Maybe another is - a low when very drunk - not a good one but it happens and is probably the worst !
I think dexcom got it right with their below 55 automatic urgent low warning I find above 55- 70 it’s fine - my doctor says it’s frying my brains but he has no proof for that so I just ignore him
He is only going to focus on the bad lows I’ve had the last few days and not the reason - i went home for Xmas and found myself eating probably too few carbs - maybe 20g a day and too much fat - my insulin resistance went through the roof - I had to take 25 units to cover 8g of carb for breakfast and probably another 30 for lunch and 30 for dinner - insane amounts - in ketosis insulin just doesn’t work I think similar to dka maybe - your body just covets the few carbs it’s get and maintaining the bg
Now I’m back home I started getting to 60g a day by having two Vega shakes with some kale,avocado and some blueberry - super healthy low GI but gets me out of ketosis and my resistance disappeared and caused some pretty low lows (30) as I adjusted and reduced - I now need 5 units for 20g of carbs and my total bolus for the day dropped from 85 to 30 !!
I think some independent concepts are getting confounded here, and lumping them all under the rubric “bad low” reduces the utility.
One concept is “low incidents that would be beneficial to discuss with my medical staff.” For this one I would include any incident in which I did not have a justified, true belief* that I was in control of the situation and was not in actual danger, [* epistemology 101] plus those incidents that I don’t understand and I want the endo’s help.
A second concept is “BG level that is bad because it is sufficiently low to cause tissue damage or death (directly, not as a side effect of an accident or something).” I think 55 mg/dL is considered the level at which repeated excursions can cause lasting impairment to the brain and nerve tissue, but I don’t have a citation so let’s call this a rumor until someone turns it into a fact. And I vaguely recall that somewhere around 30 mg/dL is where we have a significant risk of a fatal cardiac arrhythmia or other dramatic failure.
A third concept is “a BG low that is bad because it risked getting dangerously out of control.” In this group I include several kinds of scenarios. In one, I was on a long-distance drive and observed that I was getting a visual migraine — oh wait, I must be low and nearly passing out. I ate a bunch of glucose and didn’t crash, but that’s just good luck. Now I have CGM for protection. In another scenario, my BG was plummeting and I took a bunch of glucose but just kept dropping anyway. I was just barely able to stay ahead of it without passing out, but it took something like 14 glucose tabs. I think I must have grabbed the novolog vial instead of the lantus for my daily basal dose. After that incident, I developed a protective ritual. Before drawing a syringe of basal I would stare at the vial and say out loud “Lantus is long, this vial is long” as I looked at the vial to verify that it was long and thin, not short and stout. Switching to an insulin pump made this issue go away. A third scenario happened back when I was on the old Medtronic Guardian CGM. I woke up abruptly from an evening nap and glanced at the CGM which said everything’s fine at 92 mg/dL. I went into the computer room and my wife looked at me and said “Something’s not right, go check your BG.” A few minutes later she came to the kitchen to check in on me and found me staring at my meter, stupid and unable to figure out how to operate it. I have no memory of this, but she says that she gave me a glucose which I ate. She tried to give me a second but I no longer knew how to chew. So she gave me glucagon and that solved the problem. When the Dexcom G4 came out I switched and liked it much better. Not because of “accuracy” because that misses the point. The point is that CGM must be trustworthy, and for me the Dex is, whereas the obsolete Medtronic version badly tricked me several times. Trustworthy CGM doesn’t mean “always nearly correct” it means either it is close enough that I do the right thing, or it has already let me know not to rely on it completely, such as during the first 12 hours or when it shows me jitter in the graph so that I know the sensor is in trouble or failing.
So to sum up, my 3 categories are “lows to discuss with my medical staff,” “lows that directly damage me,” and “lows that were dangerous.”
But back to Eric’s original issue. If the endo were to ask me “how many lows do you have per week?” I would say “2 below 55” (or whatever the number is) because they are legitimately considered harmful, and then I’d introduce the specific incidents that I wanted to talk about because I thought maybe the endo could help (not necessarily those 2 below 55.)
I am not trying to lump them under one heading. I am actually trying to do the opposite and identify which events are worth paying attention to, independent of a BG number.