Hello! Random question. I have greatly improved by HbA1c over the last few years to the point that I am now consistently under 7 and generally under 6. I have been really excited about this. I don't have a lot of swings, but I do have more frequent low bloodsugars that I did a few years ago. My concern is this: I often don't "feel" low now until I am in the 50s or 40s. Sometimes I am actually really surprised to see how low I am when I felt fine. I VERY THANKFULLY have a CGM, so am able to catch these lows a lot when I otherwise wouldn't have thought I had one. However, has anyone else had this happen? How do you deal with it? What are some safety precautions you take, if any? I am a little nervous about this because I recently got dumped by my long-term boyfriend with whom I had lived for years and now live alone. I am not looking to increase my HbA1c, but would appreciate feedback on how people at this HbA1c level handle things generally. Thanks so much for any help!
lots of people here are hypo unaware. good thing you have the CGMS. here is a discussion with some tips on living alone with d. (sorry about getting dumped)
Esjay,
I’ve been there, done that. And I think there’s nothing like a CGM round the clock when living alone. Especially since you can set your alerts where you want.
I got rid of hypo unawareness by raising my average. I keep it under 110 but above 90. I take glucose tabs when below 70, and for my weight, 1/2 of a tablet raises me 13 mgdl. It pays to test it out and get it exact.
The only way I could raise my average without those downward spikes, however, was by eating smaller amounts of carb and being absolutely right on with the I:C ratio. The only way to get to the I:C ratios which fluctuate through the day, was to eat the same food at different times of the day.
I started with 6 grams at breakfast, 12 grams at noon and 12 grams at supper. After I had those so I couldn’t make an error with too much insulin, I added other foods and kept working at cutting out things that spiked me upward, since then I have a great tendency to tamp down, and tho I work out proportions of my dose that may still be on board, I had to even figure that more exactly. I stay at 5.3-5.9 a1c and do not get lows below 59.
Best wishes. I guess I would say Congratulations on the a1c. Don’t target being in the 70s or 80s. Raise your target but stay close so your standard deviation comes down and you rest about 100. You will then start shaking at 70 and feel it. It’s a good feeling!
Esjay,
I came back to urge you to get out of hypo unawareness as soon as you can. I decided I had not done my best in my last post to say this. It is important. All you need is for the CGM to be off you to deliver this message in a 911 way. You CAN have your a1c but you MUST set your average a bit higher to get out of it. With the sd not varying widely, you’ll still have an a1c below or around 6.
I’ve been hypo unaware for years. Only recently with the Dexcom can I catch them early. But they still happen. This morning I was 37 while at work. (My Dex was off by quite a bit) Thought I didn’t quite feel right. No longer the sweats and shaky but maybe a headache or tired or nauseous or just “not right”. Problem is by the time I’ve figured it out the current symptom, something else begins. The best advice is use your CGM to avoid the extreme lows and test, test, test! I don’t want to sacrifice my A1c either but hopefully you won’t have to. Try to learn the signals (there can be a huge assortment) My A1c’s have always been in the high 5’s and I’m hoping to keep it there by keeping a close reign on things.
I too at times have hypo unaware, I don’t have a CGM but have used one temparily. I have learned to do several things to help from getting low. I test quite often; I also adjusted my insulin to carb ratio because when I would get lows it was either right after eating or 2 hours after eating: I also adjusted my sensitivity to insulin. All of these things are features on my pump which also helped to avoid some of those fallouts I use to have years ago.
Researchers at the University of Virginia developed a system to help with hypo unawareness (http://care.diabetesjournals.org/content/24/4/637.full). The system is based on the idea that your body will react to hypos in a whole variety of ways, not just the “classic” symptoms of sweaty, clammy nervousness that everyone always associated with hypos. Rather, many people have little things that they may not notice, but with training can become clear indicators of hypos. Some of these include things like changes in taste and perception, twinges in your leg. The training has you log symptoms and then through careful correlation, identify the symptoms which are indicative of a hypo. Then, when you detect these symptoms, you can be much more effective in recognizing an oncoming hypo, test and take action. The researchers found that even for people who are severely hypo unaware, these other types of detectable symptoms were often still present and recognizable.
@bs7 Through the years I have found that little signals do exist that warn I’m hypo. Sometimes one of my signals can be a thought I have that seems strange other times it might be a pain in my legs. I have learned to depend on these signals to warn me even though I test constantly. If I haven’t had a hypo in a few weeks I will experience the normal hypo symptoms proving what my educator said is true.
Unfortunately the more lows you suffer, the less likely symptoms are to occur. Your body gets used to being low, and scales back stress and hormonal responses as it thinks these lows represent homeostasis. The best way to become aware of lows is to have less of them. Easy advice to spout, right? Personally, keeping glued to my Dexcom and fingerstick testing more frequently are the only tactics that work for me. I rolled out of bed this morning, got ready for the gym, and checked my bg’s, only to realize that I was 54! Sometimes Type-1 feels like being on a teeter-totter…
Interesting to hear. I’ve thought that was the case. I agree, there can be very, very subtle suggestions that you’re low. Many times it’s just a “somethings wrong” feeling.
Sometimes it is not that they are subtle, but that you have to look for them. For one thing your thinking get’s muddled. Many people will find that their ability to perform basic thinking tasks is markedly impaired. Time yourself adding two three digit numbers in your head, many people can do this task in a couple seconds, if you are having a hypo you may well take a lot longer and may not be able to perform the task at all. Give this a try a couple times at a normal blood sugar and then try it a couple times when you know you are low (not real low).
My niece is hypounaware if sitting down or sleeping. I doubt if most people wake up for a low if they are in deep sleep. Therefore, the first thing I would do if I were you is to raise the blood sugar target to 120 or even 130 (if you are dropping at night). We use yogurt or milk which lasts longer than juice but an even better choice might be the Extend or Nite Bite bars specifically formulated for lows by an endo or PB crackers. I raise the blood sugar to this level at the time I go to sleep (usually 3am). In addition, if an adult, I would set an alarm (or two or three) to 2am with a juice and glucometer by my bed and check BS randomly about three times a week. This may raise your A1c a little bit but with an A1c in the 5s you can afford to come up into the low 6s. Since you have cgms, I would continue to keep tight targets during the hours I was awake. But if taking a nap during the day, I would raise the target with a few carbs for safety. It is far more important to deal with the lows first; then attack highs and/or postprandials. Safety first! P.S. I don’t think this will raise your A1c that much. My niece has an A1c 6.5 and under (usually in the low sixes), despite my raising the night time target and despite the fact that she does have highs postprandially not all, but a lot of the time. Teens blood sugars are erratic. P.S. If during the day she is 70 or 80 and is not about to eat, she has about four grams of carbs to bump her up to about 100. Because our experience is if 70 or 80 she is usually going to go down, not up.
Not to make this discussion too complex, but about 25 or more years ago, just a few years after I was diagnosed with t1d, my doc told me that he was not too concerned about me running in the 30 & 40 mg% range some of the time. He referred me to a couple of research studies that found that some non-diabetics commonly run in that range during fasting conditions (in AM and several hours after meals) with normal mentation. He was, of course, concerned that I not lose consciousness (which occurred more than once) and like the folks in that VA study believed that I could train myself to recognize the lows. Life is so much easier now with the CGM checking for me! I do believe that since starting the CGM in May, my sensitivity to lows has increased significantly. I think that is due to their decrease in frequency due to the low alerts, but not sure. Happily at 5.8 now, though and still happily on the ‘poor man’s pump’ (though I had heard this phrase used to describe Lantus, not MDI.) Fun reading your discussion. Bob
I am also hypo-unaware and also live alone. I never had a problem before and last year, started passing out from low BS alot. I now have a Dexcom and I still test a lot. The CGMS is no guarantee you won’t have lows, but at least it helps prevent a lot of them. I have only passed out twice since using the Dexcom & that was right after I started pumping. I also won’t run my BS higher. I have neuropathy and am trying to prevent that from getting worse. I try to watch the Dex and not just wait for it to alert me. If I am dropping fast, I treat more aggressively than hitting in the 60s with a steady BS.
