Comment by MrFoof | Hacker News Reader

Comment by MrFoof | Hacker News Reader

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>type I diabetics with the best control are actually more likely to die from severe low blood sugars.

I'm very much in this crowd. Type 1, AIC of 6.3, LDL cholesterol around 100, BP of 110/72-75. This is with completely manual testing and subcutaneous insulin injections.

The problem of keeping your blood sugar towards an A1C of 6 is you have insulin reactions. Quite often, as you're being rather aggressive in keeping on top of your blood sugar. Worse, is I don't show or feel any real physiological symptoms until I'm at 60 mg/dL or below, which is getting fairly dangerous. I can be as low as 25-30 mg/dL and still be conscious and functioning. My tipoff is realizing that I either feel tired or that I can't think straight. It's hard to realize you're not thinking straight when you can't think straight, and have the cognizance to then test and get some carbs in you.

I've had a few close calls. One where I was driving a supercar north on Route 24 in Boston rush-hour traffic. I subconsciously took an exit and drove 5 miles into a suburb, and managed to not hit anything and the police officer told me I mostly obeyed traffic laws, aside from weaving about (but was completely incoherent) -- I was at 21 mg/dL when the EMTs tested me.

I once didn't compensate for alcohol, passed out on my couch, and when I finally came to in a pool of my own sweat, it took me 3 hours to traverse 30 feet to the kitchen to attempt to drink (and wear at least half) of a half-gallon of orange juice. When I finally tested 30 minutes after consuming an entire carton of OJ, I was barely in the 40s -- I have no idea how low I was, and I was lucky I ever regained consciousness.

Just curious, how old are you and how long have you had it? I've had it for 11 years this February, and while my A1C is pretty terrible (high), the idea that I might not be able to detect lows eventually is pretty terrifying.

Not speaking for the parent, but I'm a 35 year old T1D who has been diagnosed for only about 7 years and I am already nearly asymptomatic when I have low blood sugars. The risk of becoming asymptomatic for low blood sugars increases over time, but it is completely inconsistent. Some diabetics have always been asymptomatic for low blood sugars, others will go their whole lives and always have easy to detect symptoms. I have a friend who is in his mid forties and is also a T1D; he was diagnosed about 30 years ago and he still consistently gets the shakes when he is any lower than 70.

I was diagnosed when I was 12, about 13 years ago, and I can usually still detect when I'm under 60 or 70. I'm one of the tight-control types that the OP mentioned (6.4 A1c), so this happens a few times a week. I usually notice it when I can't think, and instead wander over the same two thoughts back and forth. Suddenly I realize I'm thinking in the tiniest of circles and go have some yogurt or something.

The first thing my endocrinologist asks when I see him (literally, before he even asks how I'm doing today) is if I can still feel lows. I think he'd get me on a CGM pretty quick if I reported I couldn't.

I'm super interested in this contact lense solution.

In my experience (Type 1 partner), it's repeated and severe lows, say like 4 or 5 in a week, that will give you hypo-unawareness. It's definitely possible to experience that and still have a high A1C, but I don't see it causing hypo-unawareness. I'd highly recommend a pump to get more control.

That is simply misinformation. The problem is you can not extrapolate your personal experience out to the rest of the population. I'm virtually hypo-unaware and I have low blood sugars maybe 2 or 3 times in a month.

I didn't say it was the only way to get hypo-unawareness, it's my experience.

About 13 years. My big tipoff is feeling tired. I'm a night owl and stream on Twitch after a long day of consulting -- I'm NEVER tired before 1 or 2AM.

The most severe problems were the result of a new doctor in their residency changing my long-acting insulin to an intermediate that was also a 30% mix of fast acting, in an attempt to drive my A1C to under 6. This created a serious problem of wanting to give myself insulin for a meal, my blood sugar only being around 90-100 mg/dL, and then being unable to decouple the fast-acting from the intermediate since it was pre-mixed. I hemmed and hawed, but the attending stood by the decision to change to 70/30. I had to change 10 years of regimen instantly, which was fraught with peril.

Two serious episodes later, and a waiting room at a prestigious teaching hospital hearing someone scream, "Your stupid decision has nearly killed me twice", and I'm now back on the long-acting with insulin reactions being rather infrequent (twice a month), and nowhere as severe (catching it around 65-70 mg/dL). My A1C has trended up slightly (6.1-6.2 to 6.3-6.4), but I'd rather that than death by overdose.

Do you just check LDL or do you also check trigs and hdl?

Weird that you don't see any symptoms at such a low level. My vision would completely black out except for maybe half a centimeter blurry hole... everyday. It took hours to recover. I was always munching on snacks to prevent low blood sugar but it never helped. Thankfully I'm alright now.

Another type 1 diabetic chiming in here.

It is not weird not feeling it until such low levels at all. Some diabetics never feel low blood sugars; the longer you have diabetes the more common it is to experience this phenomena. Additionally how you "feel" a low blood sugar varies over your lifetime so the "tells" change. This means we may be feeling different, but have no idea that it is because of a low blood sugar since we haven't felt this new warning symptom before.

When I first was diagnosed with diabetes I could tell quite early if my blood sugar was low. If my blood sugar dipped to just 70 I would start shaking like a leaf. Now I don't have any warning signs at least until I hit around 55 and sometimes not until the low 30s; when I have symptoms at all. I have twice had incidents where I fell because my blood sugar had dipped so low with no physical warning signs. Both times my vision went black for a second and I fell over. I don't know if this was me actually "passing out", but in both instances I recovered almost immediately and immediately consumed large quantities of juice to get my bgl back to normal as quick as possible.

When I do have a tell it is difficult to even notice now; the best way I can even describe it is that I have a very sudden sense of dread as a feel my mind sort of shifting away from me. By this point I'm so low as to be in serious danger zone. I try like crazy to stay out as far away from that as possible by testing as frequently as possible, but your fingers can only take so much; and even if they could take some more the insurance carriers won't cover more test strips anyway.

I think this Google product is a great idea and I would love to see something like this actually work, but like the parent of this thread; I'll believe it when I see it. I've been reading about all sorts of wonderful continual monitoring solutions for BGLs for years and have seen nothing come of it.

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