I was hypo-unaware before starting bolus insulin from years of undiagnosed reactive hypoglycemia. In December I had a 27 (double checked and got a 23) on my meter and was still conscious and functioning. I checked because I suddenly felt a little “off” and I actually felt worse going back up. Seeing those low numbers was a bit unsettling of course, I’ve also been in the 30s and was able to treat and correct myself. Everyone is different, but know that it’s possbile to be very low and not pass out.
I wonder too if the workout plus shot, 6U seems like a pretty solid dose, might make you want to consider adusting your carb/ insulin ratio or maybe also basal just a whiff, particularly on big exercise day? The "eating chocolate without spiking" suggests to me that maybe your ratio is "hot" and that you might be sort of drifting into having a "load" of insulin on board, like all the time and that maybe it contributed to this low in particular? I always sort of like to take the most insulin I can take without running low but, well, if you want to make omelettes...
I would agree with the people saying your hypo symptoms MIGHT be changing? Besides the fact that it really could be unawareness and/or exercise kind of masking it due to adrenaline.
I'm in the 5% range a1c club as well where I had a bit of unawareness a while back and I had to just religiously watch for lows and treat anything lower than 75 mg/dL until I felt some sort of symptoms again. Sometimes I do, sometimes I don't, but I test enough where I usually catch things before it could be anything bad and I also never have severe lows at home (I had 40's in the hospital though that I didn't feel at all that was a load of fun :( but it's possible all the medicine I was on made it hard to tell ) the lowest I get at home is upper 50's and I always come right back up with a few glucose tablets. I do find if I go below 68 mg/dL I feel it but those very like slightly low numbers are harder for me to feel symptoms for, but I rather treat them then let them wait so I do test if I have suspicions and 99% of the time I'm right?
Exercising can mask the symptoms of hypo-- after all they’re quite similar, shaking, sweating, heart pounding, etc. For me, any vigorous exercise that soon after bolus would be a guaranteed low. I don’t think though that vigorous exercise masking hypo symptoms quite reaches the level of significant unawareness… I think I becomes significant if it happens during normal activities when you’re not intentionally stressing your body out to the max…
good point there.
I am puzzled that no one has brought up the subject of "Active Insulin" aka "Insulin On Board (IOB)" aka "Bolus On Board (BOB)".
I believe this is one of the most common reasons people give themselves "too much" insulin. Certainly I never accounted for this while I was on MDI ... I don't remember even being aware of it back then. It wasn't until I got a pump that I started allowing for IOB.
I am also puzzled that some people talk about hypos as though it's pretty much always the same. That is not my experience. Sometimes I'll be low & surprised. Other's I don't even bother to check & I just correct because I know I'm low.
-iJohn
That is a good point. I am on MDI and use my Glucosurfer App to track the IOB. But without any tool at hand the IOB is easy to forget. This might increase the risk to overlap dosages or to correct high numbers too soon.