You told Glu: The Lowest of the Low

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The community’s response to one of last week’s Questions of the Day was impressive! Not only did hundreds of you respond with your lowest blood glucose (BG) reading ever, you were curious too…and asked for a graphical analysis of the overall results. Well, GluRyan and GluDanielle are here to deliver!

Lows Histogram

The average ‘lowest low’ people reported was about 26mg/dL. There were a surprising handful of people reporting BG values under 10 that they believe to be accurate. Some Glu members reported just a number, while others shared stories about their lows.

Lowest Low Text

Hypoglycemia can be deadly, and it’s important to recognize the signs of impending blood glucose drops and take precautions. Glu ambassador Dr. Nick Argento wrote a fantastic piece last year about hypoglycemia, and hypoglycemia unawareness. It’s well worth the full read, but some of the main takeaways were:

  • Be prepared with rapid sugar sources always
  • Remember to adjust management around exercise or when skipping a meal
  • Don’t overcorrect low blood glucose – eating excessive sugar might lead to a rollercoaster ride of BG corrections

Many people in the community refer to the fact that technology such as CGMs may help avoid such severe lows. As one Glu user put it, “I woke up to a 32. I would not say that I usually have hypoglycemia unawareness but sometimes you’re just that tired and it creeps up on you. Every insulin dependent diabetic should be prescribed a CGM if they want to use it.”

Dr. Henry Anhalt, CMO of the T1D Exchange, weighed in with his own thoughts about hypoglycemia.

“If hypoglycemia wasn’t a consequence of intensive diabetes management, achieving blood sugars in target range would be very easy! New tools, such as rapid acting insulins, sensor augmented pumps, stand-alone sensors, insightful meters with algorithms and decision-making support have made life easier, yet, as demonstrated in our survey, hypoglycemia remains a significant challenge.”

Dr. Anhalt said that hypoglycemia can have unexpected consequences on the nature of how people living with diabetes relate to their own disease, as well as how physicians treat patients with T1D. For example, physicians may “loosen” their patients’ targets for fear they will experience severe hypoglycemia. But, Dr. Anhalt says, this strategy is not likely to work.

“We have data from the T1D Exchange registry that shows equal incidence of severe hypoglycemia in those with low A1c (tightly controlled) and those with high A1c values.”

He continues, “With the promise of Automated Insulin Delivery technologies on the horizon, our hope is that we will see a decrease in overall hypoglycemia, but especially overnight hypoglycemia. Will caregivers, partners, parents and people living with diabetes be able to sleep better? We hope the answer to that question is a resounding yes!”

Glu, what do you think? How do severe lows impact your life? Would you be interested in seeing more research on this topic?

-Henry Anhalt, DO, Danielle Gianferente/GluDanielle, Ryan Brennick/GluRyan


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