I've been a Type 2 for 10+ years. I inject 42 units of insulin each night, and take 1000 mg of metformin twice a day as well as 2 mg of glimeperide at dinner time. In the past, I've felt glucose low's by suddenly perspiring excessively, then shaking, and soon confusion. However, over the last month or so, I've found that my bg is low (60 and below) by random checking - and not feeling them at all. When I reported this to my doc, she said that meters are inaccurate in measuring both highs and lows, and that if I didn't feel the low, then it wasn't low.
My questions are . . . 1) Is it common to stop feeling lows (and highs, for that matter)? 2) Are meters actually inaccurate in measuring highs and lows? 3) If meters are inaccurate at measuring highs and lows, why bother checking your blood at all?
Thanks for any insight any of you can share.
Time for a new doctor? Many of us lose the ability to feel our lows over time. And others who still can feel their lows depend on much more subtle signals than shaking and perspiration,
Meters can be 20% off which means that if you test and get a 200 you might be anywhere between 160 and 240. But if you test and get a 50 your blood sugar is in almost cases between 40 and 60. Meters are pretty good at measuring lows and get better as you get lower.
I agree, find a new endo. That's baloney. It's called hypoglycemia unawareness, and it does occur to a lot of us over time. Also you might be having "lows" more frequently than you are aware, and your body is gradually getting used to them. But regardless of how you are becoming unaware you are, and your Dr's lack of concern is frightening. Meters while not perfect are pretty reliable over all as Maurie above stated they can be 20% off, but if you test at 50, you can guaranfreakingtee you are DEF low.
My doc isn't an endo. She's a geriatric internist. Do you think I should probably start looking for an endo?
I think you should. You're on insulin plus two other drugs and your internist doesn't seem to have much exposure to patients with lows. Endos treat lows very seriously and that will be appropriate for you especially while you recover from surgery.
I've considered finding a new doc, but I'll soon undergo bariatric surgery, and feel like it's a really bad time to change doctors. On the other hand, I'll need my diabetes medications and insulin monitored closely through the process, and the bariatric surgeons tell you to involve whoever manages your diabetes medications for that aspect of the process. My doc doesn't seem to be interested in doing that, so I fear I'll be on my own anyway. Scary prospect.
Wow if you are undergoing bariatric surgery I'd want someone really on top of my medications and what they are doing. I've heard of type 2's having the surgery and because of the drastic decrease in food intake, quickly having a major reduction in the needs of their medications. Yes yes and yes again, I'd def find a new Dr to be managing my diabetes. Here where I live at, GP's and Internal medicine dr's dont even want to get involved in managing diabetes, its an instant referal to an Endo here, especially if you want to be on Lantus/Levemir/Humalog, etc. And who doesn't want to be on the newer insulins LOL, you really do get better control on them.
The meter accuracy dance is somewhere I am frequently. Though it's a waste of strips, I often test again if I see a really crazy number (like a low, since I never feel my lows). My endo has used that excuse for highs...except meters can be + or - up to 20% and 20% less than 200 is still 160.
Do you test your meter with control solution every time you open a vial of strips? If not, then you should. They make that stuff for a reason!
Some meters are supposed to be more accurate than others. The OneTouch Verio IQ and the Accu-Chek Nano are both supposed to be in the +/- 15% range, which is also not great but it's something. I personally don't find my Nano to be any more accurate than the OneTouch Ultra I had before it.
As for the other part of your question, yes, it is possible to stop feeling lows. Basically, your body burns out the mechanism for bringing your glucose back up when it's low. Part of that mechanism is adrenaline--and adrenaline causes the typical low symptoms. If your body stops responding to low blood sugars, you stop feeling them. I "feel" lows by cognitive impairment--I haven't had a true low symptom in years.
That being said, my endo has also told me to deal with lows by how I feel AND what my meter says. He told me to treat a low between 60 and 80 that I feel, and anything below 60 that I don't. True lows (meaning dangerous) are under 60. I generally treat under 70 regardless, but I'll go for something with a more simple sugar content if I'm in the 70's and feel a little funny.
One last thing--meter accuracy, even with standard meters, is +/- 20%. Erring on the high side of 20% for a reading of 60 is 72, which is borderline low, anyway. The chances are that if you're reading under 60 but you feel fine, you might be low, anyway. I'd re-test a few times to see if your meter gives you the same result again (I find that with meter inaccuracy, the meter doesn't usually throw two false numbers in a row). If your meter doesn't seem to tend to make major mistakes, I'd treat those lows.
I use a FreeStyle Lite meter, which I prefer over the One Touch. I do test it with the control solution, and when I test low (or high) I re-test. Lately, when I read low, I test repeatedly since I begin treating. I'm also finding that it's becoming harder and harder to get my glucose back up - it'll start coming up, and then drop again. I usually treat with glucose tabs, but I have to take so many of them, and it takes so long (while I continue to drop lower and lower) that I've switched to drinking a regular cola to get it back up. A 1/2 cup of that doesn't even seem to be effective, and I often need 8 oz. A week or so ago, I "discovered" a low (60) and started treating (and testing my blood every 15 minutes or so) and my bg got down into the lower 50's - began to rise, and got up to the lower 70's - but then fell steadily again back into the lower 50's. I was beginning to panic.
If you are beginning to have frequent and especially persistent lows you might need to adjust your medications. I'm Type 1 so I can't provide that much help but when I start having trouble with lows, I start to cut back on my insulin.
Have you thought you might have some gastroparesis issues? I have symptoms like that when my gastroparesis is acting up. I drop VERY fast and have the hardest time bringing it back up. I knew I was in danger the other night, and I knew as fast as I was dropping, and popping glucose tabs and NOTHING was happening, so I did the next best thing, even though I was still responsive, I knew at the rate I was dropping I wouldn't be, so I broke out the glucagon and shot up. I sucks but hey do what u have to do, beats a 911 call and a trip to the ER. I'm obviously going to have to get back on Reglan, and I have been dual waving a LOT of my boluses lately. Have apt with Gastro first of March.
Also if your not seeing an Endo, I highly recommend u do, I think a lot of GP's are clueless to managing diabetes. They are stuck in old school ways of treating, and don't seem to be very aggressive in treating either. If your doc is an Endo, then I recommend finding a new one.
I assume the 42 units you take at night is something like Lantus or Levemir? A lot of people find it helpful to split the dose. Take half in the AM and half at night. Even though these insulins are supposed to be flat, they aren't and they can and do cause lows. But I really think you'd benefit in finding a DR more up on diabetes management.
The insulin I take is Lantus - 42 units at bedtime. I may have a surgery date this week, so the time for finding an Endo and actually getting in to see him or her is short. I have peripheral neuropathy, and some symptoms of gastroparesis, but when my doc first mentioned that possibility, she was clearly not wanting to explore it any further. I definitely had the feeling that she wouldn't be comfortable treating it. I've suggested several times that I may need to see the gastro who does my colonoscopies, but each time she's discouraged me. Troughout this journey towards the bariatric surgery, I've encountered SO many medical professionals that are clueless about diabetes. One cardiologist told me not to worry about high bg "because it always comes back down." He's the same one who told me to carry a Gatorade in each hand (like weights) when I exercise, and that if my bg went up or down, to drink them. I went to another cardiologist. A dietition told me to snack on fruit because "natural sugars won't make your blood sugar go up." But then, she's the same one that told me not to worry about eating too much salt - because there's no calories in salt - and that I should exercise less, and that I wasn't eating enough. I guess SOMEBODY has to graduate at the bottom of the class.
After years of being able to keep my bg pretty much in line, lately they've just been all over the place. I don't think metformin is doing anything at all anymore, and I'm just feeling overwhelmed, I guess. The major reason I'm pursuing bariatric surgery is to get my diabetes either into remission, or back under control.
I sure don't see how T1's deal with it. It's all so complicated. Just when I think I've 'got it' - something new pops up!
I in my personal opinion of other's I've seen on metformin, I think its a nasty drug. Works well in the beginning, but tends to give out. Personally I don't think they treat type 2 aggressively enough. They let type 2's go a VERY long time with exceedingly high blood sugars before starting insulin, and then they seem to have them on some old school sliding scale method of dosing. Kinda crazy.