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Re: [IPk] Definition of a hypo



Thank you Belinda, Rhoda & Jackie for your input.

 My initial query was made partly out of curiosity as to what the consensus
might be amongst listers as to what level of hypos we tolerate in practice,
whatever 'the rules' say
The Wikipedia article is quite useful for an overview
http://en.wikipedia.org/wiki/Hypoglycemia

 In my wife's case, a study of the various care link reports indicates to me
that whether on "live" metformin or not there has been a sea change in her bg
levels in general - a downward shift of the 'plateau' if you will. Suggesting
that insulin is more effective, probably because of the metformin which she may
or may not be taking..........

 There is no single pattern of low Bgs although the first one in the morning is
a regular.
 We today intend decreasing all basal rates by a common percentage which equates
with lifting that plateau up in stages to the point where average lows are
around 4.
 That will inevitably increase her HbA1c, it will be interesting to see where
that ends up.
 It's still rather early here in the Uk so will leave the actual calculation
until fully awake!

 For the sake of saying it, we report key data monthly to our Remove trial
contact person, plus less frequent actual review meetings .
 Speaking generally, we don't feel that we are 'on our own' in any sense
although we do seem to know more about pumping than some of the professionals we
deal with across the whole piece. Which isn't saying very much !

Gareth


On 5 Dec 2013, at 23:15, "Jackie Jacombs" <email @ redacted> wrote:

While it's great to take part in trails I do have concerns that your wife may
not have been informed if she is on a medication which can affect the blood
glucose levels.  Well of course she would have know she was or might not be but
I would have thought that she would have someone on the trials who can give
advice. Also another thing to remember that if the BG levels are running lower
for longer periods that there will be greater insulin sensitivity and therefore
with really good tight control your wife may need to review both bolus and
basal
ratios.


Jackie

-----Original Message-----
From: email @ redacted [mailto:email @ redacted] On Behalf Of
Gareth Hicks
Sent: 05 December 2013 22:05
To: email @ redacted
Subject: [IPk] Definition of a hypo

My wife Jean is the T1 in our house, it's now been 48 yrs - and a pumper for
last 5yrs.

She's now almost a year into a 3 yr  trial (Removal) which I understand is to
assess how metformin might be used in T1 treatment (as against T2) to mitigate
diabetic complications (and make insulin more effective?).
It's a blind trial so we don't know for sure whether she's on metformin or not,
but have a suspicion that she is.
That's because we've seen many more 'technical hypos' since she started on it,
sometimes daily.
These are virtually ALL between 2 and 3, her hypo setting is 3.3 I said
'technical' because she has no really obvious symptoms these days, not above 2
anyway.

Aside from the administration of the trial itself, Jean's diabetic consultant
and GP are now concerned about hypo frequency and are suggesting some more
fasting tests.
Whilst this is OK in theory, our experience is that we can fiddle about with
basal settings to out heart's delight but historically have eventually ended up
roughly where we started.
That's an over simplification, and we did make some 'trial and error' basal
adjustments shortly after the Removal trial started,  but you get my point.
I'm not saying we resist fasting per se, just wondering whether the hypo
related
criteria for doing so is 100% relevant to her.

We are in fact already more actively using temporary basal reductions when BGs
are edging downwards, especially last thing at night.
And using longer acting carbs when sorting out a hypo, something we haven't
been
too good at admittedly.

Her latest HbA1c is 6.3 compared with 7.5 - 8 in pre pump days.
Considering Jean's age, the advice we have received from our consultant in the
past, and listened to,  is not to consider a  much lower HbA1c than say
7 as
a target in any sense.
Implying that avoiding hypos is now more relevant for her.

We have, about 6 months ago, adjusted the bolus settings and the insulin
sensitivity factor  and I am (fairly) happy they are Ok where they are.

I have no idea now where the 'under 3.3 qualifying line' for hypos came from,
perhaps set by the DSN when Jean first had a pump.

My question, do  other pumpers use a different definition of a hypo, and if so
does anyone know how these are worked out?
Or is a standardised  definition being used?

My growing and uninformed, concern, despite there being no obvious symptoms, is
that frequent hypos (as currently defined) are causing longer term underlying
harm, unnecessarily.


Gareth Hicks 
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