What is a LOW -- 3.5 or 3.9? -- for members measuring in mmol/L

I would also add that some of my experiments w/ IV R suggested that it’s not the ‘low’ that caused symptoms but the ‘delta’? Before I got my pump, if my BG hit 200, I’d have a couple U IV and it would drop me from 300-70 in about 30 min but, 15 minutes into it, my BG would be 120 or so but the sweat would already be coming out?

I agree the 15/15 recommendation is WAY too much for me. I treat with fruit juice or glucose tabs. I have a 50mL measuring cup that I drink out of for lows. I drink 50mL (5g CH) for moderate lows (3.0 to 3.5) and I drink 100mL (10g CH) for lower lows (under 3.0). I only eat something in addition if I have a lot of insulin on board. Then I eat 5-10g of slow acting carbs.

Do you treat these feelings from fast dropping as lows? I also feel bad if my blood sugar is dropping quickly from a high, but I don’t treat that as a low unless I’m actually close to having a low.

I try to keep my awareness for lows by treating them early with glucose tabs - the tasty ones you already know - not the chalk ;-) By not getting used to low levels I start to feel values below 80 mg/dl. A kind of nervousness sets in and this is amplified when the descent rate is higher than normal. I think I would not have preserved this awareness for more than 20 years without treating lows early. As you now my A1c is in the 5ths and this is a permanent dance on the edge of going to low - the target corridor for normal is just very small. So for me it is not so much the exact number that counts but the feeling associated with it. Todays metering technology is too prone to errors to draw the line at 70mg/dl or 3.87mmol/l. I am questioning if the 85mg/dl I have measured might be something like 75mg/dl or lower - depending on my feelings. Too often I have shaken my hands and retested and with the new blood in my fingers I was lower - maybe 15 or more.

I think when a doctor sets a lower margin for lows he is assuming that the patient will overtreat the low leading to higher numbers later. I can understand this reasoning but I think it would be better to recommend the use of glucose tabs only. One tab will bring you from 70 to 85 or from 60 to 75 and that is an important step away from the low. With juice this rise will set in later and some of that juice will come much later because of the fructose. For me even short term activity gets a little glucose tab on top. If I need to ride my bicycle for 20min and I have not prepared for that a starting number of 90 would lead to 70. Here again one tab does the trick and prevents the low. This kind of proactive counterreaction gets more and more important the more normal your A1c.

Decision about low treatment = value + feeling + planned activity

I don’t have R any more. I would treat that b/c I was expecting it to get lower as it would take 30-45 min for most (??) of that insulin to run out. I think the 'log insulins are much smoother? I also don’t run into the 200s or 300s much these days?

On a course we did they mentioned being at four ur near the floor so if I am 4.3 I consider it as a hypo.

I’m not sure that hypoglycemic unawareness is all it’s cracked up to be either. Maybe it’s a YMMV type of thing but I run into the 60-70 range pretty regularly, for at least 20 years, but still feel a very perceptable ‘buzz’ in the 70-80 range? I hardly ever run < 50 these day so perhaps that helps?

For me, a low is anything under 4. Sometimes I will treat it even if I am 4.1 or 4.2, if I am feeling low.

i use 4.0mmol and below as low, that’s what my DSNs have advised me :slight_smile: <3

agree, 4.0 - 7.0 is my "target range" that I try to stay in, but 3.5 and below is a real low to me. If I am, say, 3.8 before a meal I will often just eat the meal rather than going, "Oh no, must get sugar now!!" Same if I wake up at 3.8 or 3.7, my endocrinologist doesn't mind this and will not consider it low, except of course I usually would adjust pump settings anyway because it's getting a bit too close to low for me. During the night I will treat a 3.8 or so, but I also treat anything below 5.0 at night, as well as after meals, because there's a good chance of dropping lower. So I guess my definition of "low" varies depending on the circumstances, time to next meal, and so on.

I think figuring out customized treatments for lows is really key in achieving tighter control.

In the morning, 1 glucose tablet (4 g carb) is enough (combined with waking up) to treat a below 70 mg/dl, but later in the day I may need 2-3 (8-12 g carb). Unless I've overdosed rapid-acting or had unexpected physical activity, I typically don't have enough IOB to really warrant 15 whole g carb to treat a low.

I try to use pure dextrose. If basal and bolus are fine-tuned, there should be no need for any protein or fat to maintain on-target bg after treating a low--but unfortunately the old advice to treat a low with a carb and a protein (made sense on older insulins) seems to live on. For me, overtreating definitely lead to too many rebounds!

Now that I'm on the pump, I can also "treat" an impending low by setting a temp basal rate--although I have to be careful with not depriving myself of basal I"ll need in another hour or two!

Congratulations on your great expectations!

The 15-20 g carb, retest at 15 minutes is just a guideline--it has to cover a wide range of people, situations, and medications (such as the elderly, people with other serious medical conditions, and children, who often would be advised to avoid the below 70 mg/dl territory as much as possible).

I think the really important part of the guideline is the retest at 15 minutes part, which I am often too lazy to do! That's how we can see how much carb in what types of situations is the best treatment.

For far too many years, I stubbornly refused to acknowledge just how much variation my own body required (different I:C ratio for every meal of the day, different correction factor based on time of day). Now that I've learned I'll just have to live with all the math (thank goodness for calculators!), I'm able to achieve better control. Most days ;-)

It’s like the frog in the slowly heating cooking pot, right?!

I'd change the equation, in my case to value + recent IOB, activity, meal history + planned activity.

I still have low symptoms--but they tend to be less the sweaty, shaky symptoms of my youth and more the "I feel tired," which can also be attributed to my job, my family, my cats, etc., etc.

Some of this is due to age, some is due to the glucose levels at which I have lived for 37 years, and some is due to tighter control--I can slip just a few points to a low now that I live in a more narrow range, and it can be more difficult to sense a gradual decrease than a rapid one.

The math is certainly a project that is never done! I am still not 100% sure about the 15 minutes only because when I have OCDiabetic attacks (every other day or so…) I will test at 15 and 20 min after the load of carbs and, even if I only have 7 or 10, the BG still seems to be climbing at the second test, five minutes later? I try to wait it out a bit longer than the 15 min mostly for that reason?

I had a low this weekend on a long walk (56) took 15g of glucose tabs and 15 minutes later I was 57. I waited another 15 minutes and I was up to 84 and had climbed to 120 about an hour later. I always try to wait more than 15 minutes because this pattern is pretty typical for me.

Maurie

My endo sugguested i treat for anything below 80 but i do have really bad hypoglycemia unawareness. I remember that i blacked out driving at 50 according the the emt test kit. I tend to be really careful when im low because i really get confused and disoriented quickly. I guess thats why i treat lows sooner.

Yet another “your mileage may vary,” which pretty much sums up diabetes!

I am still continually challenged by post-run highs. I’m sure that it’s a question of timing as when the CGM gets low and I’m exercising, it seems to stay lower perhaps than it should be. Unfortunately, it’s too cold around here these days to use a meter out on the route so I am stuck guessing and trying to hold off on the carbs. Oh well, the now melted and spring is in the air, in 4 or 5 months? brrr

I’ve been down to 32 without losing consciousness or the awareness that I needed to do something. But I don’t recommend that as a habit!
I just had a 58 about an hour ago, and didn’t really feel it, but I have a CGM which beeped at me. I think CGMs are a REALLY good idea for the hypo unaware – for me it’s a luxury, in a way, but a good thing in another way, since I live alone, and there’s no one to take care of me if I did go unconscious (which has never happened, so far, thank goodness!)