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Re: [IP] Re: A1C targets

 From: "Dianna Inkster" <<A
HREF="mailto:email @ redacted">email @ redacted</A>>
Date: Fri, 14 Nov 2003 14:29:30 +0000 

>  Hypoglycemic unawareness is more common on the pump, is it not, just 
because the decline is so gradual.<

Well, not necessarily!  Where did you get this statement?

Hypoglycemia unawareness is an autonomic neuropathy where the 
 counter-regulatory response is blunted or no longer exists. Maintaining BG
goals at higher
levels, (100 to 200 mg/dL) is often recommended as safe. Some pumpers have a 
return of recognition symptoms after several weeks to months of maintaining 
higher BG goals.

Unawareness does not have to be common when using the pump.

The BG decline can be gradual even if not on a pump. You just need the right 
set of circumstances:  - too much available insulin relative to the amount of 
available food (hypoglycemia), plus a relaxed state where there are no energy 
demands (unaware of dropping BG), followed by an increased demand for 
 available glucose...ie, moving from a resting state to an active state. There
would be
other scenarios, but your glucagon and adrenalin need to be able to respond.  
If the hormone response is minimal or non-existant (common in many Type 1s), 
then you can "bottom out."  Repeated low BG episodes lead to more low BG 
 episodes as counter-regulatory responses also need recovery time, even if they
work well. 

Glycogen storage needs to be replaced. If the warehouse (the liver)  is 
continuously accessed, it is eventually empty. 

Stay safe with BG levels.

Barbara B.
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