If there is a discussion about this, please point me in the right direction. If not, hopefully this will generate some good responses.
Lately I have not been feeling my lows until they get into the 40's. For example, I started to feel a little funny about 10 mins before typing this and I tested my BS=49. What is weird is that I am still functioning somewhat "normal."
I have had type 1 diabetes since 2005, so maybe becoming less sensitive to lows comes over time.
Becoming less sensitive to lows is believed to be not so much a function of time but of frequency. When you have frequent lows it reduces your sensitivity. The way to regain awareness is to simply reduce the frequency. If you are heading down to the 40s on a fairly regular basis you might want to tweak your doses. Lows are pretty much unavoidable, but the frequency can be reduced and then awareness should come back.
I think if you run yourself higher for a while you will become more sensitive again. I haven't lost sensitivity but when I'm really focused on things I sometimes can miss it and some come on very rapidly. Have you considered a cgm? I'm trying one again soon. One of my problems is a lot of activity can drop me low suddenly while I'm sleeping sometimes hours later, but I always seem to wake up it seems. A cgm can give you more info about what is really going on.
Hypoglycemia, and Hypo-unawareness are common side effects to all types of insulin. Eliminating frequency and depth of low BG will help
with Hypo-unawareness, but for many of us this is easier said than done on MDI because we have very low insulin requirements in the middle of the night and spend many sleeping hours with low BG caused by the irregular absorption rates of Basal insulin such as (Levemir, Lantus, NPH). I spent years with low night time BG and Hypo unawareness. The only way I could stay on a intensive insulin regiment and limit low BG was to start pumping insulin. The pump gives me the ability to reduce my night time basal requirements to almost zero and then quickly increase my basal levels early in the AM to fight off dawn phenomena and hi waking BG.
Nicole - You’ve received some very accurate and helpful descriptions about hypoglycemia unawareness. Your observation about good cognitive function while low is one of the deceiving and dangerous aspects of hypoglycemia.
I’ve been engaged in extended conversation with someone and routinely tested my BG and read a result in the 30’s. I then asked my conversation partner if they detected anything unusual about my behavior. They replied that I seemed normal to them.
The problem with hypo unawareness is that your functioning can quickly degrade in a matter of minutes. If you’re driving you are especially vulnerable. In any case, one needs to treat lows as quickly as possible. They can and do kill. Restoring hypoglycemia awareness is an imperative goal that should not be put off.
yw :-) I have also been on mdi. I would definitely give a cgm a try and then maybe a pump also. I still prefer mdi if I can work all of this out because I have too many worries with a pump, but many people love them and do very well on them. MDI is more difficult, for me anyway.
Yes, many diabetics lose sensitivity to feeling low over the years, especially if you run low often. This can fluctuate. Some medications can interfere with your ability to feel lows as well, such as Metoprolol.
I think my reaction to lows has little to do with the number (68, 45, 28) and much more to do with how FAST my BG is dropping. I have walked to the grocery store, come back and started to unpack my groceries and I think, "I think I'm low."
28.
Another time,I stand up, I feel like, "whoa! I'm going low quick." 75.
I've had Type 1 for 5 years and for me, the more "stable" I am, the less this happens. It could be a bit of BG blindness mixed in with a bit of fall rate awareness.
Usually the brain will start to feel discomfort starting with 70 mg/dl. Usually the brain secretes adrenalin in response to the irritation of brain activities caused by the low blood glucose. Over time our brain is getting used to these situations. So the first level response like shacking hands and sweating will disappear over time. Same is true for people working in very stressful job environments. The adrenalin deposits have to be refilled after they have been secreted. This might take up to one day. Thus the second low within 12-24 hours will be detected much later due to the low level of Adrenalin available. So overtime we are faced with declining reponses and depending on the reccurence of lows we can have no first level signs of being low at all.
Luckily there are still second degree sings of being low. These are the side effects of functional impairments of brain activity. This is much later than the first level reponse - about 50 mg/dl or lower. Visual distortions combined with feelings of fear and weakness are strong indicators. I try to focus on these to catch the low. Now the window to actually fight the low before your consciousness is getting impaired is starting to close. The meter will start to get unreliable 50 can be 40 can be 30. This is also because your body is switching to central blood circulation. The extremeties like the hands will get less blood flow. Thus the numbers measured there can be behind the actual development (5 minutes or more). It might help to shake your hands to increase the blood flow with very cold hands. But better focus on fighting the low than measuring it. Here it really helps to have a ritual at hand to get the number of glucose tabs needed. I usually cut off 3 tablets with my finger nail from the paper packed tabs and eat them. This way I do not get confused with the counting process while being low.
As others wrote the rate the BG drops is also important. It can be very irritating to feel the BG dropping. Especially in the colder periods of the year the BG might drop very fast while your tested finger might only report low 80 mg/dl. In these situations I have learned to trust my feelings more than the exact number on my meter.
Being able to function properly at low glucose numbers can be seen as robustness or resilience. But due to the reliability problems with current meters and the unreliable measurement process itself I would not trust on that. 30 mg/dl at your finger tips can mean that your brain is already at 20 mg/dl (0,020g). Your brain needs about 140g of glucose/day = 6g/hour = 0.0972g/minute = 97mg/minute on average! So your brain consumes 97mg every minute while your heart is pumping 20mg per deciliter through your brain. Obviously this will not work for long. Other consumers like the muscles and heart need glucose too. It is a small window as I wrote before and the glucose will deplete very quickly. This will end with a seizure if not treated aggressively. The likelyhood to survive this are not that bad it seems - but we better do not test that out. I did that once in over 25 years with T1 and it was enough for my taste.
Thanks for all of the responses everyone! I feel much more informed and like I can better deal w/ this issue. I also see my Endo in a few weeks and will bring it to her attention.
You do not give us any idea of how frequently your hyps are. As suggested by other posters above, the frequency (how often?) is often more critical than the severity (how low?). If you are having hypos on a daily (or near daily) basis, you are at significant risk of developing hypo-unawareness. If you can estimate the the numbers of hypos you are having, or have any sort of records, you may want to bring this up with your Endo.
Hypo-unawareness is not a road you want to travel along! You can regain your awareness, but this requires an extended period without hypos (probably impossible for any reasonably controlled T1) or at least minimizing the frequency and severity.
As another poster points out it is common for basal insulin requirements to be much lower at night - if you are on MDI you may be drifting low in the small hours and then drifting back towards dawn (when the release of hormones will raise your BG). You may want to consider using a pump.
Hi Nicole I don't feel the lows till I am in the 30's: tingling in my tong, spots i my view... Dexcom has come to help me nicely (for the last 8 months)! now Medicare don't want to cover for it! it got worst since I started my Dt1 in 2005, it seems can get better with care, that means avoidance of lows. I am very rarely reach the old lows but still working on racing my awareness :), Do you have an CGM?
good luck!
I disagree with the people who say have less lows and you will start to feel them again…I have been diabetic for over 30 years and have always been able to feel them until the last couple of years. I personally think it had to do with age with how you feel them.
On the other hand, I had a friend in high school that never felt them. I guess long story shorter…each one of us is unique and react differently.
I am very greatful I have a CGM to help me detect the occasional lows I am now not feeling.
I've only been a diabetic for a year and I had 40's in the hospital recently (which I NEVER had at home and I test frequently enough to notice these things) and I didn't feel them at all. I'm wondering if the hospital meter was just off and I was in the upper 60's where I often don't feel any different like 68-69 mg/dL , but regardless I was treated quickly and would come up fast. Other than the hospital my blood sugar is a lot more stable and somewhere between 80-130 most of the time (once I started to eat food again, at all) but I do feel okay with 70's to some extent and I'm debating trying not to be okay with those as much to feel hypos again. I don't feel like I should have to go into dangerous levels of high to feel lows again.
I think if you are considering a CGM you really should be also considering a pump. Used in conjunction with MDI a CGM will provide warnings and useful information on BG trends, but without the pump you will not have the tools to apply the information to improve your BG levels, avoid hypos etc.
Holger, thanks for your detailed, scientific, but still easy to understand descriptions of the hypo process. All I know that after 46, years, I am not hypo unaware. I no longer get the first tier physical sy mptoms any more, the shakes and sweats , unless I am very low, say in the low thirties. I have more of an emotional/ cognitive dissonance when I am under 70. As my late brother used to say. " You are getting loopy. Check your sugar." Loopy for me is: saying whatever I think, sudden emotionality, inability to make rational decisions, just plain out wired out and weird. I had a 33 the other morning, knew I was low, and could treat it, but I wanted to boo-hoo about the spider I killed in my garage that morning instead of taking the glucose tabs; and I had to stop myself from looking up arachnids on my smartphone before treating.. Yeah, I do not seizure nor pass out; I have a semblance of functionality, but not much. That is why you do not play with lows. Wearing my CGM now with the threshold supend feature so I can avoid the Loopy Loonies. LOL.
