I woke up this morning at 58. Felt absolutely nothing amiss. I had some juice and got up to 114 took my lantus and humalog and had my normal breakfast bar and headed to work. Next time I check it's back to 69 - not a bad number for other things, but blood sugar ? Had another bar and am now at 114. Throughout the whole morning I did not feel shaky, nervous, sweaty, disoriented, my heart did not race. I know I am hypo-unaware and there is a class at the Joslin for us D's, but my CDE said she had to attend the class and it was just all about testing often so pretty much useless from my perspective. I have been very careful about humalog and have cut way back from my sliding scale days, but there are days when I really wish I felt something when I go low.
I know there are a bunch of people here who are really affected by hypo's so the question I have is what is the first thing you feel before hitting your "hypo" number? And what is your hypo number ? For me it's around 37-40.
Hi Clare:
I also would like to know what other members would add to this discussion, since my 5 years old girl layan is also hypo unaware.
yetaerday she was 58 and had no signs at all, I asked her how she feels and she said just normal . no confusion, or mood change , not even hunger wich she usually feels if she is below 80.It is so scary but we are around her all the time.
Most people who are unaware have a lot of lows. My endo once told me that if I kept my glucose level at 180 or higher for 6 weeks, with no lows, I would start to gain awareness again. But once I went back to normal glucose levels, it would go away. My last A1C was 5.8, so my control is drammatically tight.
I am hypo unaware. I have been fully functioning at glucose level of 15. I am on a pump and the CGM function has made a great deal of difference. My pump is set to alert me if my glucose falls below 70.
When I could feel them, I got all the standard things: sweaty, shaky, and I knew immediately that I was low without testing.
I have also been struggling with lows lately, and I blame it on the heat.
I think I would be dead at 15, not even remotely functioning. I have woken up with uniformed men in my bedroom after a shot of glucagon brought me up from 26.
Without any insult: people at the 30+ years of T1 mark are often - pardon me - stubborn and impervious to advice. They run in their own tracks and these have sort of worked for them. Never change a winning team, right? But are you still winning?!
My reply is a bit ironic because there is one very easy truth here. If you have lows you need to prevent them. They are not fate or heaven-sent. They are what they are: mistakes we commit daily. Still mistakes to work on with the same dilligence as with highs. Right now the risk of lows for your life expectancy is much higher than any complication from your highs. This is often not a health issue but more a very tragic accident in traffic for example.
So testing more frequently and searching for solutions is a must in this situation. If you really want to take that serious you have to put your whole approach in question. Especially your basal treatment should be analyzed in detail. For example Lantus users inject their daily dose before they go to sleep. But what happens with those users that tend to go low at night? Some will get used to these lows and that can lead to hypo unwareness.
But there is more: What about the changes our bodies experience with aging? The kidneys are responsible for insulin clearance. What if their rate is not as high as it was 10 years before. This would make you much more sensitive to injected insulin (take less bolus and basal insulin). What if the carbohydrate absorbtion of your digestive tract is slower than it was 10 years ago (beginning gastroparesis)? Your insulin - especially the analog insulins - will be too fast for your absorbtion profile (take less or take it after the meal or better switch to a slower bolus insulin). What is with sporty activities? Has this changed over time? Your metabolic rate might have changed too etc. The current heat wave is another example of seasonal changes (well, not in Germany ;-)
Try to forget about all that has worked in the past: try to reduce fluctuations, correct less aggressive and lower your basal dosage. Allow yourself a higher average BG - a higher pleateau that makes it less likely to experience drastic lows. From there you can start to optimize to reach more consistency without wide swings. No guarantee that it will work but at least you can try.
Thanks Holger, I appreciate the insight. But the reality is the question I asked is What do you feel before hitting your hypo point? Not really what should I do to avoid lows. I have been working quite hard at getting the basal right. I take lantus in 2 doses instead of the 30 units I used to take at night. Now I am taking 13 units in the morning and 12 at night. The problem is Holger, things haven't worked in the past and so now I am attempting to correct a lifetime mistakes. I will be switching to a pump in the not too distant future and have been told that the wide swings can be minimized. But I am waiting until the smaller omnipod comes out. Hell I might even get a CGM. For now though I am working on gaining insight in to what other D's experience when low.
Sorry for my misunderstanding.
In hypo unwareness classes they usually work out that the response to hypos has stages. In the first stage the effect of the low is only starting to impair the functionality of the nervous system. Normally this will release stress hormones like adrenalin to make us more alert and responsive to danger. Usually these first wave reponses are getting weaker over time in T1 diabetics. The more hypos we experience the less the hormonal reaction. Still many can manage to preserve some of their first wave response (this might be genetically). It is very likely that within 24 hours of a hypo the next hypo will be more severe. This is because the full reproduction of the hormonal deposits can take up to one day. As a result the first wave signs are weaker if the previous low was in this timespan. Long timers often only have the secondary signs to identify the hypo. In this stage the hypo clearly impairs the nervous system. Many high level operations - especially those needing a big chorus of nerve cells like the visual system - will start to break down. This whole process is not very ordered thus it can lead to very chaotic dissonanced. Problems to think clearly, visual distortions and feelings of being weak or threatened or even aggression can be the result. In this stage there is a small but serious risk that the chaotic dissonance can ignite a seizure. The timespan from detection to reaction is the problem here. It is getting uncomfortably small. I try to focus on visual distortions I have identified to accompany lows. Feelings of hunger or weakness or the absence of fear or the sensitivity to low temperatures are other good indicators too. I handle that like a checklist.
I am a t2. If I drop below 70 I start sweating and my face gets tingly. then my hands shake and I feel confused.
If I am high, I get severely nauseated.
I guess I am lucky that I get symptoms. But I listen very carefully to my body, and have since I was diagnosed 11 yrs ago.
When you have a low, you could record how you were feeling in the hour before and see if there is something you are missing?
The only signal I get that I am low are my hangs tingling and starting to go numb.
My most prominent symptom (or at least the one I'm most aware of) is cognitive - feeling a bit disoriented or sluggish in my thinking. I usually notice this in my 50s (which is where I treat) but not always. The only time I've gotten the severe drenched in sweat, shaking, barely able to function symptoms was one time before I understood how to dose my insulin when I crashed down from 209 in two hours (I was unconscious and by the time my liver kicked in and I was awake and able to test I was 38). Since then I had one odd experience where at night, long past any bolus I just kept dropping slowly but surely. I got down to 28 and felt ok and able to problem solve over what to do to get back up; I think because it dropped so slowly (I think it was a delayed absorption problem).
Hi Clare! I'm type 1 for 25 years now. Up until about 2 years ago, I had the textbook shaky, sweaty, stomach growling, wake up in the middle of the night, kind of lows.
Then I started waking up way too often anywhere from 30s to 50s with no symptoms. Like you, I would eat a breakfast bar and drink my coffee and feel fine. At first, I was like this is great not having those horrible symptoms...then I realize that it was really scary not having symptoms. At that time, I didn't have a cgm so it made me wonder how long I was that low when sleeping.
Pretty much the only symptoms I feel now are woozy headed and tingling on my scalp. These also happen to be symptoms of peri menopause so it's hard to know which it is without testing....so I test *lots*.
My lowest has been 25 and dropping rapidly (requiring a glucagon shot by dear hubby)...at that point my vision was blurry and I felt like I was about to pass out yet I still had some thought process going to grab the glucagon kit.
I now eat much lower carb so I take less bolus insulin and I also have a cgm so I can avoid most lows now. I sometimes have a problem at work when I'm concentrating on the computer, feel a little woozy and brush it off as hormonal, then look at my cgm to realize I'm dropping (usually slowly drifting). I pop sweetarts and maybe a piece of a low carb protein bar and avoid the low.
I'm still trying to master how to prevent lows when exercising, especially any activity outside right now - we've had heat index of 108 to 110 this week. When I treadmill with a -30% basal, I feel my scalp begin to tingle at about 30 minutes in and my bg drops about 30 points (gradually).
It's so strange to me the way my symptoms have changed over the last couple of years. I'm very thankful for that scalp tingling these days (and for my cgm).
Unfortunately I don't get the tingly scalp thing, but I'm with you on the trying to prevent lows when exercising. While it is not quite 110 here on the east coast, it is still hot and I love to play golf. I realize most people will think golf ? oh you don't get much exercise playing golf, especially if you ride a cart. But my pedometer which strictly measures strides not the motion of getting in and out of the golf cart has clocked well over 5 miles on a typical round of golf. Of course my rounds are usually far from typical including multiple trips in to the woods to retrieve my wayward golf balls. The only thing I have come up with so far is eat a huge breakfast ~ 60 grams of carbs and then go play. Skip lunchtime humalog and skip lunch, unless lowish in which case I'll go for some fruit or jordan almonds. I did this last Sunday. Managed the entire round all 5 hours of it my blood sugar did not go below 89 and did not get above 144 so I was a very happy camper. This week is club championship so not only will I be dealing with blood sugar crapola, but also the tension of competition so I'll see how it goes.
I don't actually remember when I stopped feeling lows. I mean I must have felt them at some point in time ? Or maybe I spent the first 25 years not going low ? Seems highly unlikely to me.
Not looking forward to peri menopause, I'm hoping the hot flashes I have had lately are strictly because it's hot out...
I had developed some hypo-unawareness that inadvertently eliminated after I spent a couple of years running higher than I should have (thanks to a bit of laziness and neglect on my part). Not the best solution, but it works.
We develop hypo-unawareness because, over time, our bodies become used to the wide fluctuations in BGs that we experience. This is the same reason why many of us start to lose the feelings of our highs as well. The problem with lows is that they can really have a sudden impact on your ability to function and do things safely (i.e., drive a car). I know I've had a few lows over the years that have resulted in my doing things that literally could have killed me. Sometimes I think I'm still alive simply by pure luck!
If you are diligent about avoiding lows for an extended period of time, it is likely that you'll lose your hypo-unawareness. That's what happened for me at least. Now, that said, my symptoms of lows are not that strong. Around 60, I will start to experience a strange, swimmy sensation and sometimes I get a tingling feeling around my mouth/lips. It's very vague and if I'm busy, I might not even notice it. In the 50s, I will have trouble making sense, but will appear normal to all those around me. It's just something that I'll notice internally; like I'll be talking and sort of making sense, but in my head I'm thinking, "Wait, this isn't the thought I really want to convey." I really start feeling things in the low 50s, though. By the upper 40s, I will have all the typical symptoms of a low (sweaty, shaky, uncoordinated, etc).
Testing frequently has helped me catch lows before they get too bad, thereby avoiding lows to begin with. Right now, I'm testing upwards of 12-14 times per day. It's a lot of work, but I've noticed a definite improvement in my number of lows.
I did try a CGM and that was helpful to some extent, but not accurate enough that I could totally rely on it. However, some folks have found CGMs very helpful in dealing with hypo-unawareness. Is this something you could obtain?
I could get a CGM if I wanted to, insurance will cover it and my endo would write a script without even questioning, but for now I'm not sure I want to be attached to anything and I'm more afraid that it will be too much information for me to process. I tried out a CGM ipro and really didn't find it comfortable at all I know the Dexcom's are a lot smaller and the sensor is finer but I'm on the fence about whether I want to put in the time and effort, of course it might make more sense than testing 12-14 times a day (that's where I'm at as well.)
I have had type one for 43 years and I understand BOTH not fearing lows and losing some of the physical awareness of them. I can get back the shaky sweaty feelings at a higher low level( say at 55 instead of 35)if I let myself run higher than range for a couole of weeks and avoid lows. I frankly have not found a way to avoid lows altogether when I have "tight" control, Usually have a low in the 60's ,high 50's every other day when I am am moderately low-carbing and am super-vigilant.
You are right, Holger, we long-timers kind of like to stay with what appears to work. I personally know that as long as I can treat my lows without help from anyone and avoid calling the Emergency squad ( last time was over a year ago), I really do not worry about it. Probably a thought pattern I need to change. I am retired now, and frankly cannot afford to use the CGM everyday, so I don't.
Clare, My hypo symptoms are more emotionally/cognitively based, as Zoe mentioned, than physical.: The loopiness, slow reactions, confusion, sadness, irritation...really do not even begin to approach physical " about-to-pass-out " levels until I am under 35 or so. This "lack of physical awareness?"has happened more in the past two years.. As I mentioned above,, I understand how to get the symptoms of lows back at a higher level and know what needs to be done. Yet I will admit, I am as Holger mentioned, stuck in my ways, not afraid of hypos, and as I say, just too lazy to do all that work of resetting basals ( again!!) and mulitple charting/ logging and carelink perusal. I test, and if under 68, I can pop in glucose tabs or Skittles . I always do extra blood glucose testing before driving, exercising, gardening etc. I guess I should be, but I am just not "skeered" of hypos.BTW, I have never had a nightime hypo I did not awake from. Never in 43 years on insulin.
God Bless,
Brunetta
You are certainly lucky not to have had a nighttime hypo you did not wake from, as I have woken twice with ambulance attendants in my bedroom and once after my husband has given me a shot of glucagon and none of those experiences was any fun.
Clare,I have had daytime pass-out lows during rapidly falling low induced naps. I then awakened to the paramedics. I think this has happened 3 or 4 times that I can remember, all since being on the analog insulins. This never happened when I was much younger and on beef and pork insulins.
and no, it was not fun. No pass-out lows and seizures are fun, even when they are very infrequent.
God Bless
One time the paramedics came to rescue me at work (long time ago,) and I kept telling them that my last glucose test had been 10. I was awake, alert, sounding a little drunk, but I knew what was happening.
They looked at me and said "N0 way!" In the midst of all this I pulled out my meter and showed them the history. They were speechless.
On the same note, I saw my endo today. Last A1C was 5.8. He said I had too many lows.... I asked what to do and his answer was "Take less insulin." Now, I just need to work on convincing myself to follow a higher glucose level regime. It ain't easy, as I am pretty OCD about being high.
That is one of the best posts I have ever seen here. Thank you.
After 50 years, the thing that has been DRILLED into my brain is to keep my glucose levels low. I do (see the above comment,) but I had not considered age. After 50 years, I am not a spring chicken!
Stubborn and impervious? Oh yes. But after all those miles, it is so hard for me to loosen up. I have been so successful.
I need to share that I was told at diagnosis that I would never live to 50 and I made it my mission in life to get there.
At the endos today it was the first time I really began to understand that lows can get me as well as highs.
I don't think I ever "feel" low. It gets into the 30's with nothing, in fact, as we speak it's 45 and I feel fine. It's gone into the 20's and I've also felt OK. Not that there aren't signs, my husband can tell before me. I have a CGM now which helps a ton. It alerts be so I'll check it otherwise I wouldn't know.
It's been a Godsend at night when I've had some really bad ones. Problem is I've gotten so I ignore the alarms (not good!)Sometimes it's OK when I check, sometimes not but I'm still checking up to 10 times a day. I don't find wearing the sensor a problem, in fact I don't even know it's on. You have to keep the receiver close by, a pocket or purse but if you don't, no problem it just doesn't register but I find I'm now lost without it.