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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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