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In the thread that was closed recently
Originally Posted by gphx
Maybe the important definition isn't 'rare' but rather 'hypoglycemia'. The NIH defines 'hypoglycemia' as a bg of 70 or less. Surely a considerable percentage of our T2 population has hit that number?
So if less than 70 is Hypoglycemia, then apparently I go hypoglycemic just about daily :confused:

I'd always thought that less than 60 was hypo.
Is there any officially blessed number other than <70?
 

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In the thread that was closed recently


So if less than 70 is Hypoglycemia, then apparently I go hypoglycemic just about daily :confused:

I'd always thought that less than 60 was hypo.
Is there any officially blessed number other than <70?
The following paper states hypo symptoms tend to begin at approximately the 60-50 range:

Hypoglycemia in Type 2 Diabetes

A big problem I see with it is they repeatedly speak of testing hypoglycemia in nondiabetic adults. I strongly suspect diabetics react differently, especially those used to high numbers and who drop from high levels quickly instead of from normal levels.

Not having a consistent medical or legal definition of hypoglycemia is a troubling thing considering driving with low blood glucose levels can result in fines, arrest, and loss of license just as driving with high blood alcohol levels can. It seems to be left up to the discretion of police to judge impairment levels which is a scary thing considering some hypoglycemic drivers have been tasered and worse.

Do a search on 'diabetic taser' sometime. The number of cases which pop up is appalling.
 

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i have always seen the 70 number, although some can function in the 60's. If your body is working efficiently your liver should kick in as your bg is falling to keep you in the 80-90 range. If you are eating a healthy diet and falling in the 60's on a daily basis you may be very insulin resistant and producing way too much insulin.
 
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i have always seen the 70 number, although some can function in the 60's. If your body is working efficiently your liver should kick in as your bg is falling to keep you in the 80-90 range. If you are eating a healthy diet and falling in the 60's on a daily basis you may be very insulin resistant and producing way too much insulin.
I don't think I'm insulin resistant. My fasting insulin levels are lower than average for healthy adults, WAY lower than average for type 2s.

I'm only seeing the 60's when I test after exercising in the afternoon.
I gather that is to be expected when taking Metformin and exercising at high levels for long periods of time. I stopped taking the Met a couple weeks ago so I'll see if that makes any difference.

My normal preprandial numbers are in the high 70s, low 80s... except in the morning of course :cool:
 

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First, many people speak of hypoglycemia but are referring to the symptoms - Somebody (whether diabetic or not) might get the shakes, etc., and state that they're "hypoglycemic" which, medically, they may or may-not be.

Hypoglycemia itself simply means low blood sugar, and is not necessarily life-threatening.

There are many thresholds, depending on who you listen to. The general medical definition is simply 'below 3.9 mmol/L or 70 mg/dl', however, this level of hypoglycemia is not life-threatening (unless it's continuing to drop, unabated - but then a 68 isn't the issue, it's when it gets into the 30's and 20's it becomes an issue...)

When medical professionals (I was one for several years before moving into another field) speak of hypoglycemia as something dangerous, they're referring to a severe, life-threatening medical condition.

Severe hypoglycemia occurs when:
  1. The patient is under the threshold the medical establishment in the area has set, and;
  2. The patient's BG levels are not self-correcting - they are continuing to drop.
The 'threshold' (whether 70mg/dl, 55mg/dl, etc.) is set according to the emergency medical governing bodies in the area. This may be as small as a per-hospital basis - or in my case (in Alberta, Canada) it's a provincially-regulated medical definition.

Regarding Symptoms:
For some reason it would appear that Type 2 diabetics feel symptoms more commonly than Type 1 - I'm just using anecdotal evidence and my own experience for that. On this forum Adjitater has mentioned he often doesn't feel symptoms we associate with hypoglycemia. In one small town I worked in we often had a patient - a Type 1 lady - that required emergency services because her hypoglycemia would come on so fast, she'd hit the floor while trying to make/get a snack to eat.

Hypoglycemic symptoms can be felt (by people who feel them... not everyone does...) at any glucose level, including WELL-ABOVE the 70mg/dl mark - but it depends on the person. This most often happens in those whose blood sugars are normally quite high; such as the newly-diagnosed, somebody starting insulin or medication therapy, etc. Most of us Type 2's have experienced it as our blood sugars started to 'normalize'.

Using my case as an example - I had fastings in the 14.8 mmol/L (267 mg/dl) mark and an A1c of 12.1% ... this would mean my 'normal' blood sugar (for my diabetic condition) was around 16.6 mmol/L (300 mg/dl). When I first reduced it to even the 9.0 mmol/L (162 mg/dl) mark, I felt hypoglycemic, though medically I was not. (You could say my body was hypoglycemic for it's normal condition, however.) As my sugars started to stabilize and my A1c reached 6.0%, I no longer feel hypoglycemic symptoms until around the 3.5 mmol/L (63 mg/dl) mark.

Dangerous/Life-threatening?
Whether hypoglycemia is a dangerous condition, or simply a condition depends on what our system is doing.

In my case, I used to have no issues with hypoglycemia. I would drop below 4.0 mmol/L (72 mg/dl) and my liver would dump glucose into my system. So even if I became hypoglycemic (according to some thresholds) my body didn't stay there. This is the case for many, if not most, of us. (Our body is normally self-correcting. It does it's best to remain in homeostasis.)

However, for those going extremely low-carb, for someone with impaired glycogen reserves, or for someone doing more activity than they have the ability to fuel (Although exercise is mostly fueled by ATP which can come from both glucose or fat, we will always burn glucose if it's available - which comes from blood glucose, carbohydrate being digested into blood glucose, glycogen stores and protein that can be converted via gluconeogenesis) or anyone using insulin or some of the more aggressive oral glucose-lowering meds - severe hypoglycemia, because either the liver has nothing to 'dump', or the insulin/medication is counteracting it too rapidly, may be a real issue - depending on their bodies, their medications, etc. That's the case for me now, and I need to be cautious. Although I usually have a liver dump that fixes lows - I don't always have what the liver needs to do this, and as such sometimes I can only fix a hypo with fast-acting sugars.

To Sum it up:
So again, hypoglycemia has different definitions depending on who you talk to:

  • Some may refer to it but mean the feeling of symptoms often associated with the condition (although this is incorrect, it would be more accurate to define this as hypoglycemic symptoms);
  • Some refer to it as simply being under 3.9 mmol/L (70 mg/dl) or any other threshold they believe qualifies (which may or may-not correct itself);
  • In emergency medicine, and when any medical professional speaks of it as something they have concern for, they mean the condition of low-blood sugar (under the threshold defined in their area) that is not being self-corrected. (Generally, if a person is still conscious, it is often corrected orally - during loss-of-consciousness or in cases of severe errors in insulin dosage, it may require IV injection of glucose to correct.)
Just my 2c worth.
 
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Well that makes sense, thanks.

FWIW I've only felt the "typical" hypoglycemia symptoms (shakes, etc.) a few times when I was taking all three meds and my BG got down into the low 40s high 30s which at the time I though was very low but was able to correct my self (yeah! candy bar!)

The time recently when I've seen it in the 60s was just after my afternoon bike ride. Sometimes when I get home I head straight to the fridge to get an apple or something and my wife will say "Hey, what are you doing? Dinner is in 45 minutes" and I'll think "well then why am I so hungry?" and I'll check and see my BG in the 60s.
No big deal and when I see that I figure I can handle the carbs in an apple, etc. in addition to dinner.

Anyway, if anything below 70 is medically considered hypoglycemia, then I guess I can see why so many reports consider it "common" in T2s.
Not trying to open that argument again, it's pretty clear that was just about a differing opinion on the definitions of "rare" and "Hypo"

I was really, just curious what folks here considered Hypo.
I'm seeing on this forum some of the T1s getting down into low single digits and still functioning which seems pretty incredible to me.
 

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Peter? I'm trying to reconcile your type 2 diagnosis with your comment that you aren't insulin-resistant, since insulin resistance is a hallmark of type 2.

What were your numbers upon diagnosis - your A1c, OGTT if you had one? Fasting numbers are often the last ones to fall, so I'm not surprised that your fastings are low, but unless you've had tests showing that you're insulin-deficient, it seems like you must be somewhat insulin-resistant. What say you?
 

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Fasting numbers are often the last ones to fall, so I'm not surprised that your fastings are low, but unless you've had tests showing that you're insulin-deficient, it seems like you must be somewhat insulin-resistant. What say you?
Is the fasting insulin test as unreliable as a fasting BG test to detect insulin resistance? e.g. you can be insulin resistant with low fasting insulin? I have a fasting insulin of 5, never understood how to interpret that number...

I also get low post cardio exercise (low 50's) though I guess I'm not allowed to call that hypglycemic anymore. Good to know the real definition, still feels bad enough to prevent me from driving home from the gym! :)
 

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Is the fasting insulin test as unreliable as a fasting BG test to detect insulin resistance? e.g. you can be insulin resistant with low fasting insulin? I have a fasting insulin of 5, never understood how to interpret that number...

I also get low post cardio exercise (low 50's) though I guess I'm not allowed to call that hypglycemic anymore. Good to know the real definition, still feels bad enough to prevent me from driving home from the gym! :)
Your guess is as good as mine, Daytona . . . have never had the insulin test & don't know at all how it's interpreted.
 

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I'm not sure if the fasting insulin test is a reliable way to test for insulin resistance. Many people who are inuslin resistant are also insulin insufficient. Also some Type 1's may be insulin resistant as well. What people don't understand sometime is that when you are insulin resistant your cells don't respond to the insulin you make, so your pancreas tends to overproduce which is what sends you low. Many type 2's are hypoglycemic for many years before they develop full blown type 2. Metformin is used to treat insulin resistance. It doesn't send bgs low by itself. I exercise a ton, sometimes for several hours and never go low on the maximum amount of metformin. Usually the glycogen in your muscles is released during exercise to keep your bgs higher.
 

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While I agree with Beefy's distinctions it doesn't matter if a person gets heat stroke because it's blazing hot outside or if it's a nice day and they have four coats on, three too many. The results are still the same.

Personally I've gotten blurry vision, shaky, and had to sit down or risk falling down following prolonged exercising. Something like that could've caused me to fall off a roof doing the job I used to do but no longer can because of that reason. Just 'dropping out' like that could obviously be quite hazardous while driving or performing other activities as well. Or try doing customer support in a place you're not allowed to eat in the office. As your vision goes fuzzy and you start to hypo a customer you're trying to help is screaming at you full blast over the phone. That, and possibly your job, isn't going to end well either.

So while I agree with the distinction between eventually self correcting hypos and those which aren't self correcting I don't think self correcting hypos should be minimized because they could easily kill indirectly and certainly impact employment and other important areas of people's lives.

IMO this is similar to the ymmv of which foods cause spikes. We can tell people what should happen, how it should effect them, and how they should feel about it all we want but only they and their meter know the answer.

We used to think only driving while impaired was a problem but now we have laws against distracted driving too because both can have fatal results. Similarly hypo symptoms can impact one's physical, mental, and financial well being.

The studies on hypos in actual diabetics crack me up because they typically start by saying doctors are encouraged to voluntarily report anyone who has suffered unconciousness or impairment as unfit to drive. Then the doctors ask diabetics how often they've experienced such a state. They rely on accurate self reporting where it isn't in their best interest. It's like the IRS doing a study asking people if they cheat on their taxes.
 

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Apparently, this is some new "colloquial" use of the word which simply means "low". Clinical hypglycemia is not defined as <70. It is defined (daignosed) with a triad of three requirements which I described at length in that closed thread. Hypoglycemia is a serious potentialy life-threatening condition. BG of 70 or 60 is not.

i have always seen the 70 number, although some can function in the 60's. If your body is working efficiently your liver should kick in as your bg is falling to keep you in the 80-90 range. If you are eating a healthy diet and falling in the 60's on a daily basis you may be very insulin resistant and producing way too much insulin.
 

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Apparently, this is some new "colloquial" use of the word which simply means "low". Clinical hypglycemia is not defined as <70. It is defined (daignosed) with a triad of three requirements which I described at length in that closed thread. Hypoglycemia is a serious potentialy life-threatening condition. BG of 70 or 60 is not.
The National Institute of Health says:

'Hypoglycemia When Driving

Hypoglycemia is particularly dangerous if it happens to someone who is driving. People with hypoglycemia may have trouble concentrating or seeing clearly behind the wheel and may not be able to react quickly to road hazards or to the actions of other drivers. To prevent problems, people at risk for hypoglycemia should check their blood glucose level before driving. During longer trips, they should check their blood glucose level frequently and eat snacks as needed to keep the level at 70 mg/dL or above. If necessary, they should stop for treatment and then make sure their blood glucose level is 70 mg/dL or above before starting to drive again.'

Hypoglycemia - National Diabetes Information Clearinghouse
 

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Apparently, this is some new "colloquial" use of the word which simply means "low". Clinical hypglycemia is not defined as <70. It is defined (daignosed) with a triad of three requirements which I described at length in that closed thread. Hypoglycemia is a serious potentialy life-threatening condition. BG of 70 or 60 is not.
Clinical hypoglycemia is usually defined as 1) BG below 55 or 50 (lower for women) AND 2) accompanied by hypoglycemic symptoms AND 3) rapid reversal of symptoms upon the administration of glucose. All three parts of this "triad" are required.

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Apparently, this is some new "colloquial" use of the word which simply means "low". Clinical hypglycemia is not defined as <70. It is defined (daignosed) with a triad of three requirements which I described at length in that closed thread. Hypoglycemia is a serious potentialy life-threatening condition. BG of 70 or 60 is not.
If you are correct hyperglycemia means high glucose but hypoglycemia doesn't mean low glucose, only a subset of low glucose. For the rest of low glucose we are left without a medical term.

An alternate idea is that hypoglycemia simply means low glucose as hyperglycemia means high glucose, and the subset/complication of hypoglycemia you're talking about is neuroglycopenia. Similarly we call a subset/complication of hyperglycemia 'DKA'. We don't use the term hyperglycemia to refer to DKAs only and leave the rest of hyperglycemic conditions without a name. We shouldn't call neuroglycopenia hypoglycemia and render the other hypoglycemic conditions nameless either.

Seems to me some of us are talking about hypoglycemia in general and others are referring to that subset/complication of hypoglycemia known as neuroglycopenia.

If we can agree we're talking about apples and oranges then perhaps we can agree.

'Hypoglycemia is a chemical definition and must be distinguished from neuroglycopenia which is a clinical one'.
The measurement of blood glucose and the defi... [Horm Metab Res. 1976] - PubMed - NCBI
 

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I thin as diabetics we try to avoid hypos. I think that is why the recomendation is to treat when you are below 70 before it goes any lower. I do think it is important to test before you drive so you don't go low while driving. There is also something called hypounawareness when people feel no symptoms as they drop which can be very dangerous. Although 50's and 60's are not life threatening they should be treated with a small amount of carb.
 
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Peter? I'm trying to reconcile your type 2 diagnosis with your comment that you aren't insulin-resistant, since insulin resistance is a hallmark of type 2.

What were your numbers upon diagnosis - your A1c, OGTT if you had one? Fasting numbers are often the last ones to fall, so I'm not surprised that your fastings are low, but unless you've had tests showing that you're insulin-deficient, it seems like you must be somewhat insulin-resistant. What say you?
My numbers are displayed on my Signature line, however...
When Diagnosed my fasting BG was 315 and my A1C was 12.1 which is way up there diabetic no matter how you define diabetes.

Measuring insulin resistance is a fairly long and complicated test requiring a an IV glucose feed with continuous monitoring of insulin levels and a specially trained technician to constantly adjust the glucose feed to keep your blood glucose level.

Several studies have indicated a high degree of correlation between fasting insulin levels and insulin resistance making it a simple fairly reliable indication of insulin resistance.
If you have high fasting insulin levels then you are most likely insulin resistant even if you're not diagnosed with diabetes/prediabetes.

Depending on what you read, normal fasting insulin levels are between 5 and 25 uIU/mL. Those who are insulin resistant (but not diabetic) tend to be towards the higher end of that range and Type 2 diabetics are often far above 25, I've seen some studies where they were up around 60.

For T2s insulin levels after eating, or during an oral glucose tolerance test, aren't a very good indicator of insulin resistance because many T2s no longer produce enough insulin. However fasting insulin levels are still a fairly good indicator.

All of that said. I never had my insulin levels tested until a couple months ago and at that point I had my diabetes fairly well controlled, plus I was taking Metformin which can impact insulin resistance.
So I can't say whether or not I was insulin resistant when I was diagnosed. 'm just fairly certain that I'm not insulin resistant now.

I do know that there seems to be a whole bunch of different types of T2s with widely varying symptoms.
For example most T2s have high BP and high cholesterol, at least when initially diagnosed. I have never had high cholesterol, in fact mine is lower than "normal" and I have excellent BP, almost always below 120/80, typically around 116/74.
 

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Once again, many of you are confusing the matter. Some are confusing the meaning of hypoglycemia with the medical definition of hypoglycemia.

Hypoglycemia is a term which derives from Latin. It's meaning is low blood sugar.

Hypoglycemia is the word used to describe a medical condition, it's definition which I think I covered clearly in my earlier post.

The meaning of the word (simply 'low blood sugar') and the definition (severe, life-threatening medical emergency which requires immediate intervention) are very different.

The reason there's confusion is many doctors, internet sites, etc., don't even know the difference.

Regarding gphx statement of hypoglycemic symptoms being dangerous - sure they can - driving, falling, etc. are all hazards when undergoing hypoglycemic symptoms - these could happen to someone who's not medically hypoglycemic though, especially new diabetics. When I was first diagnosed, I sure wouldn't want to have been navigating rush-hour-freeway-traffic at a 9.0 (162) as I could barely stand or think there... But I wasn't hypoglycemic.
 

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I do know that there seems to be a whole bunch of different types of T2s with widely varying symptoms.
The Handbook of Diabetes by Gareth Williams and John C. Pickup agrees with you saying this about T2:

'Ranges from predominantly insulin-resistant, with relative insulin deficiency, to a predominantly insulin-secretory defect, with or without insulin resistance'.

The label is a basket.

What's with the emoticon that looks like someone getting a blood drop with a straight razor? Creepy... :lever:
 

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I think the important question to ask is whether we need to worry if our blood sugar levels get into the 60s. If you're not on medication or insulin, then probably not. If you're on Metformin, also probably not.
 
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