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[IPk] Tighter control and hypo unawareness
Re the correlation between tighter control and hypo unawareness, I think it
might be worthwhile considering a another facet of the DCCT and what has
become less-than-unusual practice since. The DCCT recommended 'at least
four' bg tests/day. Many pumpers and several MDIers I know personally do 7
or so. Four has become the guideline for people on 2 injections. The more
often one tests, the more frequently one has the chance to 'catch' a falling
bg before it hits bottom.
Also, I have run across some interesting anecdotal studies of hypo symptoms
(sorry, I don't have references). I think most of us who can sense hypos
would say that the ones with a bg of 4 are normally not quite as
incapacitating as the ones we get at 2.5: 4 is closer to 5 and so it should
take fewer carbs and less time to sort that one out. I have found since
being on a pump that I may not have the same hypo symptoms all the time, but
I am very rarely surprised to have a bg below 3.5. I am also quite
frequently 'aware' when my bg is above 12, though I can't always put my
finger on the exact reasons why I think I should test or just bolus a unit
even without testing.
One thing we haven't really delved into as a list is how tighter control may
help us see what our bodies may do when they are functioning well. My most
typical hypo symptoms these days are intense hunger and slightly slowed
thinking. In the past, my hypos have been characterised by physical shaking,
intense headaches, stomachaches, inability to complete a sentence, and
tingling lips (usually some combination of 3). Judging from the standard of
diabetes education I have seen in the UK thus far, I bet the idea that
individuals have their own most likely--or even unique--hypo symptoms, and
that those symptoms can change, hasn't made it far over here yet.
I do believe hypo unawareness exists; however, some people may discover they
are not necessarily as unaware as they thought if it is the case that their
symptoms have changed.
As I am wont to mutter: diabetes is an art, not a science.
IDDM 9+ years; MiniMed pumper 6+ years
Co-ordinator, Oxford University Student Union Diabetes Network
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