You may hear this question from your Endo, something like “How many low blood sugars do you experience in a week?”
The problem is that their definition of “low BG” is not very good. They define a low BG as anything below 70. That definition is incredibly inaccurate.
For example, for a big meal you may want to be dropping down to prevent a spike after a meal, so you take insulin well ahead-of-time so you are dropping down before the meal. That’s not a low BG, that’s just smart proactive planning.
Or maybe you are 65, but you feel fine and are going to eat a meal in a little while, so you just wait for the meal. Again, that shouldn’t count as a low.
So I want to put together a better definition, so when asked that question, it isn’t just about a BG number.
Help me out with a better definition. Here is what I came up with so far:
Here are lows I consider bad:
unexpected / unpredicted
impairs you mentally or physically
requires the help of another person
Am I missing anything? What else would you put in this list?
Think broad definitions. Like you don’t need to add “makes me see spots” because that would be covered by #2. Or I wouldn’t say “requires food” because sometimes I eat at 80 if I know I am dropping, but I didn’t really get low, so that wouldn’t count.
Eric, I don’t have anything to add to your description, I think it is well thought out and makes sense. Just for a second, I hope you can humor me, and let’s look at it from the physician perspective. What would I be concerned about that answering that question could help me, to help you.
basal insulin set incorrectly
too aggressive with bolus insulin
not adjusting correctly for activities
Person is a danger to the community (i.e. some states make physicians report LOC events)
Anything else they could be looking to help you with?
Maybe when you have symptoms where you actually fear for yourself going lower? That is pretty squishy since it will vary so much from person to person, but I guess also a strength.
Yes, but for me if I am hovering at 70, my basal and bolus and everything was perfect. I don’t think 70 is low. So if they want to help me, I think they need to define low better.
For some people 70 is low, but for others it is not.
So I am looking for a definition that works for everyone that isn’t just number-based. They could provide the same help - even better help - if they weeded out the ones that were not bad, and just addressed the actual bad lows instead of only looking at a number.
Example - before dinner I take the bolus early because I am making spaghetti, waited a few more minutes because the table needed to be cleared and the kids were getting washed up, so I ended up at 65 before I started eating. Not unexpected, didn’t impair me. Let’s not waste our time talking about that 65.
Agree completely, do they talk to you about that 65? Because our conversation with our team doesn’t look/sound anything like that. i.e. they ask us how many lows, did we have any problems from the lows, then move on.
Seems like it might be helpful to provide some cutoff point (e.g. anything below 55) so that they know that if a predicted low goes below that point then you would still consider it a low and treat it accordingly.
No, we couldn’t possibly talk about every time I am below 70. The appointment would never end.
But when they ask the low question, I would like a better definition of low, so we can have a more worthwhile discussion. They seem focused on the number 70!
This is a tough one for me that I’ve even mentioned to my endo. I often prevent lows by eating. But if I do that often enough, then it DOES indicate that something is out of whack. But, since it doesn’t show up in reports or graphs as lows, it’s very hard to look at data and go, “Hey, I’m having to eat after lunch every day to prevent a low, maybe I should reduce my bolus.” It sort of hides the lows (that never happened but would have happened if you hadn’t taken proactive action) so that, unless you’re doing it every day, you may not notice a pattern.
I think this problem though needs to be viewed from a slightly different angle–what can we do to make our docs look at and treat us like individuals, not average statistics?
I think we are on the same page, because even though it doesn’t look like a low strictly by the number, it would fall into a worthwhile category. So that leads me to update my list with a number 4 - unexplained.
Thanks. That’s what I am hoping to accomplish. A complete list of worthwhile events that are not based strictly on a number.
A bad low to me is one that refuses to come back up no matter how many carbs you feed it. It serves two bad purposes in my mind. First, prolonged lows aren’t good for Liam. Second, inevitibly, when he comes up, he’s going to shoot up like a rocket and then we are playing roller-coaster for the entire day because every action has an equal or opposite reaction.
The other lows are either anticipated (and treated) before they are low so IF they go low, they’re only for 1 to 2 ticks, or they’re averted altogether because we treat in time to stop it.
The only other bad low to me is one that I sleep through, don’t realize he’s low and don’t wake up until he’s been low (under 70) for more than 15 minutes…sometimes I’ve slept through lows for as much as an hour and those nights are the worse for me because I know like I’ve let my son down and hurt him.
However, if I’m low according to your excellent definition, I would definitely eat/treat, so I think that should be included. I’ve certainly skirted the low point and not treated, but I know food is coming and/or I am not impaired in any way and do not need assistance.
Or maybe by “food” you were excluding all things in the treat-a-low food group.
I was thinking that if I am dropping, and I eat a cracker or something preemptive, that would not count as a low. It’s just preemptive. Different than a cookie or juice type of treatment.
I agree, if my son takes 4 carbs to land a drop from 250-90, that wouldn’t be a low treatment in my book. We do that frequently when in good control, in fact we can usually tell where he is (when taking a Dexcom break) by how much candy is leaving the house. (note we also have to ask the big brother because sometimes candy disappearing has nothing to do with diabetes). If he goes through 10-30 carbs a day in candy things are great, if it is 50+ he is being a little aggressive with insulin, and if no candy is leaving then he is probably high.
Nice list. Harold suggested the one I was going to add…a sustained low that won’t budge and/or returns several times after treating it (drops low again fairly quickly).
