Stumble It!
Wayback Wednesday: Hypo School
I was chatting with diabetes investor / expert / friend Robert Oringer the other day, who has two teenage sons with Type 1 diabetes. “I’m obsessed with finding ways to prevent severe hypoglycemia,” he pronounced. I guess I knew this about him, but it reminded me of just how complex and scary blood sugar lows can be. Which led me back to this post, which, three years later, still rings true:
Hypo School
I have been schooled in hypoglycemia, in more ways than one.
TYPE 2) First off, you were all right, of course: hypoglycemia is apparently often an early sign of Type 2 diabetes.
Excerpts from Connie Bennett’s carb-bashing book, Sugar Shock!, cleared this right up:
When the body is resistant to the insulin it makes, the result is “… an ‘overshoot’ phenomenon characterized by a large spike in insulin, followed by a drop in blood sugar. Over time, repeated insulin spikes may lead to a decrease in pancreatic reserve, or more insulin resistance,” Bennett’s experts say.
Meaning: “The brain craves more glucose so you consume more simple carbs to get your blood sugar back up again. You get into this vicious cycle of low sugar, high sugar, low sugar, high sugar, low sugar, high sugar. And that taxes your pancreas, which then leads to either insulin deficiency or to greater insulin resistance and, therefore, type 2 diabetes. (Type 2) diabetes really is chronic hypoglycemia.”
Hmmph, so it’s the continual lows that make you high all the time. Yet another twist to this confounded disease. So if you feel shaky and ravenous after eating sweets, beware. You may have — or be headed towards — Type 2 diabetes. Loverly.
TYPE 1) Back in my world of continually struggling to get the insulin dosing just right, I have hit a new (and quite frightening) record! Felt a little strange the other day — nothing too alarming, mind you. Just a sense of some buzzy disorder at the back of my head. Checked and discovered I was at 36!! WtF? Began gorging on raisins immediately as I checked again: 43. Well now I know I’m not imagining it: as time goes on, I am most certainly becoming more and more hypoglycemic unaware! 
How much longer until I land in the ER, I’d like to know?!
To date, I’ve been very lucky. I’ve only had one instance in which I was truly disabled and needed help — but Oh, Chrissie (in Belgium), I feel for you on the bad hypos!
Thank you also, Chrissie, for noting why this happens to us: “A hypo normally makes the body react with epinephrine, cortisol and other BG raising hormones. However, this causes toxicity. Your body is merely trying to avoid this toxicity, and therefore you do not produce these hormones so easily…”
The experts put it this way: “Symptoms of a low become less obvious after having diabetes for several years because repeated lows impair the body’s release of stress hormones. The major counter-regulatory hormone that causes glucose to be released by the liver to raise the blood sugar is glucagon. Glucagon secretion is reduced in most people who have Type 1 diabetes within the first two to ten years after onset.”
They also note: “Women are more prone to this problem because they have reduced counter-regulatory responses and reduced symptoms.” Now isn’t that Loverly, too?
so what can be done about these bad hypos? I have noticed that when I’m working out I must go so low that my liver releases glucagon to raise my blood sugars. I come out of the gym with BG’s in the 300’s. I was working out to keep them down and now it’s the opposite. This seems to be happening more & more often, now that I’m going on 20 yrs of type 1.
Posted by: Joyce | December 2nd, 2009 at 10:27 amI found this post very full of knowledge and a Very good Read.
Posted by: John Lesson | December 2nd, 2009 at 4:53 pmOnly rarely do I see hypoglycemia in a person with type 2 diabetes who is not being treated with drugs that cause hypoglycemia.
But maybe Bennett (above) was referring to people developing diabetes, but not there yet. Here’s a quote from UpToDate.com:
“Drugs are the most common cause of hypoglycemia. Hypoglycemia is common in type 1 diabetes, especially in patients receiving intensive therapy in whom the risk of severe hypoglycemia is increased more than threefold. Less commonly, hypoglycemia may also affect patients with type 2 diabetes who take either insulin secretagogues or insulin. In contrast, hypoglycemia is uncommon in individuals who do not have drug treated diabetes mellitus. In such patients, hypoglycemia may be caused by a variety of other drugs, including alcohol, and common critical illnesses such as hepatic, renal, or cardiac failure, sepsis, or inanition. It may be due to adrenal insufficiency, an insulinoma, or an IGF-secreting tumor. In addition, hypoglycemia can be factitious, accidental, or even malicious.”
-Steve
Posted by: Steve Parker, M.D. | December 2nd, 2009 at 5:39 pmAs a T1 for close to 30 years (!) – I am here to tell you that hypoglycemia unawareness does not necessarily lead to ER visits. I have had h.u. for about 15 years. It has meant I need to test more frequently, and that I’ve learned to notice some very slight, subtle, personal cues (like if I’m biting my fingernails more intently, or have a strange thought out of nowhere, that kind of thing). I remember totally freaking when I first saw shockingly low meter readings – but felt nothing! Yet, 15 years later, with or without h.u., I have never gone unconscious from hypoglycemia – not yet at least! (Now THAT’S lovely
Posted by: T1 in Boston | December 2nd, 2009 at 11:16 pmThank you for more info Dr. Parker, all quite loverly! sigh.
Posted by: Diane J Standiford | December 2nd, 2009 at 11:17 pmJust went to the endo with my soon to be 11, T1D son ( 2 yrs T1D) The MD diagnosed us correctly with hypoglycemic-ophobia !! I immediatly agreed. My son’s A1C has been 7.4 for 6 months I am happy to see that number frankly, the way he eats. Any how, he has no h.u. yet.He has had a few lows that make him sick enough to be very phobic about lows . So far he even wakes up in the night if he feels low , ( lowest so far about 66). I wonder if we keep from having the really bad lows is it better off to be a tad high at his age, or to loose the sensitivity of the lows by having to many hypos?
Posted by: Pam Messenger | December 4th, 2009 at 9:39 pmWe just had the death of a high school senior in his sleep from T1D hypo in our town last week. Very sad experience. I wonder… is the risk for a low A1C and the possible resulting h.u.worth it ? Our school nurse points out that when the kids have consistently higher BGs they begin to feel low when they are near normal . She is seeing this in an elementary school RN office where they come in feeling low but are not even close because they usually have way to high BGs. that is not great either but at least they are not h.u…. yet.
Kids just don’t grasp the health risk of high BG’s at age 10 and really, who wants to scare them, it is hard enough to live with this.
I was diagnosed 37 years ago, and know that for the first 10 years of Type I, my hands would shake when my BG dropped to about 70. In those days we had no meters, and my fasting BG was tested once per month, then my afternoon BG was tested the following month. (The labs that took the blood from my vein for a BG test were not open in the evening, so I never got an evening BG reading until I purchased my first meter (27 years ago this fall.) Fortunately, I got my first meter just as soon as the shaking hands symptom disappeared. Now I am very thankful for my CGM, especially during the night! I still catch an occasional low seconds before the CGM beeps, but at other times the CGM beats me to the punch!
Posted by: June S. | December 6th, 2009 at 5:45 pm