I've been a Type 2 for 10+ years. I inject 42 units of insulin each night, and take 1000 mg of metformin twice a day as well as 2 mg of glimeperide at dinner time. In the past, I've felt glucose low's by suddenly perspiring excessively, then shaking, and soon confusion. However, over the last month or so, I've found that my bg is low (60 and below) by random checking - and not feeling them at all. When I reported this to my doc, she said that meters are inaccurate in measuring both highs and lows, and that if I didn't feel the low, then it wasn't low.
My questions are . . . 1) Is it common to stop feeling lows (and highs, for that matter)? 2) Are meters actually inaccurate in measuring highs and lows? 3) If meters are inaccurate at measuring highs and lows, why bother checking your blood at all?
Time for a new doctor? Many of us lose the ability to feel our lows over time. And others who still can feel their lows depend on much more subtle signals than shaking and perspiration,
Meters can be 20% off which means that if you test and get a 200 you might be anywhere between 160 and 240. But if you test and get a 50 your blood sugar is in almost cases between 40 and 60. Meters are pretty good at measuring lows and get better as you get lower.
The meter accuracy dance is somewhere I am frequently. Though it's a waste of strips, I often test again if I see a really crazy number (like a low, since I never feel my lows). My endo has used that excuse for highs...except meters can be + or - up to 20% and 20% less than 200 is still 160.
Do you test your meter with control solution every time you open a vial of strips? If not, then you should. They make that stuff for a reason!
Some meters are supposed to be more accurate than others. The OneTouch Verio IQ and the Accu-Chek Nano are both supposed to be in the +/- 15% range, which is also not great but it's something. I personally don't find my Nano to be any more accurate than the OneTouch Ultra I had before it.
As for the other part of your question, yes, it is possible to stop feeling lows. Basically, your body burns out the mechanism for bringing your glucose back up when it's low. Part of that mechanism is adrenaline--and adrenaline causes the typical low symptoms. If your body stops responding to low blood sugars, you stop feeling them. I "feel" lows by cognitive impairment--I haven't had a true low symptom in years.
That being said, my endo has also told me to deal with lows by how I feel AND what my meter says. He told me to treat a low between 60 and 80 that I feel, and anything below 60 that I don't. True lows (meaning dangerous) are under 60. I generally treat under 70 regardless, but I'll go for something with a more simple sugar content if I'm in the 70's and feel a little funny.
One last thing--meter accuracy, even with standard meters, is +/- 20%. Erring on the high side of 20% for a reading of 60 is 72, which is borderline low, anyway. The chances are that if you're reading under 60 but you feel fine, you might be low, anyway. I'd re-test a few times to see if your meter gives you the same result again (I find that with meter inaccuracy, the meter doesn't usually throw two false numbers in a row). If your meter doesn't seem to tend to make major mistakes, I'd treat those lows.
I agree, find a new endo. That's baloney. It's called hypoglycemia unawareness, and it does occur to a lot of us over time. Also you might be having "lows" more frequently than you are aware, and your body is gradually getting used to them. But regardless of how you are becoming unaware you are, and your Dr's lack of concern is frightening. Meters while not perfect are pretty reliable over all as Maurie above stated they can be 20% off, but if you test at 50, you can guaranfreakingtee you are DEF low.
I use a FreeStyle Lite meter, which I prefer over the One Touch. I do test it with the control solution, and when I test low (or high) I re-test. Lately, when I read low, I test repeatedly since I begin treating. I'm also finding that it's becoming harder and harder to get my glucose back up - it'll start coming up, and then drop again. I usually treat with glucose tabs, but I have to take so many of them, and it takes so long (while I continue to drop lower and lower) that I've switched to drinking a regular cola to get it back up. A 1/2 cup of that doesn't even seem to be effective, and I often need 8 oz. A week or so ago, I "discovered" a low (60) and started treating (and testing my blood every 15 minutes or so) and my bg got down into the lower 50's - began to rise, and got up to the lower 70's - but then fell steadily again back into the lower 50's. I was beginning to panic.
I've considered finding a new doc, but I'll soon undergo bariatric surgery, and feel like it's a really bad time to change doctors. On the other hand, I'll need my diabetes medications and insulin monitored closely through the process, and the bariatric surgeons tell you to involve whoever manages your diabetes medications for that aspect of the process. My doc doesn't seem to be interested in doing that, so I fear I'll be on my own anyway. Scary prospect.
If you are beginning to have frequent and especially persistent lows you might need to adjust your medications. I'm Type 1 so I can't provide that much help but when I start having trouble with lows, I start to cut back on my insulin.
I think you should. You're on insulin plus two other drugs and your internist doesn't seem to have much exposure to patients with lows. Endos treat lows very seriously and that will be appropriate for you especially while you recover from surgery.
If you aren't feeling the lows, that would be indicative of hypoglycemic unawareness, which can be a problem as you can transition from a moderate low you don't perceive to "check out time" really quickly, if there's insulin on board, perhaps coupled with the met and glimeperide (I'm T1 too, so I don't know that much about them...). The "meters are inaccurate" sounds like a copout from the doc and says to me that she's not totally engaged with your care. Is she like a GP role for you? She shouldn't be put off if you want to see an endo. Another thing I do is try to be cognizant of my BG when I drop blood off for an A1C, so I can get it checked vs a lab and get a feel for the meters. I've always used One Touch and they've worked fine but if you like another kind, that may be ok too. I think I've gotten calibrated. I suspect I have a shade of unawareness but still feel buzzed when I drift downwards so I figure that's my symptom. On occasion, I sort of feel like I lose that and try to eat more or turn my pump down a bit to get it back.
Have you thought you might have some gastroparesis issues? I have symptoms like that when my gastroparesis is acting up. I drop VERY fast and have the hardest time bringing it back up. I knew I was in danger the other night, and I knew as fast as I was dropping, and popping glucose tabs and NOTHING was happening, so I did the next best thing, even though I was still responsive, I knew at the rate I was dropping I wouldn't be, so I broke out the glucagon and shot up. I sucks but hey do what u have to do, beats a 911 call and a trip to the ER. I'm obviously going to have to get back on Reglan, and I have been dual waving a LOT of my boluses lately. Have apt with Gastro first of March.
Also if your not seeing an Endo, I highly recommend u do, I think a lot of GP's are clueless to managing diabetes. They are stuck in old school ways of treating, and don't seem to be very aggressive in treating either. If your doc is an Endo, then I recommend finding a new one.
I assume the 42 units you take at night is something like Lantus or Levemir? A lot of people find it helpful to split the dose. Take half in the AM and half at night. Even though these insulins are supposed to be flat, they aren't and they can and do cause lows. But I really think you'd benefit in finding a DR more up on diabetes management.
Wow if you are undergoing bariatric surgery I'd want someone really on top of my medications and what they are doing. I've heard of type 2's having the surgery and because of the drastic decrease in food intake, quickly having a major reduction in the needs of their medications. Yes yes and yes again, I'd def find a new Dr to be managing my diabetes. Here where I live at, GP's and Internal medicine dr's dont even want to get involved in managing diabetes, its an instant referal to an Endo here, especially if you want to be on Lantus/Levemir/Humalog, etc. And who doesn't want to be on the newer insulins LOL, you really do get better control on them.
The insulin I take is Lantus - 42 units at bedtime. I may have a surgery date this week, so the time for finding an Endo and actually getting in to see him or her is short. I have peripheral neuropathy, and some symptoms of gastroparesis, but when my doc first mentioned that possibility, she was clearly not wanting to explore it any further. I definitely had the feeling that she wouldn't be comfortable treating it. I've suggested several times that I may need to see the gastro who does my colonoscopies, but each time she's discouraged me. Troughout this journey towards the bariatric surgery, I've encountered SO many medical professionals that are clueless about diabetes. One cardiologist told me not to worry about high bg "because it always comes back down." He's the same one who told me to carry a Gatorade in each hand (like weights) when I exercise, and that if my bg went up or down, to drink them. I went to another cardiologist. A dietition told me to snack on fruit because "natural sugars won't make your blood sugar go up." But then, she's the same one that told me not to worry about eating too much salt - because there's no calories in salt - and that I should exercise less, and that I wasn't eating enough. I guess SOMEBODY has to graduate at the bottom of the class.
After years of being able to keep my bg pretty much in line, lately they've just been all over the place. I don't think metformin is doing anything at all anymore, and I'm just feeling overwhelmed, I guess. The major reason I'm pursuing bariatric surgery is to get my diabetes either into remission, or back under control.
I sure don't see how T1's deal with it. It's all so complicated. Just when I think I've 'got it' - something new pops up!
1) SOMETIMES THE HIGHS CANNOT BE FELT BUT ONLY IF THEY ARE LOW HIGHS (200s) AND WHEN THERE'S NO KETOSIS .. HOWEVER THE LOWS ARE USUALLY FELT . BUT THEN AT A CERTAIN POINT I HAD DAYS WHERE MY BG WAS 30 AND I DIDN'T FEEL THAT I HAD A LOW .. BUT MY BODY WAS CERTAINLYNOT NORMAL AS IN I KNEW THERE WAS STH BUT I WAS SURE IT WASN'T A LOW ! 2) i DON'T THINK METERS COULD BE THAT INACCURATE .. SOMETIMES THEY DOO GET MESSED UP BUT IF U REMEASURE UR BG AGAIN AFTERWARDS (IF U DOUBT THE READING) U'LL JUST BE CERTAIN .. IT CAN'T BE WRONG TWICE !
HOWEVER...IF U ARE TALKING ABOUT THE 60S LOW RANGE THEN HEMIGHT ACTUALLY BE RIGHT .. BECAUSE METERS COULD BE UP TP 10 MG/DL INACCURATE SO THAT WOULD MEAN U ARE 70 STH WHICH IS PRETTY NORMAL !
So as the wise people in this forum have told you, when you spend time with a low blood sugar, you will become accustomed to the low blood sugars and you can become hypo unaware. You won't feel it and it can become dangerous. Sure, you can blame the meter, it is only good to +/- 20%, but the real blame is your treatment regime. You are being given a basal insulin And glimeperide both of which drive a constant high level of insulin through your body. But you don't have anything to help you with meals. Every time you eat, your blood sugar goes up and the only way to counteract that is to raise your basal or glimeperide. When you do this, you virtually assure that you will have lows between meals.
In my view, you need a new doctor, one who has a competency in diabetes. Once you start a basal insulin, you no longer need glimeperide. It is redundant and has the potential to do harm (as older patients, we do not need extra medications). And you need to handle your meals, not by raising your basal insulin, but by following a carb restricted diet and using meal time insulin. And if your medical team has not put you on a low carb diet and has instead shuttled you off to expensive and dangerous bariatric surgery, shame on them.
If you follow a modern regime as I have suggested, you should be able to attain much better control of your blood sugar and avoid constant lows. With attention and keeping your blood sugar above 70 mg/dl you should hopefully regain some of that hypo awareness.
I in my personal opinion of other's I've seen on metformin, I think its a nasty drug. Works well in the beginning, but tends to give out. Personally I don't think they treat type 2 aggressively enough. They let type 2's go a VERY long time with exceedingly high blood sugars before starting insulin, and then they seem to have them on some old school sliding scale method of dosing. Kinda crazy.
I told my doc that I didn't think metformin was working for me anymore, but she assured me that it is. You must've been reading my mind, because that was another question I was considering posting on here. Used to be, when they first put me on it years ago, if I took it and forgot to eat, I'd get really nauseated, and would have to then force myself to eat something to get the feeling to go away. But now I can take it, and . . . nothing. Doesn't matter if I eat or not. It doesn't seem to effect my sugar one way or the other. I was wonder if it was possible to develop a tolerance or a resistence to it.
The more I read here, the more I'm thinking that I really DO need to find an Endo.
I don't have a medical "team." :-) Just an Internist. She's actually against the bariatric surgery. I'm not doing the gastric bypass, but the gastric sleeve, which isn't nearly as drastic - and certainly no more dangerous than uncontrolled blood glucose levels that could drop low enough in my sleep to kill me. My daughter just had the sleeve done last week, and since we live together, I followed the two-week liver reducing diet with her. During that time, I consumed 10 or less grams of carbs per "meal" on an all-liquid diet. I monitored my bg closely and checked my urine for keytones. I continued to take all my meds, and injected my insulin as usual. For most of that time my bg readings were in the 102 to 105 range, consistently. I discovered one low when I tested at bedtime - before injecting insulin - and it took me about two hours to get it back up. I dropped from 60 to 52 while treating, it then went up and down a few times before I got it up to 70. At that point I went to bed, and didn't inject any insulin.
I had hoped to discover any problems with the pre-op diet, when I could treat it, so that I could enlist my doc's help when I was going through it for my own surgery, and wouldn't be at liberty to treat it. But she made it pretty clear that she had no intention of advising me how to manage my meds and/or insulin pre-op OR post-op.
As I continue to read the posts here, though, it's becoming pretty clear to me that it doesn't really matter if I change docs at this point, or try to before surgery, because I'm really on my own already. I definitely need more guidance than what I'm getting from my current doc.
I was diagnosed a little over 5 years ago, and was told my A1C was off the scale. During the 1st year the few times that I felt lows, my meter was reading around 120. The past month or so, I finally started getting a bit of control and see more BG's below 180, and seldom see above 200. What I have noticed tho, is I don't start to feel lows until I am below 70. Also I don't feel those lows like I used to in the beginning, no sweating, shaking, just find it a little more hard to concentrate and find my thoughts wandering off in all directions. I worry a bit that I may be an excellent candidate for hypo unawareness in the future. Seems a bit ironic to me, the better control you have over the high BGs, the less control you have over the low BGs.
The reason you were probably feeling low when your meter read around 120, DiabEric, is because you had been much higher for a long time.
"I don't start to feel lows until I am below 70". That is because numbers higher than that are not considered lows! Some people consider a low below 60 and some below 70, but if you are starting to feel lows at 70 that is right on the mark.
The key to preventing and even removing hypo unawareness is to reduce the number of lows in a close period of time.
