Our friends at Healthline shared with us a GREAT infographic about what happens in your body during a hypoglycemia.
Also, hypoglycemia can not only help induce heart attacks, but it is also now suspected, perhaps through its pro-inflammatory effects, of worsening cardiovascular disease. So now we may well have two causes of complications: the treatment and the disease! See:
Diabetes Care(https: 2016 Aug;39 Suppl 2:S205-9.
Hypoglycemia and Cardiovascular Risk: Is There a Major Link?
Hanefeld M, et al.
Severe hypoglycemia is recognized to be one of the strongest predictors of macrovascular events, adverse clinical outcomes, and mortality in patients with type 2 diabetes. However, it is uncertain whether a direct pathophysiological link exists or whether hypoglycemia is primarily a marker of vulnerability to these events. Large clinical trials have reported an increased hazard ratio for all-cause mortality and cardiovascular events in patients with type 2 diabetes and severe hypoglycemia, but such an association has not been demonstrated in prospective trials of people with type 1 diabetes. Several cardiovascular effects occur during hypoglycemia either as a result of low blood glucose levels per se or through activation of the sympathoadrenal response: hemodynamic changes with an increase in cardiac work load and potential attenuation of myocardial perfusion, electrophysiological changes that may be arrhythmogenic, induction of a prothrombotic state, and release of inflammatory markers. Although the potential for a causal relationship has been demonstrated in mechanistic studies, the evidence from large prospective studies that hypoglycemia is a major causal contributor to cardiovascular events is limited to date. Other preexisting cardiovascular risk factors in addition to hypoglycemia may be the major link to the final cardiovascular event, but a low blood glucose level can trigger these events in patients with a high cardiovascular risk.
People who treat diabetes with insulin must live with the tension created between hypoglycemia and hyperglycemia. This daily navigation between these two opposing evils brings to mind the Greek mythological sea monsters, Scylla and Charybdis.
Scylla was a rocky shoal on one side of a mariner’s course through a strait. Charybdis, an equally dangerous whirlpool of water, occupied the other side of the strait. This tale of Greek mythology illustrates the human condition of having to choose between two equally dangerous options. This is the myth that gave rise to the expression of finding yourself “between a rock and hard place.”
We must set our diabetes course each day with both Scylla and Charybdis in mind. From the outset of our journey and at almost every clinical opportunity, our medical partners counsel us to steer well away from the danger of hypoglycemia, almost as if saying, “hyperglycemia be damned!” I think this advice causes us much harm.
Even though we live in a time without a cure for diabetes, we now enjoy treatment tools that permit us to often sail a course safely between a rock and hard place. Medical counsel intended to bolster an over-correcting bias against hypoglycemia is poor advice, from my perspective.
With low carb diets, continuous glucose monitors, and the advent of automated dosing systems, we enjoy a much-improved ability to safely steer a path between the twin dangers of diabetes.
We need to give hypoglycemia its due but we needn’t bias our thinking so much that we steer well away from hypos and find ourselves foundered on the jagged rocky shoal of hyperglycemia.
Which is why many doctors recommend high blood sugars levels for their older patients. But again, each patient is different and the doctor and patient must come to a safe range. Just because a person is older does not mean they should run higher but if they are living by themselves, it should be a consideration. Safety above everything else.
And this is another reason I love my CGM. Those arrows give me so much knowledge. With 2 arrows up and a blood sugar of 140, I now know I might be thinking about a little insulin to keep it in target. Verses just a meter reading saying i’m 140 and let it ride. The tools we have now help so much keeping us on the tightrope and not falling off.