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[IPk] re questions on lowering BGs and a confession

I certainly agree that one should not be living one's life on the verge of
hypoglycaemia all the time. Also the aim should be to retain reasonable
hypoglycaemic awareness rather than just feeling vaguely off colour with a BG
of 2 mmols. I have noticed that the latter can really vary from feeling light
headed at 4.5 mmols to only feeling vaguely unwell when BG hits below 3,
according to number of recent hypos in the last few days and also speed of BG
drop: sometimes this can enhance symptoms but at other times I find I am less
aware if BG drops quickly .
I find the comment about loss of awareness with novo and actrapid, and
regaining it with humalog,interesting. As novorapid is not as fast acting (
quite) as humalog, perhaps this is due to a slow drop allowing your body to
acclimatise so that you don't feel unwell when it hits hypo levels

Surely target BGs should be individually tailored to optimise control while
minimising hypos assuming that optimal tools are available as well as
education, to achieve this. below 4 mmols you are not legal to drive: you are
officially hypo and if an accident occurs , can be charged with driving under
the influence of insulin. While this will invariably happen on occasions,
especially if control is good, I do not beleive it should be regarded as a "
good " level. Due to the inherent variability of diabetic BG levels if we have
a BG of 11 mol on one day it may be 7 on another ( or vary from 8 to 3) with
same doses, food and activity, so I personally believe it is a little
unrealisitc to achieve DCCT targets all the time, Remember the increased
severe hypos ( threefold) which are sometimes more than just an inconveniance
and can cost driving licences, livelihoods or even live's if contributing
factors to accidents , as well as the increased risk of mild hypos which if
frequent can cause loss of awareness or be plain demoralising.. A patient
should NEVER be labelled non complaint if they are just trying to avoid hypos,
rather a troubleshooting approach should be adopted by someone who really
understands intensive insulin therapy, at the same time as reiterated that
occasional ones are a consquence of having good or reasonable control

Regarding postprandial levels. The instruction booklet with my one touch ultra
stated that levels on glucometer can be 3 mmol higher than actual levels in
plasma if testing within 2 hours of food. I was perturbed to find that I would
have a 90 min postprandial level of 12 or 13 and be down to 5 before luch
before I read this. Now I tend to take postprandial readings less: only if I
suspect I may be heading for a low and want to drive, or feel really high .

3.9 to 6.7 before meals. At present I DREAM of having BGs in the single
figures consistantly
( cold, hormones, stress...)
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