So I really will get lectured about hypos every single visit

Let’s say each of those events was 30 minutes being under 70 mg/dl.

So in 90 days there are 71 events * 30 minutes/event = 2130 minutes under 70 mg/dl.

In 90 days there are 129600 minutes.

So 2130 minutes in 90 days is about 1.6%. Or your wife’s libre shows she spends less time below 70, than I do!

1 Like

Wow, 23 hypo events requiring assistance per year on average? That just seems staggering to me. Even in the R and NPH days and only testing three or four times a day before meals, when (at least in my experience) the risk of severe hypos was much, much higher than it is now, I only had a handful each year that progressed to a point where I couldn’t treat myself.

I’ve only had two events requiring assistance, and they were both when I was on NPH and Regular. In fact, the last event prompted my doctor to put me on a pump.

I always test before driving, and won’t drive unless I’m at least at 80, plus I always keep glucose tabs in handy reach, so if I’m on a long drive, I can easily pop a tab if needed. That said, I do sometimes go low without noticing it, but I’ve also found that unless I’m below 50, it doesn’t seem to affect me that badly. Luckily, the only times I go lower than that are usually at home when I’ve done some heavy-duty cleaning or extra exercise. And even at 30, I can treat myself. Lower than that and I’d probably need help.

But again, the key thing is how low bg affects the individual, I think, and testing before driving.

I also have a doctor who pretty much lets me do my own thing. He’s my PCP, but he’s also an endo. My last A1c was 5.8, and no lecture about lows (which I did have at 5.6, but not so much at 5.8) He trusts me to tell him if I’m having a problem, and I trust him to help me figure it out, not to just give “orders.”

2 Likes

I was just at my endos, she was delighted but I brought in proof of my control to show I spent less than 1% under 70 hypo time. My last A1C was 5.1%. I took her 14 days of complete reports and summaries of 30 and 90 days.

The DE I saw about a month ago was delighted too, I know in the past she’s talked about 2% being acceptable but they prefer less than 1% hypo territory and never requiring help.

But I keep hearing stories of people being lectured for low A1C’s so I went in well prepared. I even wrote on the reports a couple of explanations, like when I had an MRI and pulled the sensor off instead of stopping it and it registered a low even though it showed no sensor readings. Or a pod failure and I had a 225 reading.

But I have 0% under 70 for weeks, not months though? I did change my CGM to alert me at 80 instead of 75 and that has helped stop me from going below 70 very much and almost completely cut out under 65. (It still happens off and on)

2 Likes

Mine is probably not the “brilliant” post to which you are referring, but this is a blogpost I wrote a few years ago about walking the tightrope. https://testguessandgo.com/2015/11/02/balance/

2 Likes

Love it @Laddie! Thank You!

1 Like

I have my endo appointment tomorrow and even I think I am having too many lows (8.3% below 70). Probably 30-40% of those are the result of Dexcom tending to trend low. But the lows are so easily treated unlike highs which take forever to return to normal. Plus I never need help with lows and feel perfectly fine through most of them.

I have finally received Dexcom G6 through Medicare and will start Basal IQ on my Tandem pump in the new year. Until then I am using up G5 supplies in order to have a small stash of G6 sensors.

My endo asked how far below 70 I was really getting (she completely understands what a cgm says, and what I know my fingersticks are, and she KNOWS that I watch my numbers.)
After I said I only really get to maybe 65 or so, and not for long, and that was the end of that conversation.
Since I got my cgm, I rarely get any hypos that I can’t easily stop before they cause any concern.
I have yet to have one I couldn’t easily handle though.
With Fiasp and Basal-IQ on my X2 pump, I have VERY few issues at all! And I am AGGRESSIVE with my overnight basals!

1 Like

Well before I managed to get my diabetes under better control I would say that I had 1 or 2 severe hypos a month where my vision went black and it would have been difficult to see what I was taking or get some juice or find my glucose tabs not to mention the times as a child were I was actually unconscious.

Remember those of us on forums like this are often better controlled than the average diabetic. I get shocked medical professionals all the time at my control even though I haven’t ever even gotten an A1C in the 5’s.

@ Tim12

We all know how hard you worked. :star_struck::star_struck::star_struck::star_struck:
Congrats.

1 Like

I am definitely not meaning my post to come across as criticizing, if it did come across that way… I am not one of the super-tightly-controlled ones. Like you, I’ve never had an A1c in the 5% range and my current A1c is not even within the recommended target range. But I just find it surprising that on average people are having hypos so severe that they need assistance so often. I guess it also depends on the type of assistance being referred to. When I was younger, I’d have hypos where I’d pass out or collapse and definitely could not treat myself without assistance, so that’s the type of hypo I think about when I read that statistic. But I read of many who ask a loved one to go get juice for them or whatever, because it’s easier, even though they may be able to do it themselves if they had to. So that would be a totally different type of scenario and would be much less surprising to me than actually passing out or collapsing. I live alone, so I can’t ask anyone for assistance for lows. I always, always have glucose tablets within arms reach, so even when I’ve had hypos where I feel close to passing out or can’t see (which has happened), I’m able to treat with glucose tablets. I’ve had lows where I doubt I’ve had made it to the kitchen if I’d relied on getting up and walking over and opening the cupboard and finding and opening juice.

1 Like

We are in the few percentage of diabetics that have ‘better’ control than most of what our Dr.s see on a normal basis.
My last A1c was 5.2, which my endo said in the first place was probably too low of a target (I always set my target at just under 5%, so I am close.)
But, I EAT. I am not on a low carb diet (I have done low to almost zero carb already.)
It is a lot harder to maintain a low A1c and actually EAT.
It was a lot easier before to get 5.6 to 5.8 and be low carb without much thought. But I got tired of the diet.
My endo is rightfully wary of my low A1c, and I do not blame her in the slightest. But, she is not accusitory, she is honestly making sure I am being safe. Really hard to fault a Dr for that!

4 Likes

Nope.

I had a Doc like that for a long time.

It seems I’m in the same boat as you again with new Doc. Your data is considerably better than mine, though. You have 0% below 50. No reasonable person could be upset with this data. It probably puts you in the top 1% of type 1 diabetics.

Even non-diabetics float around in the 70s sometimes.

My CGM tends to read lower than manual check a lot, so you might as well chalk those up to sensor error. 70 is very close to 80. If you run in the 80s, you will see stuff in the 70’s simply due to sensor error.

3 Likes

A couple of comments:

If I EVER saw 91% TIR, I would be ecstatic. Congratulations!!! You are a superstar in my book!!!

To me all lows are not equal: there is the scary crashing low and there is the coasting, grazing, just barely hit 70 type of low. We all know the difference and know that a crashing low is the really scary situation. Interestingly, however, a grazing low, in my experience, often results in longer total time below 70 than an “oh, my, I’m crashing …” low.

Finally, in terms of getting hollered at:

I was in a car accident one time. Fortunately, I was not hurt even though I “rolled to a stop the hard way” … 5 1/2 roll overs. My only issue: 3 hours of memory loss.

Well, upon telling my endocrinologist that I had been in an accident, he REALLY let me have it: “Face the truth! You blacked out at the wheel …”

Because of my memory loss, I had no idea what had happened until I received and read the CHP (California Highway Patrol) accident report 10 days later: it turns out that another driver swerved in front of me, clipped my bumper, and caused my rollover accident. That was the first time that I even realized that another car was involved. The other driver was cited for an unsafe lane change, their insurance company paid for my totaled vehicle … and, best of all: I showed a copy of the CHP accident report to my endo and he profusely apologized for ASSUMING that a T1D in a car accident was AUTOMATICALLY at fault!

Have a good day … and congratulations on your excellent control!!!

John

8 Likes

I didn’t take your other post as criticizing :grinning: . Just wanted to give a real experience as to why the average diabetic could have 23 hypos a year that required assistance and remind everyone that we are all probably in the top 1% of well controlled diabetics including you and me with our gosh darn hormone driven BG roller coasters.

2 Likes

I actually think you want to be careful, Tim12, about what ends up in your medical record.

I had a primary care Doc say this week that I, “Have trouble with lows.” That dates back to the very 1st Doc opinion from 10 years ago. It can follow you because every single Doc will just adopt the opinion of the previous. I would never have characterized that as a valid opinion. But, it follows me still.

Maybe there is some reason why they write that. It could be in all of our medical charts. Maybe it helps decrease their liability or ensures insurance coverage for our CGMs & pumps. I believe I originally had trouble getting access to Omnipod and she had to claim ‘medical necessity’ to get it paid for.

Marilyn, I’m curious how a lab error causes a falsely high A1c.

(I ask because my recent A1c test came back in the prediabetic range for the first time. I was upset about this, and tried to search online for silver linings and found that sometimes people with low blood sugar can actually have RBCs that last longer and when RBCs last longer that can result in a higher A1c number. However, as much as I would want this to be true, I do enough finger sticks to see that I’m usually in the mid to high 90s and low 100s, often higher, so I don’t think I have high-performing RBCs due to low blood glucose, but it was a nice little dream while it lasted.)

1 Like

@Tim12 your Dexcom graph looks very similar to mine. My Low is normally 1-2% with a hypo risk of “Minimal”.

So far my Endo has never brought it up to me. They actually compliment me for my numbers each visit.

On the other hand I do get pressure related to cholesterol numbers. So far the different medications I’ve had to discontinue because they are triggering joint pain/injury.

2 Likes

Sorry Senator, I have no idea if my 5.8 could have been a lab error, it was just out of my ordinary range and I dropped from 5.8 down to 5.2 by my next A1c. 5.2 is closer to normal for me.

I am so sorry that you had a higher A1c than you are used to. You didn’t recently start a statin did you?

1 Like

No. No statins.

I’ll check the test again. But the trend has been up not down with the A1c which is disappointing.

2 Likes