If you’ve spent any time interacting in this and other diabetes online communities, you’re well aware that hypoglycemia is the limiting factor to near-normal glucose control in insulin-treated diabetes. Anyone who has experienced severe hypoglycemia (defined as < 54 mg/dL or 3 mmol/L by the Hypoglycemia Study Group) knows the existential threat accompanied by sweatiness, confusion, and social embarrassment. It’s a situation, once encountered, we all try to avoid. We get why severe hypos are unhealthy and indeed dangerous.
On the other end of the glucose spectrum is extended time spent in high hyperglycemia (> 180 mg/dL or 10.0 mmol/L) is strongly associated with long-term increased risk of eye, nerve and kidney damage. So we live in the tension between those two extremes.
If we see doctors regularly to follow our diabetes, we likely hear warnings about avoiding hypoglycemia, even if that means we spend more time in hyperglycemia. In my 34 years living with diabetes, my clinicians have almost universally been hyper-phobic about hypoglycemia.
I fully understand we need to respect severe hypoglycemia, but most medical practitioners seem to over-react to “alert” levels of hypoglycemia. I place these levels at 60-70 mg/dL (3.3-3.9 mmol/L). This is a range that we do need to take note and action but don’t need to be reaching for the glucagon kit and calling 911.
I read a report several years ago about the Ambulatory Glucose Profile or AGP, a one page standardized report using continuous glucose monitor data. This report includes glucose text data as well as a good graphic that the clinician and patient can quickly and easily see where forward looking treatment gains may be made.
In reading through this 14-page report, I came across the AGP report for what the report authors considered as “representative of a normal reference population.” Here is the pertinent text-section of the report that caught my eyes.
Check out the “Glucose Ranges” box near the top center of the page, the one that gives details of the amount of time spent below 70 mg/dL or 3.9 mmol/L. This report shows that gluco-normals spend about 5.2% of their time below 70 (3.9). More simply stated, typical people without diabetes spend over 70 minutes on average each day in hypoglycemia. Not only that, non-Ds typically spend 30 minutes on average each day under 60 mg/dL or 3.3 mmol/L!
This surprised me. In my efforts to maintain my blood glucose as close to normal as is reasonably possible, it’s rational that in my control efforts, I am allowed to experience hypos similar to the non-D population and my clinician would not over-react to that circumstance.
Now I know that the risk and dangers of severe hypoglycemia are higher for people with insulin-treated diabetes. I respect that notion. But the game we all play driving a metabolic system in manual mode would be easier if our medicos would relax about our spending some time each day in the “alert” zone of hypoglycemia.