself if I've given too much insulin. I simply give myself the amount of glucose that will hit 100 on the dot. Every time.
Thank you, karen.
Thanks, Terry. I do low carb too and find it to be the only way to stabilize my blood sugar and gain any sort of certainty in life. Maybe they just exit in my head these diabetics that never have to "up" their blood sugar with some carbs now and then? I do this often daily and sometimes as often as 2-3 times a day. Maybe my actual question is if it´s even possible to achieve a stable bloodsugar without having to do a minor correction more than maybe once or twice a week.
Thanks, Zoe. I´ve been hypoaware for years so that´s not part of the deal for me. I seldom have severe lows but bloodsugar is often too unstable to be trusted not going too low if left unattended. I just got myself a CGM and that´s the greatest tool I´ve ever had and without my knowing missed for the last 30 years.
Drift is a good word for most of the lows I experience too. I never overtreat them, I´ve got that part covered. I use regular soda and has figured out that one sip equals 1 gram carb. I never treat drifts or lows with anything else than liquid with the same amount of sugar in it. Baby steps is the way to go, I agree on that one. Thanks for your reply, Black Llama.