How often hypo?

I’m wondering how often those of you who try to maintain fairly tight control on their numbers go too low? (And then what does “too low” mean, for you?) Especially those of you without a pump who do MDI (but for those w/ pump I’d be happy to hear your thoughts as well). I know 80 is a great number to be at while fasting, but it’s so close to going hypo it’s hard to do (I find).

I try to be 80-110 in between meals and 70-100 overnight, and I don’t even care that much about spiking after meals, as long as I’m maximizing my time in range, but I still have to deal with lows and it’s so annoying, I hate feeling that way. Usually for me the lows are during the day, because I just took too much Humalong for the meal (overnight’s not so much of an issue sincee I go to bed 5-5.5 hrs. after eating dinner, so my numbers are pretty stable at that point.)

Of course I never TRY to take too much Humalog - I keep very careful track and records of all my meals/insulin/#s, and base my insulin dosing on past experience… and still… ugh. I think I’m getting better, there’s just so much variability and it’s such a slow learning curve (10 months into my diagnosis)…

Anyway I’d be happy to hear your thougths…

I should add, b/c I can already hear people freaking out about “70-100 overnight” - no, I do not go to bed with a 70 blood sugar. I just mean that I try to not bottom out below 70 overnight, which hardly ever happens if I’m 100-110 before bed (often I bottom out around 80, sometimes higher), but I also do not want to be much above 100 for eight hours, given the body likes it best at 80 for fasting. So I try to have a good fasting blood sugar overnight, which I think is reasonable (and attainable). Anyway, just wanted to clarify that.

Back when right control first became “a thing” people were bottoming out - I think this was before CGMS to help us track our numbers. Even so, I think we need to be careful about where we set our. If 80 works for you and you don’t have issues functioning that may be fine. But if you have issues frequently going low you might ask a little higher. Of course this is a discussion you should have with your doctor. I use Control IQ to help keep my numbers in range but it’s not perfect and I do go lower than I want sometimes so don’t be afraid to aim a little higher if it will be safer. Again talk with your doctor.

Hello, @BKN480 That is a great question. I recently had to change my Lantus (Basal Insulin) because I was going low overnight. I similarly to you, would go to sleep at about 100-120 and would end up low. I know it is not quite the same, as you said yours were happening during the day. I would not say that I have very tight control. I try to keep a broader range for myself with MDI, but most days I try to get as much in 70-140 as I can. But I feel good anywhere in that range and my doctor has no problems with it. I think it is about where you feel good, so you could try a little higher range for a week or so, if you want, and see how it feels to you. Please talk to your doctor about your concerns as well. I am not trying to give medical advice. It is different for everyone, so I think it is about (1) feeling safe with your blood sugar and (2) seeing how your body feels in your usual range. I definitely feel a little better in the lower side of my range, but I focus on how I feel above my range and below that range. I can feel a change outside of that range. Again, I do not have a very tight range, so for me it is probably a little different.

Yeah I was going lower overnight much more frequently (I hardly ever do now) for a while, when, thanks to Dexcom, I finally understood it was my Lantus, which I lowered (I now take 10 units/day, in the morning, and it keeps me pretty darn stable). My aiming for tight control certainly doesn’t mean I achieve it a huge majority of the time - and if I’m 140, I think, “hey, not too bad”, I just try to get down from there into the 80-100 range as much as I can. Anyway thanks for your good advice!

Thank you for your thoughts!

One thing that was drilled into me when I first became diabetic in 1990 was “better too high than too low.” Going a little high can have cumulative long-term consequences, but even those can be headed off with good overall control. (My A1C hovered in the low 7s for nearly 30 years before I switched to a pump and CGM, and I don’t have any signs of complications yet.) A low, on the other hand, can be an imminent danger, and it can cause permanent brain damage (the same way lack of oxygen can).

For me:

:green_circle:80 is a good threshold.
:yellow_circle:70 is where I’d start to be concerned.
:red_circle:60 is where the symptoms (beyond feeling a little tingly) kick in, and that’s dangerous.

Your body may vary. But 80-120 is a good target. You won’t see much long-term benefit from being 70 instead of 80, but it could put you at risk. Especially since a CGM has a 20% error factor and a time lag. By the time it reads 70, you could well be much lower. I also find that lower blood sugars interfere with my sleep.

Talk it over with your doctor, and consider when you feel symptoms, but I think a slightly higher target might be better.

Thanks for the advice, it is much appreciated

@BKN480 , the lower your average, this higher the possibility of lows. When possibility goes up, usually frequency of occurrence goes up. That’s the main reason the ADA recommendation of 7% hba1c, its because it’s higher than normal blood sugar, but the frequency of lows is more acceptable. For normal glucose, your a1c needs to be below 6%, but that would be an unacceptable exposure to lows, for most people.

I like normal blood sugar 70-100. it’s super narrow, so I don’t get overly excited if I am outside the range. I get below 70 mg/dl 4-8 times a week. I get below 60 less and below 50 even less, but do they happen.

Thanks for the info, and for sharing your own stats - it really helps me put my own numbers in perspective. I guess I’m doing pretty well after all, and that lows at the frequency you mention are just a nuisance that have to be dealt with if you want to keep a lower overall average… thanks again!

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I try to stay between 70-140, but I don’t freak out like i used to when I get up to 150, and even occasionally 180. I just try to bring it down by going for a walk, or if that’s not possible, i might take 1/2 a unit of novolog. After doing this for three years I FINALLY realize there are just too many factors, and I don’t have control over many of them (hormones, stress, the weather, delayed absorption…). I do go too low at times, which for me can be below 50, however, this is mostly with running, as it can be really hard to figure out just how much and what type of carbs to take (and when), so I am still working on this. Any runners out there - I’d love to hear about your experiences and any advice.

Thanks,
Jess

Thanks for sharing, Jess. It’s really helpful to hear about people’s experiences.

I don’t run (for a couple of health reasons), but I can - fortunately - hike. Hiking can make my blood sugar plummet from 180 to 60 (for example), depending on how much short-acting insulin I took and when, and what I ate and when. It became too frustrating for me to deal with (like managing all this isn’t difficult enough), so my solution is, I don’t eat breakfast (I neither need it nor want it, and it makes one less meal to deal with regarding insulin), and I do any hiking, or even household chores, etc. before I eat lunch. This way only my Lantus is in my system, and I can do an 1 hr. hike at a decent clip and not drop five points. Anyway, that’s my solution, at any rate!

Thanks again.

I should follow up by saying that, often in the morning I do take some short-acting insulin if my levels are a bit high (say from 100-130). But this amount of insulin doesn’t adversely affect my levels when exercising. Also, it means I can be at 85 and not have to purposely get my numbers high to buffer any exercise-related plummets.

I have recently been getting back into running. So, I may go for a 2-mile run, but end up walking half of it. Despite my other cardio-heavy workouts being manageable, running is harder to do sometimes. I don’t tend to drop too low when I do any exercise though. I actually tend to run 2 hours after I eat a meal when I expect my blood sugar to be higher and then if I am dropping a lot afterward I may have a very low carb snack with some protein, which keeps me from dropping too far. I would suggest that you try different pre-workout snacks and see if they help you. It can be very trial and error. As I said, I usually eat protein. Something like a cheese stick or an apple with 2 tbsp of peanut butter works for me. Again, this is just what works for me and it may be a little different for you. You may need more carbs or need to eat after your workout as well. I suggest giving some different options a try. Maybe yogurt, fruit, whole-grain crackers with cheese, or other snacks that have a balance of carbs and protein, to raise your blood sugar just a little bit and the protein to extend it a little. I am not a nutritionist or a doctor, this is just my experience. Maybe consider asking your doctor about options. I am overweight, so I may need far fewer carbs than you or less protein, again, not a doctor, just trying to point out that everyone is different in their needs. I do a pretty intense workout 5 or 6 days a week and I usually don’t need a snack, just because of my timing between meals, so for me, it depends on when I work out. There is a lot to consider and there is a lot of trial and error.

It can be tough to feel like you can’t or don’t want to exercise because of fear of lows!!

Thanks for sharing all that! Yes the protein + nutritious carb source sounds like a good combo. And yeah, timing is important too. I’ve already done a ton of trial and error (and continue to do so) just to get more used to insulin and food aspect, without the hassle of exercise added in. And I hate going low (hence my original post), especially in the middle of exercise or an activity. Ugh. Anyway thanks and kudos on your good management!

I certainly understand and trust me, that is simply the way my body responds to exercise. Everyone is different, exercise right now is just something that I am lucky to have control over. There are plenty of other aspects of this that are hard for me to control. I really hope you can find something that helps you. I am afraid that lows happen and we obviously want to feel safe with type one. Take it as slow as you want and you are obviously working hard for yourself and your future. I have had it for almost four years (not nearly as long as many who have posted) and I still learn new things about how my body reacts every day, every week, and every month, etc. Trial and error are all we can do and it seems like you are making an awesome effort to learn about yourself and what you need. I also hate going low. It definitely feels awful. Keep up all of your hard work and your range is something awesome to strive for!! Stay Strong and keep asking questions!!

I think the longer you have Type 1, the easier you are with lows because it is just a fact of life. Until I got a CGM, I didnt know what the patterns were. Much easier to fix when you have that but I can not even tell I am at 50 so it has really helped to have a CGM. I am not afraid of being low or high. What frustrates me more is that a high is harder to fix than a low. I am set at 70-130 and most weeks I am 88% in range with 4% below and 8% above.

Thanks for sharing! It really helps with my expectations. I thought I was abnormal going low at the rate I do, but apparently I seem to be above average, which is actually somewhat depressing. But at last I know what to expect from now on (though I’m not going to stop trying to mitigate lows (or highs))…thanks again!

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This is a great topic and I appreciate all the comments. I sometimes wish there was a site with what is a “normal” range for an age group, “normal” exercise amount and impact; then realize the number of variables involved for age, body type, etc. makes it difficult. I tend to stay in a range from 90-150, may linger for a day or so at the low or higher end, then suddenly shift for no apparent reason. I start getting shakes at anything under 80, very noticeable at 70-75, realizing the CGM is several minutes behind actual, it’s probably 60-70. Fortunately, it’s about once a week and quickly resolved with a tab or two of glucose or some fruit. I tend to wander high (160-180, occasional 200-220) an hour or two after dinner, even with appropriate Novolog prior, and sometimes a correction bolus has no effect; then hours (3-5) later with no action, it will drop right down into range. I notice a quick change on rising from sleep; if low (84-90), it starts to rise; if 150-160, it drops. It’s sometimes like my body gets stuck at a level and needs a kick start to recover.
Hope this helpful to someone!

Thanks for sharing your experience. It’s really helpful to hear about the “details” of what e/ of us go through, in order to better understand and manage one’s own situation (imo). I start feeling low below 80 as well, which I’m actually glad for, since I want to keep my body as a “first alert” for potentially immanent lower numbers. However it’s of course such an awful feeling, I tried to avoid it as much as possible, but yeah, I tend to drop below 80 fairly frequently (maybe every other day; I just immediately correct (w/ a very small amount of carbs, around 2-4, depending on the situation)), and drop below 70 maybe 2-3 times/week. I wish it were never!! I get the morning rise as well, starting around 4:30-9:30, and then it may go up even more til about 10:30. Fortunately for me they’re pretty modest - I think the highest I’ve been so far is 138 - I just take a correction dose of short-acting insulin, w/ amount depending on the number. Spikes in the 180-220 range after eating, even w/ pre-bolus and correct amount, is fairly common for me, but I don’t worry about it, as it comes down in the short-term (if not, I just take a correction). Spiking is actually fairly common even among normals (non-diabetics), which people are realizing more now w/ the advent of CGMs, so that’s why it doesn’t bother me too much.