How many Hypos a week is acceptable?

[mazea]

I was wondering how many hypos on average people think is acceptable before they would consider lowering their insulin?

I have on average 1 a day for a week of about 3.2 when my Levemir/novorapid is going through change period and 2 hypos a week of 3.5mmol or less when my Levemir/novorapid is stable(which it can be for 3 weeks at a time). Do you think my blood sugar control would be a bit too controlled?

[viranth]

If I'd go under 4 every day, I'd consider changing the dosages. Being in tight control, is good, but it also removes your ability to feel lows.

I could feel lows much better just a few months ago, now I don't really feel anything at all. So be careful!

[Lizzie G]

id have to agree with viranth on that one. losing hypo sensitivity is definitely something you dont want to do, and along with that come all sorts of safety issues, particularly with driving and so on. when i first started pumping i was having quite a few hypos whilst i got things sorted out, and i really hated that feeling that i could be a danger to myself or other people if i wasnt careful....i feel a lot better in myself now knowing that the likelihood of having a problem when driving or doing sport is so much less.

[strack350]

as I am trying to get my basal bolus schedules tuned in I drop in the 50s about once every two days. It was a couple times a day when I just started levemir. I feel It's getting better:D Every once in a while I'll bolus too much and drop to the 30s, but those times are rare now compared to my old NPH, and I feel them coming on better now also.:confused:

[Delphinus]

Since January, I have had two mild hypos, and one I would consider not to be mild. So three total.

All three were the result of extra physical activity on those days. Had I not been doing alot more on those days, I would have been fine.

I am fairly conservative when I bolus, but I still get the desired ranges.

I am sure as time goes by, I will experience some form of insulin resistance, and will end up bolusing amounts I am not accustomed to, and over do it.

[DanG]

The majority of my lows arrive when I wake up. I can count on being at 60 about 3 times each week at wake up. That really is not a problem, as all insulin is out of my body by the time I wake up, as I do my lantus in the morning, and all the humalog is gone by the time I go to bed. Low blood sugar seems acceptable at wake time since there is really nothing to make it stay there or drop further.

The other time I get hypo is on weekends - well, on my extra weekend day off as the work schedule has been cut for the past 8 months due to the ekonomy. I eat breakfast and then do not do the humalog until at least an hour later - the extra activity of walking the grocery store to shop for the week's groceries must be just enough with the usual humalog to put me a tad low - never low enough to fall over, but low enough to know I am low - ya know what I mean? The vision gets to seeing white clouds, but I am still lucid.

[sable_032592]

there was one week when i had 12 lows... i think it was the worst week i'd ever had... anytime i go under 4.5 (81), i start to feel funny, but that week i was under 3 (54) at each low...

[Lizzie G]

The majority of my lows arrive when I wake up. I can count on being at 60 about 3 times each week at wake up. That really is not a problem, as all insulin is out of my body by the time I wake up, as I do my lantus in the morning, and all the humalog is gone by the time I go to bed. Low blood sugar seems acceptable at wake time since there is really nothing to make it stay there or drop further.

The other time I get hypo is on weekends - well, on my extra weekend day off as the work schedule has been cut for the past 8 months due to the ekonomy. I eat breakfast and then do not do the humalog until at least an hour later - the extra activity of walking the grocery store to shop for the week's groceries must be just enough with the usual humalog to put me a tad low - never low enough to fall over, but low enough to know I am low - ya know what I mean? The vision gets to seeing white clouds, but I am still lucid.

i tend to run a lower basal on the weekends, the stress of work is definitely the reason for me

[Ray4Rick]

I would think that even 1 low would be unacceptable. My problem with low's is that I over treat them shooting my BG higher than I want it. So bring down your insulin that is causing the low's.

[Subby]

I was wondering how many hypos on average people think is acceptable before they would consider lowering their insulin?

I have on average 1 a day for a week of about 3.2 when my Levemir/novorapid is going through change period and 2 hypos a week of 3.5mmol or less when my Levemir/novorapid is stable(which it can be for 3 weeks at a time). Do you think my blood sugar control would be a bit too controlled?

What do you mean by "change period" and the insulin being "stable"? You mean you go through cycles with your body?

If I was getting around or below 5s for A1cs, but getting those daily hypos, I'd be trying to adjust a little, myself, potentially trade in a few decimal points for stability.

[Lizzie G]

What do you mean by "change period" and the insulin being "stable"? You mean you go through cycles with your body?

If I was getting around or below 5s for A1cs, but getting those daily hypos, I'd be trying to adjust a little, myself, potentially trade in a few decimal points for stability.

i think the change period thing is probably to do with being pregnant?

[Subby]

Aha... that would probably be it. Sometime I must learn about what happens with diabetes and pregnancy - not that I'll need the info for myself - but it sounds like quite a whacky time.

[mazea]

Subby, I guess what I mean with a change period is the eg below where my basal insulin changes every 12 hours for 15 days. I'm not sure what else to call it - a Levemir insulin depletion and remission cycle? because I am type 1.5. My doc says that I go through periods of insulin resistance and doesn't recognise type 1.5 only recognises me as type 1. I don't think I can have insulin resistance but he and I can disagree on that. I went through these change periods last year when I wasn't pregnant so it isn't a pregnancy phenomenon I don't think. I have a lot of hypos when my insulin goes through this change period because I am guessing how much insulin to take as it changes every 12 hours and often I am out by a 1 unit of Levemir during this change period.

Pregnancy seems to have a little effect on my blood sugars. Pregnancy may be increasing the amount of insulin depletion remission cycles I have had in the last 5 months. I had many insulin remission cycles last year when I wasn't pregnant. I have also had some strange drops in pregnancy not attributable to anything like a drop from 7.0 to 1.5mmol for no reason one day. And these odd drops have not happened the next day.

I am not taking much insulin, it doesn't mean that I don't have a need insulin I can rise quite quickly to 19mmol or more if I don't take insulin. My doses are low because I am insulin sensitive.

Eg of change period/ insulin remission depletion cycle
day 0 started off on 2 units Levemir a day which was the same dose for the last 6 weeks. Novorapid stayed the same pretty much.
day 1 took dose up 1/4 unit
day 2: took dose up half a unit
day 3 up 1/2 unit Levemir
day 3 took dose up 3/4 unit Levemir
day 4 took dose up a 1/4 unit Levemir
day 5 took dose up 1 unit Levemir
cold/flu start and my insulin on
day 6 dose went up 2 1/4 units Levemir
day 7 dose went up 4 1/4 units Levemir
day 8 dose went up 3 1/4 units Levemir
cold/flu ended
day 9 dose went down 1/2 unit Levemir
day 10 dose went down 1/4 Levemir
day 11 dose went down 1 1/4 units
day 12 down 1 3/4 Levemir
day 13 down 3/4 unit Levemir
day 14 up a 1/4 unit Levemir (finetuning)
day 15 up 1/4 unit Levemir (finetuning)
I am now taking 10 1/2 units Levemir a day. The last time I was at 10 1/4 units of Levemir was 27 weeks ago and I was stable on the 10 1/4 units of Levemir for 13 weeks.

This happens every few months for novorapid dose too at a different time. The good news is that that one drops my novorapid in half not in 15 days, but over 4 hours and I have dropped to 1.3 mmol for 2 hours after lunch when the novorapid changes. It is like having twice as much insulin as you should for a meal and seeing what happens.:D

I had bad hypos day 11 (which I corrected) of 3.4 at 7.00am, 2.4 at 10.00am, 2.1mmol at 4.00pm and 2.4 at 6pm and 2.5 at 6.30. I guess I didn't guess on reduce my basal enough on day 11 which caused all the hypos. Guessing is all I have been doing to fix the problem. I fixed the hypos that day at night time by having a 30g fat meal. I had a cheese toasted sandwhich with 2 pieces of cheese and 200g icecream. The fat in this meal made my blood sugar rise that night helping me to get through the night and have some sleep( 30g fat raises my basal rate for 20 hours after the meal.) And I set my alarm 5 times that night to get up and check.:)

[mazea]

I figured out how to increase by Levemir by guessing. I find out how much my blood sugar rises in 2 hours. If my blood sugar rises 1/2 mmol in 2 hours I increased my Levemir by 1/4 unit Levemir. If my blood sugar rises 2 mmol in 2 hours I increased my Levemir by 1 unit. If my blood sugar rose 3 1/2 mmol points in 2 hours, I increased my Levemir by 1 1/2 units. Really I'm just guessing though.:o Then I did a basal test at night to finetune it.

[gettingby]

By my endo's standards, more than one is too many. He almost went through the roof the last time I was there. 9 hypos (below 60) in 2 weeks.

[lark 27]

By my endo's standards, more than one is too many. He almost went through the roof the last time I was there. 9 hypos (below 60) in 2 weeks.

My guess would be that your endo isn't a diabetic himself. It's lovely to go with a textbook statement that you should not have a hypo, but in reality they will happen.

Of course if there are circumstances where you are not able to safely recognize/deal with a hypo (very young, very old, etc.) then target ranges need to be raised, but then you'll be sacrificing a low A1C.

I like the original question post of how many hypos and appreciate that you indicated 9 in 2 weeks, as I look back at my results from my meter I've got 5 in the last week. 57, 46, 55, 45, 53

[xMenace]

I don't know what's acceptible.

I go below 4.0 about twice a week. I go below 3.0 about once a month. I've had one nasty but not what I'd consider dangerous hypo this year. I needed minor assistance with it, and I was already at the table with dessert in front of me.

[xMenace]

Of course if there are circumstances where you are not able to safely recognize/deal with a hypo (very young, very old, etc.) then target ranges need to be raised, but then you'll be sacrificing a low A1C.

You don't have to be very old to experience hypo-insensitivity. Mine started when I was 34.

I'm not a believer in raising target ranges. There are many things you can and should do before doing this, things to reduce your variances: lowering your carbs, basal tuning, meal profiling, hypo-symptom training, etc.

[fgummett]

I'll probably get in trouble ;) for posting in a Type 1 thread but anyhoo...

Reading John's post above I have to wonder how do you define a "hypo"..? Is it automatically just any reading below 4mmol/l (or 3mmol/l?) even if you have no other symptoms? Of course I realise there is potential danger if someone is hypo-unaware but a single BG reading is only a snapshot... perhaps your BG is already on the way back up? Perhaps the meter just ain't that accurate? Perhaps you didn't get quite the right-sized drop, or some other contaminant on the test strip?

Again -- as a Type 2 -- I would add my vote to eating a higher proportion of fat and protein in real whole foods... I have found my BG to be much more stable and predictable, using a fraction of the insulin I was on before... no more roller-coaster of highs and lows for me.

[It Ain't Over]

I read in Bernstein's book that when a patient tells him that hypos don't bother them much he goes on alert. Over the years he has noticed these are the patients that will head into deep trouble with lows.
After reading that and heeding his advice on diet and proper dosing I lowered my a1c under 6% (5.8) for the first time in 30 years, and have had a lot fewer hypos and they are far from dangerous. I am beginning to return to some ability to recognize them when they start creeping in on me. Not the classic symtoms by any means, but have noticed lately there are definate signs of going low. Have been able to catch them above 60.
His basic teaching can been summed up in the rule of small numbers, less insulin & less food. That works out to less trouble for me. :D

[Delphinus]

I'll probably get in trouble ;) for posting in a Type 1 thread but anyhoo...



Why?

We learn from each other.

I don't care where I post, I am all over the place. :D

The info you typed is as relevant as any other info posted here in this thread.

[fgummett]

Thanks Jason... I tend to agree with your sentiments in general terms but -- even though I have felt the symptoms of a few hypos with too much insulin following too much gym -- I doubt I have even come close to what some of you guys must have gone through with true Type 1 hypos :)

[foxl]

Frank there certainly are type 2's having hypos. I was on glimeprimide for what -- 10 days? And had a few.

[fgummett]

Frank there certainly are type 2's having hypos.Not what I said or meant Linda :) I've also had hypos -- BG below 3mmol/l, shaking, sweaty, panicky, weak, poor coordination etc... that needed rapid treatment with glucose -- but for me, just speaking personally, I don't feel confident to speak authoritatively on the subject.

[mazea]

fgummet I think a lot of type 2's have trouble with hypos. I've heard that when a type 2 has a big meal, too much insulin is released and then 2 hours later causes blood sugar levels to drop too much. Just as justified for posting I think.:)

[xMenace]

Reading John's post above I have to wonder how do you define a "hypo"..? Is it automatically just any reading below 4mmol/l (or 3mmol/l?) even if you have no other symptoms?

It is an interesting question. I have struggled much with it.

Last night I had an interesting hypo. At 1am, about to go to bed, I was 3.0 but feeling fine. A review of my day and evening showed aggressive treatment of dinner, but I found no reason to think I was in any danger of dropping further.

I'd just read the thread on optimal A1C's, so I guess I was hesitant to eat anything and raise my sugars too high. I just left it and postponed bed for half an hour. When I tested again, I was 3.5. Still feeling fine I went to bed and fell right to sleep.

This morning I was 4.1.

I suppose I consider this whole affair a hypo, but I had no symptoms and I didn't treat it.

[lark 27]

.
You don't have to be very old to experience hypo-insensitivity. Mine started when I was 34.

I'm not a believer in raising target ranges. There are many things you can and should do before doing this, things to reduce your variances: lowering your carbs, basal tuning, meal profiling, hypo-symptom training, etc.

And

I suppose I consider this whole affair a hypo, but I had no symptoms and I didn't treat it.

Hey XMenace,
Wanted to respond to a couple of things from you. I hear you about the hypo-insensitivity. I was not well controlled for a while after college and tended to rely too much on low BG experiences to identify my BG level. This of course led to hypo unawareness around age 25 and a seizure episode whilst I was sleeping. That was a "wake up" call for me and tighter control led to the awareness coming back for hypos even while sleeping. However, I'm still unaware of Hypos if I'm working out or just working hard in the yard or something, so in those situations I just have to really monitor and be OK with running at 160 instead of taking insulin to drop down to normal range because it's just safer. I also am not for raising target ranges because even with hypo-unawareness a person can monitor, use cgms, watch diet including reducing carbs, etc. as you mentioned.

Regarding you example of being "low" all night and not feeling the symptoms: Do you think that being in a state like that for that long might contribute further to the hypo insensitivity since your body get's used to being 3.1 and 3.5 (55-63 if I'm converting properly)?

Take good care,
Lark

[Delphinus]

Hey XMenace,
if I'm working out or just working hard in the yard or something, so in those situations I just have to really monitor and be OK with running at 160 instead of taking insulin to drop down to normal range because it's just safer.

Most docs will say to get within range anyway.

I say no.

My experience has been that I only avoid the hypos if I am a little high before partaking in anything that is physically taxing.

If I make a correction, then go out and knock a few Douglas firs down with my hatchet [Dramatization. May not have happened.] , I go too low, and fast.

[lark 27]

Most docs will say to get within range anyway.

I say no.

My experience has been that I only avoid the hypos if I am a little high before partaking in anything that is physically taxing.

If I make a correction, then go out and knock a few Douglas firs down with my hatchet [Dramatization. May not have happened.] , I go too low, and fast.

If i start out at 160 on a run it's going to drop down into range anyway, so I guess in a sense I am medicating for it because if I start higher I might not drop my basal rate, but if I start in range I'll drop my basal rate. So, in a sense that basal dose that I don't change actually is kind of like a bolus. (I guess it's all semantics).

Now this AM was a bad example of how this doesn't work. Last night I had to change my infusion set and when I do this I find that (sometimes but not all the time) my insulin needs will be higher for a while. Of course while sleeping it's hard to note this and I bolused a little extra but don't want to overdo it whilst sleeping. my 2.5 year old daughter woke me up at 415 a.m. and I checked and I was at 208 or something awful like that. My smart pump tells me to take 3.8 units of insulin and I'm thinking that I'll be getting up at 5:20 for my run so I don't want that much and I take 1.3 units. Of course I then ignored my 5:20 alarm since I had just fallen back asleep and didn't get my run in this a.m. and should have just bolused.... cest la vie OK that was a bit of a rambling.