Hypo unawareness
Hello! Random question. I have greatly improved by HbA1c over the last few years to the point that I am now consistently under 7 and generally under 6. I have been really excited about this. I don't have a lot of swings, but I do have more frequent low bloodsugars that I did a few years ago. My concern is this: I often don't "feel" low now until I am in the 50s or 40s. Sometimes I am actually really surprised to see how low I am when I felt fine. I VERY THANKFULLY have a CGM, so am able to catch these lows a lot when I otherwise wouldn't have thought I had one. However, has anyone else had this happen? How do you deal with it? What are some safety precautions you take, if any? I am a little nervous about this because I recently got dumped by my long-term boyfriend with whom I had lived for years and now live alone. I am not looking to increase my HbA1c, but would appreciate feedback on how people at this HbA1c level handle things generally. Thanks so much for any help!
Replies to This Discussion
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Permalink Reply by Marie B on -
lots of people here are hypo unaware. good thing you have the CGMS. here is a discussion with some tips on living alone with d. (sorry about getting dumped)
http://www.tudiabetes.org/forum/topics/583967:Topic:170338
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Permalink Reply by Leo2 on -
Esjay,
I've been there, done that. And I think there's nothing like a CGM round the clock when living alone. Especially since you can set your alerts where you want.
I got rid of hypo unawareness by raising my average. I keep it under 110 but above 90. I take glucose tabs when below 70, and for my weight, 1/2 of a tablet raises me 13 mgdl. It pays to test it out and get it exact.
The only way I could raise my average without those downward spikes, however, was by eating smaller amounts of carb and being absolutely right on with the I:C ratio. The only way to get to the I:C ratios which fluctuate through the day, was to eat the same food at different times of the day.
I started with 6 grams at breakfast, 12 grams at noon and 12 grams at supper. After I had those so I couldn't make an error with too much insulin, I added other foods and kept working at cutting out things that spiked me upward, since then I have a great tendency to tamp down, and tho I work out proportions of my dose that may still be on board, I had to even figure that more exactly. I stay at 5.3-5.9 a1c and do not get lows below 59.
Best wishes. I guess I would say Congratulations on the a1c. Don't target being in the 70s or 80s. Raise your target but stay close so your standard deviation comes down and you rest about 100. You will then start shaking at 70 and feel it. It's a good feeling!
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Permalink Reply by Leo2 on
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Esjay,
I came back to urge you to get out of hypo unawareness as soon as you can. I decided I had not done my best in my last post to say this. It is important. All you need is for the CGM to be off you to deliver this message in a 911 way. You CAN have your a1c but you MUST set your average a bit higher to get out of it. With the sd not varying widely, you'll still have an a1c below or around 6.
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Permalink Reply by MissKitka on -
Any diab who lives alone should test at least one or two points A1c higher than others. This is only sane and logical. Any doctor who does not agree with this should be replaced in my opinion. This goes double for people under 20 years old who are active at a moment's notice. I spent half my time, under 12 years old, on the sidewalk in convulsions.
Being comfortable and confident is worth much more than making any doctor happy, You are the important one, and you should be happy, to hell with the rest. Tell your doctor what you plan to do and then do it..
In other groups I have described what I did in order to sense BG, I used to write down what I thought and then test. After 10 years of this I was able to tell what I was within one point. I use 2 test strips a month now. I always know where I am now.
Don
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Permalink Reply by barbraann on -
I've been hypo unaware for years. Only recently with the Dexcom can I catch them early. But they still happen. This morning I was 37 while at work. (My Dex was off by quite a bit) Thought I didn't quite feel right. No longer the sweats and shaky but maybe a headache or tired or nauseous or just "not right". Problem is by the time I've figured it out the current symptom, something else begins. The best advice is use your CGM to avoid the extreme lows and test, test, test! I don't want to sacrifice my A1c either but hopefully you won't have to. Try to learn the signals (there can be a huge assortment) My A1c's have always been in the high 5's and I'm hoping to keep it there by keeping a close reign on things.
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Permalink Reply by Betty J on
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I too at times have hypo unaware, I don't have a CGM but have used one temparily. I have learned to do several things to help from getting low. I test quite often; I also adjusted my insulin to carb ratio because when I would get lows it was either right after eating or 2 hours after eating: I also adjusted my sensitivity to insulin. All of these things are features on my pump which also helped to avoid some of those fallouts I use to have years ago.
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Permalink Reply by Brian (bsc) on
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Researchers at the University of Virginia developed a system to help with hypo unawareness (http://care.diabetesjournals.org/content/24/4/637.full). The system is based on the idea that your body will react to hypos in a whole variety of ways, not just the "classic" symptoms of sweaty, clammy nervousness that everyone always associated with hypos. Rather, many people have little things that they may not notice, but with training can become clear indicators of hypos. Some of these include things like changes in taste and perception, twinges in your leg. The training has you log symptoms and then through careful correlation, identify the symptoms which are indicative of a hypo. Then, when you detect these symptoms, you can be much more effective in recognizing an oncoming hypo, test and take action. The researchers found that even for people who are severely hypo unaware, these other types of detectable symptoms were often still present and recognizable.
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@bs7 Through the years I have found that little signals do exist that warn I'm hypo. Sometimes one of my signals can be a thought I have that seems strange other times it might be a pain in my legs. I have learned to depend on these signals to warn me even though I test constantly. If I haven't had a hypo in a few weeks I will experience the normal hypo symptoms proving what my educator said is true.
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Permalink Reply by barbraann on
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Interesting to hear. I've thought that was the case. I agree, there can be very, very subtle suggestions that you're low. Many times it's just a "somethings wrong" feeling.
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Permalink Reply by Brian (bsc) on
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Sometimes it is not that they are subtle, but that you have to look for them. For one thing your thinking get's muddled. Many people will find that their ability to perform basic thinking tasks is markedly impaired. Time yourself adding two three digit numbers in your head, many people can do this task in a couple seconds, if you are having a hypo you may well take a lot longer and may not be able to perform the task at all. Give this a try a couple times at a normal blood sugar and then try it a couple times when you know you are low (not real low).
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Permalink Reply by MissKitka on
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Until I came here I never heard of a CGM. I sure could have used something like that as a kid in the early 60s. I am very fortunate that I can sense my BG at any moment and only have to test with a strip 2 times a month.
Living alone means having to have higher A1cs for safety. Don't worry though, I know many diabs who test in the 8s and are in their 60s and 70s with type one from childhood and are complication free and lead active lives. They are people that provide me with motivation to carry forward as I am in my 50s.
Don
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Permalink Reply by Matt on -
Unfortunately the more lows you suffer, the less likely symptoms are to occur. Your body gets used to being low, and scales back stress and hormonal responses as it thinks these lows represent homeostasis. The best way to become aware of lows is to have less of them. Easy advice to spout, right? Personally, keeping glued to my Dexcom and fingerstick testing more frequently are the only tactics that work for me. I rolled out of bed this morning, got ready for the gym, and checked my bg's, only to realize that I was 54! Sometimes Type-1 feels like being on a teeter-totter...
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