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Re: [IPk] Definition of a hypo

 Remember that if you need to decrease basals due to increased insulin
sensitivity (for whatever reason) then you'll almost certainly need to decrease
bolus ratios too. Your body can't distinguish between basal and bolus insulin.

Sent from my iPad

> On 6 Dec 2013, at 06:51, Gareth <email @ redacted> wrote:
> 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
> or may not be taking..........
 > There is no single pattern of low Bgs although the first one in the morning
> a regular.
 > We today intend decreasing all basal rates by a common percentage which
> 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
> 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
> 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
 > for longer periods that there will be greater insulin sensitivity and
> 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
> 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
> 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
> but have a suspicion that she is.
 > That's because we've seen many more 'technical hypos' since she started on
> 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
> 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
> 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
> 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
> 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,
> that frequent hypos (as currently defined) are causing longer term underlying
> harm, unnecessarily.
> Gareth Hicks 
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