Thanks, Leo2. "Lows happen",- I like that :-)
"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."-- Siri, OP
To me, a low that needs to be prevented is one that interferes with your life. I'd rather aim a shade lower than Leo and nudge it there but I test like a dozen times/ day. I also am eating 120-150G of carbs, a bit more through the holidays but my SD is in the 20.9 in the last week and 21.4 the last month (although that is perhaps "cooked" as I ran it in the teens a couple of weeks before the holidays and undoubtedly ran a bit more whacky through them. But not that much...). I am certain that if I cut out a number of carbs (incl beer!) I could likely smooth things out but I am very pleased with where I'm at and don't have a huge amount of motivation to change right now.
I don't worry about being a bit tighter than the medical societies recommend and my doctor is very supportive and had been there for my last big hypo (perfect storm, + exercise, made tactical error, Mrs could have handled but other people called 911...oh well...) a couple of years ago and knows that I'm aware of the risks involved and says she's very pleased with my results with diabetes and, more generally, my general health, exercising regularly, eating more healthily 75% of the time (until oh, 7:00 PM?).
Re "preventing" vs "treating" lows, I think that's a very good question. I usually just try to keep an eye on when I'm running down and, if I see a pattern of repeated lows or highs on a regular basis, turn my basal up or down a click (.025U/ hour...) if it's a fasting BG or adjust my carb ratio +/- .1U/G if it's a post-prandial number that seems to require fixing. My doc only gave me an adjustment after the significant hypo by telling me to turn it down after the last significant hypo. By the time the nurse emailed me to tell me to do that, I told them I'd already done it myself...LOL. As long as you stay out of the ER, I think this approach is fine and that you shouldn't feel anything negative about it.
Another thing I picked up, maybe when I was studying Tae Kwon Do and feeling phsyically "successful" was not to get complacent or give up. Diabetes is dangerous and I don't think that it's misplaced to pay close attention to it. Testing 12x/ day, along with a CGM may not be the norm but it's gotten me where I want to be healthwise. Except for doing more chinups. That will take some more work.
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.
There probably are some diabetics with such stable blood sugars that they can avoid lows without even a mild carb correction. Perhaps someone with some residual native, endogenous, insulin production. I'm not one of them. I also have "drifting" lows that approach my 70 mg/dl threshold at a low angle. For these I use Altoids, three mints = 2 carbs. If I can keep my BG above 70 then I don't count them as a low.
You've asked a good question. I can't imagine a T1D without endogenous insulin maintaining that kind of control. If that's possible, I'd like to know how they do it! What your question implies is what I hope for in the artificial pancreas project, where I can assume the role of passive observer.
I agree with Terry that for most of us we have occasional lows and occasional highs and I believe that prompt correction is the way to keep your blood sugar stable. However, returning to your original question about "how many lows is acceptable". You said that you correct lows daily and sometimes 2-3 times a day? For me, at least, that would not be acceptable. That much lows is a clear indication that too much insulin is being used. I would look for a pattern in my numbers. If the lows are two hours after a particular meal I would lower my I:C ratio for that meal so I got a tad less insulin. If they are in between times/waking or bedtime then I would look to the basal. Though lows (and highs) come with the Type 1 territory for most of us, if they are regular or show a pattern than there is a need for tweaking of dose.
Wise words, acidrock23. Thanks again for taking the time and effort explaining your thoughts to me.
Good to hear, Terry. Maybe it´s just how it is beeing diabetic for many of us. They´ve used the term "brittle diabetes" on me several times, so clearly I´m not one of those rare, stable diabetics out there.
Thanks Zoe, I too have had thoughts about having too many lows as a symptom of something not beeing right with my insulin regimen. But for now I will settle with what I´ve learned from all the great thoughts and response I´ve got here. I have lately got myself great tools to work with (Dexcom G4, pen with 0.5 units, 0.4 mm needles, iPod Touch with RapidCalc) and life feels so much easier alltogether. I know now it will take care of itself with time.
I pretty much tweak my doses by small amounts whenever I see a pattern of lows or highs. Just curious, since you have a CGM and other technology that I don't even know what it is..lol...have you considered getting a pump? It makes it waaaaay easier to regulate doses and levels.
I understand your curiosity, Zoe. Answer is kind of a long story: Two years ago I had two islet transplants and got off the pump which was the technology I then had used for almost 20 years. Insulin pens never worked for me back in the 80s, I never understood how to use them, a pump was easier to use and understand, and I felt safer always having only small amounts of insulin on board. Drugs I had to use after the transplants was devestating to me. The gain of producing my own insulin never outconquered the side efects from the drugs and I was really never myself for these two years. Finally I ended in a hospital bed for a whole month (this november) due to kidneys starting to fail, serious malnutrion and whatnot other things. After testing and testing again for a month where I slept through the whole thing, they concluded with all my symptoms being side effects from the drugs.
Writing 2013 I´ve finaly got off all the drugs, starting to use insulin again and slowly recovering. Alongside I have had to learn and accept the whole diabetes thing again, or maybe for real this time. I don´t want to go back to using a pump yet because pens - for me - is easier "needle wise" and a short 4mm needle is almost painless. When I was on the pump I alwas had serious trouble every time I had to change the cannula. I could do 2-3 cannulas before I found one that flowed freely. That said, when it worked it was kind of a breeze. Lantus is new since last time I used an insulin pen, so is the CGM and not to mention the RapidCalc I keep talking about. This is an app that works like an insulin pump, I´ve posted a discussion about it here: http://www.tudiabetes.org/group/lantususers/forum/topics/useful-app-that-works-like-a-pump?xg_source=activity
I could easily get an Animas Vibe with a built-in Dexcom G4, but for now I´m figuring out if the regimen I´m on right now actually is easier for me both mentally and in daily life.
Thanks for the explanation and history, Sirc. Wow, you've been through a lot. I'm glad you came through it well physically and emotionally sound like you are at a good point as well. I can understand "keeping it simple" and doing what works for you at this point.
I wouldn't consider that a "low" but I would take note of it so that next time I'm more likely to use the right amount of insulin for what I ate.