What are so bad about hypos?

[mhall812]

I sustain a level of about 90 all day. Sometimes my sugar goes into the 50's and I just pop a glucose tab or eat some fruit.

I have been reading on here that if you are acheiving low numbers, but getting lows it is bad. Why? It just makes me a little sweaty and and shaky then I am fine once the carbs kick in.

[fgummett]

I think of my body like a house-plant: given just the right amount of light, water, soil, food, temperature etc... and it will grow and thrive, but change any of those - too much heat, or too little water for example -- and my leaves wither up and drop off :eek:

Normal BG is within a specified range, any excursion outside (above or below) that range is detrimental to health. Imagine the strain on your body if you had a fever (temperature above normal range) every afternoon. Plus a severe enough hypo can cause loss of consciousness and death...

[Scratch]

The biggest difficulty is that over time the body will acclimate and many of us who have diabetes for a long time lose ability to sense hypos some to varying degrees. Which means that while now you might be able to feel yourself down in the 50s, some years from now it could be the 40s. If your blood sugar is up in the 50s, there is no risk of passing out. But eventually there is threshold where consciousness can be lost.

[Mich]

Oh MY GOSH, Frank. I'm going to keep an eye on my leaves from here on out! ;)

Mich

[notme]

Keeping your blood sugar in a low normal range is great. Hypo's can happen at very inopportune times. It can happen while you are driving.

Over time, I have found I feel lows much less until they are dangerously low. I used to get a bit sweaty and shaky, now I don't feel them until I am close to losing consciousness. The lower you tend to keep your blood sugars, the more your body acclimates to those low numbers and you will be very low before you notice, if you notice at all.

Once I have a low in the 30's or 20's, I am quite weak and tired for the rest of the day.

[Gary_W]

Diabetes is all about baselines - it is amazing how quickly your body gets used to being at a certain BG level, and anything that differs from that level feels odd. This is the reason why there are millions of folks out there with undiagnosed T2 running BG readings of 200-300 who don't notice because that's just how they feel...

Equally, on the low end, you can get used to running low so you notice them less. You will get to a certain level whereby your motor functions and powers of reasoning let you down. It is your motor functions and ability to reason that enable you to treat your own hypos safely and to therefore live an entirely independant life with this condition. If you get to a state where you cannot see them coming then it stops you driving and also limits a whole bunch of lifestyle choices (e.g. childcare, certain work situations etc) so keeping hypo awareness is vital for us all.

I'm with you that most hypos aren't too bad - a bit of woozieness and shaking, but a cup of sweet tea (or whatever your tipple is) and 15 mins and you are right as rain. But keep in mind that this minor inconvenience (that's what they are to me) can become a life-changing event if your brain can't see them coming and persuade you to have that cup of tea before it's too late. Sailing close to the wind is great from a 'numbers' point of view, but does increase the risk of hypo awareness going.

I have been at this for 13 / 14 years now and so far I have been fortunate; whilst I've had some very unpleasant hypos, I have never ever had one that I couldn't self-treat. As I have young children that I sometimes look after alone and I have a job that involves hours alone in a car, I really cannot afford for this to change. Whilst I like the low HBA1c levels, I know the risks of staying 'too low' in terms of my daily quality of life. I cannot sacrifice daily quality of life now for an extra year when I'm 80 (and as my HBA1c is <6 anyway that's unproven). That's my lifestyle choice, YMMV ;)

[TommyC1]

While driving or operating machinery, hypos can be deadly. Not much different from operating under the influence of drugs or alcohol.
If you lose your awareness you may well be down in the 20's or worse before you realize it. Or you may not realize it until someone brings you back.
Severe hypos can result in seizures and even coma ala Sunny Von Bulo.
I was taken to the hospital from work once and visited by the EMT's in my bedroom several times. Not to mention the times my wife managed to get some OJ down my throat.
I was very concerned that I might lose my job and my drivers licence last year before I got off of the NPH.
Since then I have not had any bad hypos but I'm wary. If I lose my awareness again I will be very scared.

Tommy

[Maddogg]

The biggest difficulty is that over time the body will acclimate and many of us who have diabetes for a long time lose ability to sense hypos some to varying degrees. Which means that while now you might be able to feel yourself down in the 50s, some years from now it could be the 40s. If your blood sugar is up in the 50s, there is no risk of passing out. But eventually there is threshold where consciousness can be lost.


So true about the body getting used to hypos! I can't even feel hypos until I get to 2.5 mmol/L or lower (<45), sometimes I'll go as low as 0.9mmol/L (<16) before I actually feel any symptoms at all! :eek: It worries me because I can function normally, I can work and drive and do all my other regular activities when I'm hypoglycemic between 1-2.5mmol (18-45). However, I can't maintain a solid erection when I'm that low!

[BlueSky]

... I can work and drive and do all my other regular activities when I'm hypoglycemic between 1-2.5mmol (18-45). However, I can't maintain a solid erection when I'm that low!
Well, thats a good reason to stop doing it then ... :D . But more seriously, in animal studies neurons were found to die off if BG stays below 1 mmol/l for more than an hour. That probably doesn't happen to a lot of us. But more of a concern is that neurons die off in even bigger numbers when the hypo is corrected. Apparently the surge in glucose causes oxidative stress, that results in brain damage. So even if you don't feel the hypos, it is a good idea to avoid them.

[xMenace]

So true about the body getting used to hypos! I can't even feel hypos until I get to 2.5 mmol/L or lower (<45), sometimes I'll go as low as 0.9mmol/L (<16) before I actually feel any symptoms at all! :eek: It worries me because I can function normally, I can work and drive and do all my other regular activities when I'm hypoglycemic between 1-2.5mmol (18-45). However, I can't maintain a solid erection when I'm that low!

I've driven in Montreal more than once. Me with a severe hypo would fit right in :eek:

[Maddogg]

Well, thats a good reason to stop doing it then ... :D . But more seriously, in animal studies neurons were found to die off if BG stays below 1 mmol/l for more than an hour. That probably doesn't happen to a lot of us. But more of a concern is that neurons die off in even bigger numbers when the hypo is corrected. Apparently the surge in glucose causes oxidative stress, that results in brain damage. So even if you don't feel the hypos, it is a good idea to avoid them.


I was aware about the brain damage from hypos; but I wasn't aware that neurons die off in even greater numbers when the hypo is corrected! :eek:

I'm sure it does not help that since I've been type 1 diabetic (for 8 years now) I've been given 4 shots of glucagon, and one of those incidents, the paramedics had to give me 2 shots of glucagon in a 10 minute span because the first one wasn't enough... :eek: Yeah... not good! No wonder my brain always feels dumber and slower after these types of episodes lol.

[soso]

Well, thats a good reason to stop doing it then ... :D . But more seriously, in animal studies neurons were found to die off if BG stays below 1 mmol/l for more than an hour. That probably doesn't happen to a lot of us. But more of a concern is that neurons die off in even bigger numbers when the hypo is corrected. Apparently the surge in glucose causes oxidative stress, that results in brain damage. So even if you don't feel the hypos, it is a good idea to avoid them.

Does that apply to any hypo under 3.8 or just hypo's that are very low?

[Lizzie G]

Diabetes is all about baselines - it is amazing how quickly your body gets used to being at a certain BG level, and anything that differs from that level feels odd. This is the reason why there are millions of folks out there with undiagnosed T2 running BG readings of 200-300 who don't notice because that's just how they feel...

Equally, on the low end, you can get used to running low so you notice them less. You will get to a certain level whereby your motor functions and powers of reasoning let you down. It is your motor functions and ability to reason that enable you to treat your own hypos safely and to therefore live an entirely independant life with this condition. If you get to a state where you cannot see them coming then it stops you driving and also limits a whole bunch of lifestyle choices (e.g. childcare, certain work situations etc) so keeping hypo awareness is vital for us all.

I'm with you that most hypos aren't too bad - a bit of woozieness and shaking, but a cup of sweet tea (or whatever your tipple is) and 15 mins and you are right as rain. But keep in mind that this minor inconvenience (that's what they are to me) can become a life-changing event if your brain can't see them coming and persuade you to have that cup of tea before it's too late. Sailing close to the wind is great from a 'numbers' point of view, but does increase the risk of hypo awareness going.

I have been at this for 13 / 14 years now and so far I have been fortunate; whilst I've had some very unpleasant hypos, I have never ever had one that I couldn't self-treat. As I have young children that I sometimes look after alone and I have a job that involves hours alone in a car, I really cannot afford for this to change. Whilst I like the low HBA1c levels, I know the risks of staying 'too low' in terms of my daily quality of life. I cannot sacrifice daily quality of life now for an extra year when I'm 80 (and as my HBA1c is <6 anyway that's unproven). That's my lifestyle choice, YMMV ;)

Hi Gary

I think I started a thread a while back about hypo inawareness and whether it was a factor of time or frequency of hypos; i dont know if you read that one but i was bascially trying to establish whether if you maintain a status quo with no, or very few very minor hypos you will ever lose your hypos awareness? Im lucky enough to run HbA1C between 6 and 6.5% with no hypos (in 2 years I can count the times I dipped below 4 on one hand, im extremely cautious about insulin on board etc etc and it seems to work for me and hopefully will go a little lower when i get my pump)....anyhow, currently my threshold seems to be that i can 'feel it' if im going below 5, not yet shaky but i know im going lower, below 4.5 i feel a little shaky. below 4 i feel out of sorts. anyhow, if i maintain this kind of balance will i ever lose hypos awareness do you think? you say you have done 14 or 15 years, sounds pretty good going?!

Liz

[BlueSky]

My considered opinion is that hypo awareness will happen over time, whether the counter-regulatory system has been overstimulated or not. This what research has found :

... 25% of the diabetic patients are unaware of hypoglycemic episodes and this impairment increases with duration of diabetes. 50% of diabetics with a disease of more than 20 years duration have some degree of impaired awareness and are more prone to develop severe hypoglycemia. ...

There is a big increase in hypo-awareness in long term diabetics. People who have had diabetes for 20+ years. For me, hypo-unawareness was not a problem for the first 20 years. But I now often don't feel anything until BG gets below 2 mmol/l. And no matter what I do, I don't seem to be able to regain that hypo awareness.

Desensitization from overstimulation of response mechanisms is usually very quick. It doesn't take 20 years. There must be something else going on.

[BlueSky]

Does that apply to any hypo under 3.8 or just hypo's that are very low?
This was observed in animal studies, and the hypos were apparently deep enough to cause coma. Here is an article (http://www.rssdi.org/2002_jan-mar/review2.pdf) about the study. They don't speculate on the effects of treating a milder hypo. Presumably similar principl;es would apply.

"This study tells us for the first time that, in rats, the brain damage occurs not during the coma, but after it, when we give them glucose and their blood glucose levels return to normal," principal investigator Dr. Raymond A. Swanson, chief of the neurology and rehabilitation service at the veterans' center, said in a prepared statement.

He and his colleagues also identified how the brain damage occurs. The sudden return of glucose to the brain activates the enzyme NADPH oxidase, which triggers a process of oxidative stress that kills neurons.

The study is published in the April issue of the Journal of Clinical Investigation.

"The rats could remain hypoglycemic without evidence of significant oxidative stress for at least 60 minutes. It was only when we gave them glucose to reverse the hypoglycemia that the oxidative stress occurred. This was a real surprise," said Swanson, who is also professor and vice chairman of neurology at the University of California, San Francisco.

[IrishJoe]

Interesting... I will have to get them to remove my brain before bringing me out of a coma :D

But in all seriousness hypos cause a stress to the body and also you release adrenaline and other fight/flight hormones doing that 2x per day 7 days per week is not good for you at all!

[Gary_W]

Hi Gary

I think I started a thread a while back about hypo inawareness and whether it was a factor of time or frequency of hypos; i dont know if you read that one but i was bascially trying to establish whether if you maintain a status quo with no, or very few very minor hypos you will ever lose your hypos awareness? Im lucky enough to run HbA1C between 6 and 6.5% with no hypos (in 2 years I can count the times I dipped below 4 on one hand, im extremely cautious about insulin on board etc etc and it seems to work for me and hopefully will go a little lower when i get my pump)....anyhow, currently my threshold seems to be that i can 'feel it' if im going below 5, not yet shaky but i know im going lower, below 4.5 i feel a little shaky. below 4 i feel out of sorts. anyhow, if i maintain this kind of balance will i ever lose hypos awareness do you think? you say you have done 14 or 15 years, sounds pretty good going?!

Liz

Hi Liz,

As BlueSky says below, it seems common for folks to become rather less hypo aware as time goes on, but as with everything in this disease treatments move on so fast so it's not always sensible to extrapolate the past... I don't think I'm any less sensitive to hypos now than I was and I hope it continues, but I can't say what the future brings unfortunately.

When I was first diagnosed, my fasting BG was 20 odd and a PP test gave a 28 IIRC (memory going due to all the hypos ;) ). I know when I started on insulin, the first hypo I ever had was a blood glucose of about 7 (126). I was told I was being silly, as hypos were below 4 but I had all the symptoms and I know now from experience that my body was indeed experiencing a hypo. A hypo IMO is a level below what your body is used to that causes symptoms, it's not a set number.

If you are used to running really, really high then you get hypo symptoms (the shakes and sweats) higher up the scale. My brother's prefered baseline is a BG of 8-10 all the time (140-180 odd). He feels hypo when he is 5-6. Me, I generally feel them at a 3 - 3.5, though sometimes I feel a bit odd at a 4.5 and occasionally I'll dip into the high 2's before I know about it. In all cases, I've still got enough about me at that point to sort it out, and that's the main thing for me right now...

[TommyC1]

My considered opinion is that hypo awareness will happen over time, whether the counter-regulatory system has been overstimulated or not. This what research has found :


There is a big increase in hypo-awareness in long term diabetics. People who have had diabetes for 20+ years. For me, hypo-unawareness was not a problem for the first 20 years. But I now often don't feel anything until BG gets below 2 mmol/l. And no matter what I do, I don't seem to be able to regain that hypo awareness.

Desensitization from overstimulation of response mechanisms is usually very quick. It doesn't take 20 years. There must be something else going on.

After 14 years flirtng with disaster, I was VERY hypo-UNaware. Last year, when I switched from a steady dose of NPH to MDI, I had far fewer hypos and, after a few weeks, my hypoawareness came back.
I have heard other, anecdotal cases where folks have regained awareness by staying out of the danger zone (below 70).
For me at least, it makes sense to do everything I can to avoid hypos and maintain my awareness while still trying to keep my numbers low enough to stave off complications.
From what BlueSky is saying I may lose it eventualy regardless. But in the meantime I'll hang on to every trick I can find.
Feels a bit like a highwire act.:eek:

Tommy

[Scratch]

The problem with the historical dataset of type 1 diabetics is that we really don't know too much about the quality of their blood sugar control and that for many years the treatment program was shoot up insulin and feed the insulin. It's very likely those diabetics had blood sugars all over the place and over time the body's ability to sense being out of normal glycemic range will degrade.

I've had 2 pass-out hypos in my life, 2003 and 2006. About a month after the 2006 one, I switched to basal/bolus through MDI. My blood sugar control is now excellent and I have had some restoration of hypo awareness, although it is nothing like back in the late 1980s when I could feel them easily with how my heart would begin to pound and I would feel dizzy.

Now I have to be alert for more subtle signs -- just a sense of feeling off or that my thoughts are becoming stuck are a couple of those.

Oh well. I hope I never have another pass-out hypo again. I like to hope that I can retain the symptoms I've regained with better control the past 2.5 years.