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Re: [IPk] Tighter control and hypo unawareness

In message <email @ redacted>,
Tori <email @ redacted> writes
>I find it odd that the two documented ways that hypo 
>unawareness comes about are so completely opposite - tight control or 
>hugely bouncing BGs.

I think the cause is the same: with tight _low_ control (i.e trying to
run 4-7 all day, every day - 'tight control' could mean trying to run at
9-10, all day, everyday), and with bouncing bgs, one gets frequent lows.
With tight low control (TLC?) one dips to hypo perhaps two or three
times a week (or perhaps a day?).  This is a shallow dip, caused by the
bottom of 'normal' being very close to 'hypo', and happens quickly
(because one hour you can be in 'normal' range at 4.2, and you drop 0.4
over half an hour, and you are hypo.  So there are no 'plummeting bgs'
symptoms to be aware of.

With bouncing bgs, while the average can be higher than the average
achieved with TLC, there are still a number of excursions into
hypoglycaemia - perhaps as frequent as with TLC.  They happen more
slowly (a 4.0 drop over half an hour is not unusual, but it's more
unusual than a 0.4 drop), and (I find) have nastier side-effects than
the TLC 'dips' to hypo.

But whatever the cause of frequent hypos, it seems that frequent hypos
is related to hypo unawareness.  It may simply be a biproduct of
learning: the unusual stuff (one hypo a month) is something 'different'
that we pay attention to, something that happens on a daily or near-
daily basis is something we ignore.

And yes, Melissa, we are taught here (or were taught, 30+ years ago)
that different people have different hypo symptoms.  Mine were/are
greater concentration (both needed to achieve things, and applied),
shakiness, and a new one, yawning.  But 30 years ago we had, I think,
better advice (isn't that an awful thing to say - I am going to lament
the demise of #Sd, bemoan Young People Today, and start saying that
crisps don't taste the same ....).

That 'greater concentration' is something which doctors (and ourselves)
like to treat as patient non-compliance rather than as a symptom of
hypoglycaemia: if you 'just have to finish' hanging out the washing,
typing a letter, or whatever, despite thinking 'hmm... wonder if I could
be hypo', and five minutes later you are still at it, thinking 'gosh, I
really feel odd, but I really have to finish this, before I go measure
my bg ...' this is NOT you 'ignoring your diabetes' (in the way you
might do if you decide to skip exercise today) ... this is your brain
shutting down as it runs out of energy.  It focusses down on the task in
hand.  It's a symptom, not a cause, of hypos.

Best wishes to all,

(dm 30+, 508 1+)
Pat Reynolds
email @ redacted
   "It might look a bit messy now, but just you come back in 500 years time" 
   (T. Pratchett)
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