How Low Is Too Low???

[KiaKaha]

This may seem a dumb question but prior to my current non insulin dependent diabetes I was only ever a highly insulin dependent gestational diabetic (300+ over night). Thus I have no experience of controlling diabetes through diet.

Since starting I went from around the 205 - 215 mark overnight and after main meals to about 108 +/- 10 over night and about 72 +/- 5 after meals. About 2 weeks ago I stopped recording except for over night when I could remember (about every other day).

Well I thought I'd better make an effort over the last week and get on top of it (just measuring after dinner and overnight). What I am finding is when I have a light dinner particularly I am down to 75 - 80 over night and about 54 after dinner.

Dinner is always my largest meal so lunch and breakfast are probably lower than this (generally what happens with me). If I was insulin dependent at or below these levels I would be getting visual disturbances etc but I am not having any sign of this. I seem to recall someone saying that if you arent insulin dependent your body will never allow your BG to drop too low.

Am I becoming too low?? Should I be eating more carbs or eating carbs more regularly?

I am having about 24 - 30C a day but I am also finding it very difficult to lose weight (1/2 lb a week is fine but at my weight not great) and have been wondering whether I am actually eating enough overall.

Thoughts?

[Lisa N]

IMO, the important thing here is how you feel. I would be about to pass out at a blood glucose reading of 54 but others don't feel hypo even at that low a level.
If you aren't taking insulin, it's not likely that your blood glucose levels are going to drop to life threatening lows but they could drop low enough for you to pass out and that presents dangers of its own, depending on where you are or what you're doing when that happens; for instance, driving or going down stairs.
Your fasting reading looks great, but you (and we) are not getting the whole picture. For example, what does your blood sugar do the rest of the day? Is after dinner the only time you get that low? What do you typically eat for breakfast and lunch? Do you snack during the afternoon? What does your typical daily menu look like? Do you consume diet soda or use artificial sweeteners?
All these are important things to consider as part of the larger picture. :idea:

[CarolynC]

To add to Lisa's questions, are you taking any medications?

I also couldn't handle a low of 54, but you might be able to. (However, I've never had a problem with hypos, only hypers.)

[KiaKaha]

After reading what you have said and doing my bloods for the last few meals I think I may have figured it out.

Today I was back up to 115 over night and am tracking along after meals at about 95 which is a big change from the last few days. After meal last night was also 90 so I was trying to think what was different.

Up until yesterday I had a sore throat for 3 or 4 days and it occurs to me that blood glucose can be affected when you are sick. So maybe this is why?

The only other thing that is different in the last week is that I am taking a homeopathic preparation to improve my pancreatic and liver function as I have a slightly fatty liver.

I would suspect that first off as the timing is right but that doesnt explain why it seems to have normalised again.

Dietwise there were some slight differences during the period it went up. I was tending to have fish and salad a couple of times a day rather than meat and veges (just because I wasnt feeling 100% and couldnt face anything more stodgy) although I get more carbs in salad than from veg as I always have some tomato, avocado and peppers in it. The only other thing that was different was that I drunk more coffee during that time - maybe 4 -5 cups as opposed to my usual 1 - 2.

[CarolynC]

Up until yesterday I had a sore throat for 3 or 4 days and it occurs to me that blood glucose can be affected when you are sick. So maybe this is why?
That's probably it. Since eating low carb, I don't get sick as often as I used to (especially with colds and flu). But, when I am sick, my blood sugar takes a jump up. When it drops back down is when I know that I'm better.

[Rose1942]

This might be a stretch, but have you checked y our meter for accuracy lately? Some of them come with a control solution for that, some don't.

I have a Bayer Contour meter that _says_ it is within normal range, but the new batch of test strips that I got last week show a much higher reading overall than the same meter did with other batches of strips. I've only had the meter for 2 months so I don't think it is the meter, maybe the strips. I have tested each batch of strips using the control solution and until this batch, the range number given was around 117-120 - this batch tested at 142. Still within normal range but gave me a little concern as it was so high.

I also have an Accu-Check and that is showing more or less the same readings that it did previously, which pretty much coincided with the Bayer (before). However that one does not have a control solution and I can't seem to find out how to get it.

So what I have done is to do a little experiment with testing the meters the way Dr. Bernstein suggests - it does waste a lot of strips though and I hate to do it. What you do is to use 4 or 5 strips in a row, taking the blood from a single finger stick, in rapid succession. The readings should be within about 5 points from each other. If not, there might be a problem with either the meter or the strips.

This is what happened when I did it today, because I was alarmed at the 136 reading I got from the Bayer: Using 3 more strips, I checked the Bayer and got readings of 127, 126, and 115 - all in a row within about 1 minute. That 115 didn't look good - how could it drop that much in that time? So I did the same thing with the Accu-Check immediately afterwards and got 109, 107, 109, and 110. Much better , and considering the meal that I ate and the reading before it, I felt this was more accurate. Which leads me to believe that the Accu-Check is more reliable, at least with this batch of strips. But - I don't really know! Maybe I am high all the time, maybe not, this is not funny anymore!

I wish all the meters and strips were better quality controlled to avoid this sort of thing because you just don't know where you are at when you get such widely diverse readings. They are not cheap either, that's for sure. Sort of makes it a worthless excercise in frustration. I can't afford to keep buying meters and test strips to find one that works right, and how would you even know anyway?

I wonder if a reading in the 50's is something you should question, that's all - and if the meter you are using has anything to do with it.

[Samantha22]

Just as a general medical standpoint...as a nurse...without reading anyone else's responses...anything below 70 you should be careful.....mid 60's and your brain is not getting the energy/glycogen that it needs.
Hope this helps :)

[Korban]

I just did 4 sticks from my ReliOn Ultima (Walmart) with cheapo strips...

87
100
89
99

Not too impressed with it anymore... :( I think I may look into Accu-Check. I am especially surprised that the Bayer meter has such lousy precision. Bayer has long been noted for quality.

/smile

[Lottadata]

I
Not too impressed with it anymore... :( I think I may look into Accu-Check. I am especially surprised that the Bayer meter has such lousy precision. Bayer has long been noted for quality.

/smile

I had an Accu-Check Aviva that measured 50 mg/dl higher than the lab when I took it with me. So I'm not thrilled with their meters. With that meter it would be fine for a while, then I'd get a pack of strips that seemed defective. Happened twice and I switched to the Ultra.

And I'm now facing two Ultra meters where one is reading 99 while the other is reading 71. Different vials of strips is the only difference I can come up with. I've had both these meters for a while and never had a problem with them being this far off before, but I just opened a new box of strips on the one. Since I felt hypo, I think the 71 was correct.

The point being that paying the extra bucks for the brand meters doesn't always help. If you are paying for your own strips, you might as well use the Relion.

[Rose1942]

Gee, Jenny - I am surprised about that Accu-Check Aviva and this is why:

A couple of weeks ago I took Dr. Bernstein up on it and called the number for his clinic that is given in the book. They will tell you what meter they are currently recommending. And the lady said 'Accu-Check Aviva'. So I looked that up on the net and it is pretty pricy, decided not to go for it. The one I have is Accu-Check Active' which was $20 (strips for $31) at CVS.

Korban, since 3 of your readings were spot on - I wouldn't give up on it yet, the differential wasn't all that bad compared to what I found with the Bayer. And that may be the strips too.

Something's weird about it all, though - that's for sure!

[Korban]

And I'm now facing two Ultra meters where one is reading 99 while the other is reading 71. Different vials of strips is the only difference I can come up with.

If the two meters use the same type of strip it might be interesting to cross-calibrate the meters with the other's strip... and then check with the different lot of strips in the meters. If you get about the same readings on the same meters as before, the meters are biased. If the strips from the various lots still read the same in the different meter - their is a strip bias (I would guess this). This is probably obvious and I hope I didn't confuse by the way I decribed it above. Perhaps this is too academic anyway but seems like 71 and 99 are significant diffences.

I think I will stay with the Relion for the moment and thanks for the comments re: equipment.

/smile

PS - I wish I felt hypo at 71, I think the beta blockers I take must be messing with me because I didn't feel strange at all with three different days testing in the low 50's. It kinda scared me.

[Lottadata]

I
/smile

PS - I wish I felt hypo at 71, I think the beta blockers I take must be messing with me because I didn't feel strange at all with three different days testing in the low 50's. It kinda scared me.

I have checked these meters before and they are usually within 5 mg/dl.

These strips are reading lower in my other meter, too. Hard to know what to think. With what they cost, you'd think you could trust them, but you'd be wrong.

Beta blockers are known for damping down counter regulation. In my case that might be a benefit. I get too much of it, often when I'm not really low. But the one time a beta blocker was prescribed for me, I read the Prescribing Information and found out they are dangerous to people who are slow metabolizers--which I probably am. My whole family on one side has a long history of overdose reactions to normal doses of medications, self-included, and my doctor told me I am probably missing a liver enzyme. I can't drink worth a darn either.

[KiaKaha]

Well thats really interesting. I did the 4 strip test using the same ones I have been using for the last couple of weeks. It was:

88, 93, 93 and 86 so not much variation there. (We are lucky our meters and strips are free - Medisense Optium by Abbot - seems like a good quality one)

I also dont think it was the strips because it was an after dinner and the following morning reading so that would mean 2 consecutive 'accidentally' low readings which is probably not too likely.

So if you get sick - is your blood supposed to go up or down? Because mine went down so maybe it wasnt being sick.

I am wondering whether it was the homeopathic stuff. I have heard that you can get quite a strong reaction to homeopathic preparations in the first few days of taking them. Given that the stuff I am taking is designed to improve liver and pancreatic function - I suspect it may have temporarily improved insulin production?

Wierd anyway - teaches me not to get complacent about testing!!

[KiaKaha]

Its happenned again!!

Had a light lunch - had someone over so only had about 1/2 a salad and then had a busy day. Was wondering what I was doing having not eaten for 5 hours and did a quick test. So it was down to 70. Debated eating something but had started cooking tea anyway but then tea got screwed up and took longer than I thought so that when I sat down to eat 50 minutes later, I was feeling bad and I was down to 47!!!

I know I should have eaten but I am sure I read somewhere that as long as you are not on medication, your body will not go below a certain level and that it is self regulating. Is this right? Does anyone know? My doctor has never given me any advice at all so all I know is from when I was last pregnant with gestational diabetes and that was insulin dependent.

If its true that I should self regulate it means that the homeobotanicals are acting in some way like insulin and I better keep my carbs more regular to be sure this doesnt happen again.

As a diabetic, how often are you supposed to eat? When I didnt low carb that was something every 3+ hours but now I dont get hungry so go for much longer stretches especially in the afternoon with kids to pick up, toddlers to bath and tea to make.

I know its pathetic that I dont know these things but my doctor isnt exactly engaged (I had to buy all the strips etc to prove to him that I had tripped over into full diabetes and then he told me that readings of 190 were no big deal) and now that I am controlling it with diet he doesnt consider it appropriate to refer me to the diabetes clinic because I am not really diabetic!

I'd love to kick him into touch (sorry rugby analogy - meaning the full length of the field) but we have a 2 year+ waiting list for doctors in our area so having a useless one is better than not having one! Also I heard today that there is something called the Diabetes Society which is a voluntary organisation for diabetics so I am going to mosey over there later in the week when they're open and see if they have any useful advice (no - not the food pyramid again! With the little book that says to eat 2 pieces of toast, 1 cup of cereal and 1 potato per day).

So then my final question is - How do diabetics who IF (like MizzKitty) manage not to go too low when they are Intermittent Fasting?

[Lottadata]

If you aren't taking any meds, supplements or herbs that could lower blood sugar, those lows are really really strange.

Just for the heck of it, why not stop the homeopathic stuff. Supplement manufacturers have been known to put real drugs in supplements to enhance their efficiency. Your response suggests a sulf might secretly be in the remedies you have.

Stop taking them and see what happens. If that doesn't do it, you might have to eat a bit more carbs.

[Nancy LC]

Whenever I get ultra low readings like that it is usually a testing issue. I restick in another spot and try again. It always happened to me when I didn't get enough blood on the test strip and I poked another hole to finish it off.

Also, I think meters tend to be way off when you're under 80.

I would disagree that 70 is low. I think 70-80 is just fine. Maybe if you're used to higher blood sugar levels it feels uncomfortable.

[Lottadata]

Well, today I realized my strips were bad, because they continue to read way too low and my other strips don't.

I called One Touch and they are sending me a replacement box.

Kinda gonna miss those 70s, though. But I know my body to know that I don't see seventies all the time, though I do get hypo symptoms in the 80s.

[Rose1942]

No kidding? You can call the company and they will replace bad strips on just your say so? I didn't know that. Do all the companies do that for you? Because those strips cost plenty of $$$, mine for the Bayer are around $50 and I doubt that Medicare would replace them.

[Lottadata]

Rose,

You can always call the company if you get either defective strips or a bad meter and they will replace them.

I registered this meter when I bought it, well over a year ago, and I registered the meter I bought two years before that. This is the first time they've ever heard from me about bad strips, so that seems legit.

Plus, they send you a label and ask you to send back the box of unused strips. So it isn't like I'm getting any freebies.

[Nancy LC]

I just want to say I'm more and more convinced that my lows are caused by bad testing. It seems to happen most when I have a dot of blood that just barely is enough. For instance, last time I got a reading of 78 and I was somewhat suspicious. So I tested again and got a bigger dot of blood and got a reading of 100.

[Lottadata]

Nancy,

Great to hear you figured that out! Now you can get used to normal blood sugars and start feeling much better!

[dancinbr]

I just did 4 sticks from my ReliOn Ultima (Walmart) with cheapo strips...

87
100
89
99

Not too impressed with it anymore... :( I think I may look into Accu-Check. I am especially surprised that the Bayer meter has such lousy precision. Bayer has long been noted for quality.

/smile

If you are going to do this kind of test the readings MUST come from the same fingerstick of blood not 4 separate sticks.

From what I am getting you will see potentially 10% difference in back to back tests from separate readings from separate finger sticks.

According to Dr. B you should be able to do back to back say up to 4 like you did from the SAME fingerstick (do a good one plenty of blood) and see readings within a range of 5.

Ralph

[RobLL]

87 + 89+ 100+ 99 = 375

375 divided by 4 = 94 (average of the 4 readings)

deviations 7,5,6,5 totaling 23 (difference from average to each of the readings)

average deviation 5.6 (and 5.6 out of 94 is about 6% error or variability from average)

We all would like these to be closer, but this is well within the range offered by ALL suppliers of meters. Res Ralph, if you were to do this from the same finger it likely will have a lower deviation

[dancinbr]

87 + 89+ 100+ 99 = 375

375 divided by 4 = 94 (average of the 4 readings)

deviations 7,5,6,5 totaling 23 (difference from average to each of the readings)

average deviation 5.6 (and 5.6 out of 94 is about 6% error or variability from average)

We all would like these to be closer, but this is well within the range offered by ALL suppliers of meters. Res Ralph, if you were to do this from the same finger it likely will have a lower deviation

Yes, the meter is fine.

I too was in contact with Accuchek and they sent to me the level 1 and level 2 control liquids and some test strips.

My meter tested OK.

These deviations are OK.

The best we can expect is to be within a 10% window of accuracy.

Now, the close deviations, according to Dr. B are only going to be experienced for BG readings between 70-100. Accuracy goes down as BG goes up, but we know that up isn't good so it doesn't matter if a reading of 200 is off by 10% or 20%; it is simply too high.

Ralph

[RobLL]

Ralph - I have never heard about level 1 and 2 control liquids, what are they?

[Lisa N]

Ralph - I have never heard about level 1 and 2 control liquids, what are they?

Rob, some manufacturers refer to them as 'high' and 'low' test solutions. See this link (http://www.medplususa.com/list-product_info-p-Accu_Chek_Compact_Glucose_Control_Solution_Box_of_2-pid-6074.html) for more information.

[Rose1942]

Ralph, thanks for pointing out the variables in testing.

(your comment: )
Now, the close deviations, according to Dr. B are only going to be experienced for BG readings between 70-100. Accuracy goes down as BG goes up, but we know that up isn't good so it doesn't matter if a reading of 200 is off by 10% or 20%; it is simply too high.

I hadn't thought of that, actually. Makes sense.

[Nancy LC]

Does the ReliOn meter have control liquids like that?

[eddiemcm]

Checking the accuracy of the Relion glucose meter can be accomplished with Solartek control
solution.Information is available thru Relion
customer support/website.
A lot of meters include the control solution with the meter
but not Relion.
Eddie

[Nancy LC]

Ah cool! Thanks, Eddie.

[Nancy LC]

Here's the web page for ReliOn with the phone number: http://www.relion.com/information/faq-relion_ultima.htm

[Lottadata]

FWIW, my partner has a Relion meter, since he has normal bgs and his insurance won't cover testing, though he does have a strong family history.

Comparing his Relion to my Ultra, the Relion reads 10-12 mg/dl higher pretty consistently. The Ultras (I've had 3) always read low compared to my old Accu-chek, which is possibly why my A1c is always higher than I expect. But they are consistent. And they are the only meter whose strips my insurance want to pay for at a reasonable copay.

[eddiemcm]

Glucose meter readings are relative.They shouldn't be thought of as absolute.Real blood tests and A1C are the real thing.
Eddie

[Rose1942]

I finally got around to calling Bayer about my Contour meter and the Ascensia test strips. I have been thinking that this batch of strips was somehow off because I was getting consistantly higher readings than with previous batches, and I wasn't doing anything differently. I also have an Accu-Check Active, and that one seems to be more accurate (to me) because testing with the 4 strips in a row always gets me pretty much the same readings, and with the Bayer there is always a big differential. So......... here is how the talk with Bayer went:

First I was asked to do various things with the meter to determine if the electronics in it were working properly. They said it was, so now on to checking the strips. First I had to put 3 drops of control solution on a piece of waxed paper (or any non absorbent surface) and put a test strip into the 2nd drop. Then another strip into the 3rd drop. I gave the tech those readings. Then I was to test with a new strip with my blood. I gave him that reading. He said all readings were within normal range and that the test strips were fine.

However... and this is a big however - he was very specific as to the technique I should use to test with this Bayer meter. He said not to leave the meter lying flat and put my finger TO the meter and let it sip up the blood, but to hold the meter like a pencil and bring it to the blood drop instead. He said that I must never let the tip of the strip touch my skin while testing, or the reading might be off. The end of the strip must touch only blood, so you have to be very steady with the thing. The reading that I got while on the phone with him was 90 mg/dl.

So we ended the conversation with the conclusion that both my Bayer meter and that batch of strips were fine. Frankly I am still not convinced because only with this batch have I had problems. Previous bottles of strips seemed to be accurate to me, with none of the variations that I saw with this batch. I am sure that I have possibly touched my skin sometimes while testing, ever so slightly but even so, I feel that I was getting appropriate readings.

After I got off the phone I wasted even more strips (geez this is getting pricy) and tested the thing again, making sure to be perfect with my technique as he instructed. Immediately got reading of 118 (5 monutes ago I got 90, remember). So I dragged out the trusty little Accu-Check Active and wasted strips for that too - got within 2 mg/dl of 114 four times in a row from the same drop of blood. I still think that one is right!

Anyway, I am only going into this whole thing for you to let you all know that there are indeed many variables involved with testing, and with different types of meters. I guess the best thing is to use one meter only, that you trust to some extent, and use it to determine highs and lows only, not expecting it to be a perfectly accurate but to give you an idea whether you are going up or going down or staying the same. I don't know what else to think!

[dancinbr]

The meter, any meter of the good ones, apparently is only within 10% accuracy.

It is still a good relative measure. You can tell if you are doing well by your reading not jumping all over the place during and after meals.

This gets back to good carb control and/or proper use of insulins both basal and fast acting if you choose to do insulin.

I like to see my BG readings under 100 2 hours post prandial. I like to see my low reading in the 80s. This will happen when I do fast in between meals at least 5 hours.

So, this is part of Dr. B's recommendations that I try to follow.

I suspect as I begin to increase my exercise again, my readings will improve and I may reduce the amount of basal insulin that I now use.

I am doing what is necessary to get my A1C below 5.0.

Ralph

[Lottadata]

Eddie,

Actually the A1c is NOT the "real thing." It's real if you wonder how much sugar is bonded to your hemoglobin A1c cells, but that is about it.

It varies greatly with your hematocrit--if you are at all anemic it will read very low. It also varies with the length of time your red blood cells live. Paradoxically, the better your blood sugars, the longer those cells will live and the more glucose they can collect.

It also, I'm told, is affected by the fructose you eat which has no impact on your lab glucose measurements.

I have yet to ever get an A1c test that begins to match my meter measured blood sugars even when my meters match the lab very closely, except during those periods when I was NOT cutting carbs.

And to validate that the A1c is difficult to interpret, doctors have two different formulas, the Nathan formula and the DCCT formula which give entirely different "mean glucose" equivalents for a given A1c.

And before you get too excited about the lab value--even those may be dicey, I'm told, if the blood sits around for a while before being transported to the actual laboratory.

My strong feeling is that once you get a meter you trust that comes in very close to a fasting blood draw, you can rely on it. I see very similar readings for the same meals over a period of weeks if I don't change meds. Always have. Given an A1c that doesn't match what I've been seeing on the meter, when the meter matches the fasting draw done on the same day, I go with the Meter.

The real question is how good an index the A1c is to complications in an individual. ALL the data about A1c and heart disease, for example, is mean data done with large populations.

When they look at individuals and complications, as is the case with some neuropathy studies, they find that the only measurement that maps to increased complications is the individuals 2 hr GTT test. The A1c is not, for individuals, predictive.

[KiaKaha]

I would have to say that in each of the dozen+ HBA1C's I've had done. The reading has always been lower than my actual and the 2HR GTT (done 6 times). A fair bit lower (I made the assumption it was because my blood glucose was dropping down low during my long between meal times and that this was affecting the average).

[dancinbr]

Fortunately I do not have any complications or other conditions; at least that I am aware of !!! :D

My A1Cs come in pretty close to my average BG readings that my meter produces over 7,14 and 31 days. Close enough that I can use A1C as a good measure along with my BG readings.

I have also asked my Doctor to do a c-peptide test this time to see how much pancreatic function I do have at this point and still can preserve by behaving properly.

Ralph

[Lottadata]

I would have to say that in each of the dozen+ HBA1C's I've had done. The reading has always been lower than my actual and the 2HR GTT (done 6 times). A fair bit lower (I made the assumption it was because my blood glucose was dropping down low during my long between meal times and that this was affecting the average).

This discussion got me doing a bit of research and I turned up an interesting journal article from last year about recent research on A1c variability which I have written up on my blog at http://diabetesupdate.blogspot.com.

As you will see there, research finds that the variability appears to be genetic in origin and that a person whose A1c higher or lower than predicted from glucose monitoring will usually maintain the same difference. This can be confirmed with the fructosamine test which measures something that corresponds more closely to plasma glucose than does the A1c.

What isn't clear from research is whether the A1c or glucose is more predictive of complications. There are conflicting findings there.

[dancinbr]

This discussion got me doing a bit of research and I turned up an interesting journal article from last year about recent research on A1c variability which I have written up on my blog at http://diabetesupdate.blogspot.com.

As you will see there, research finds that the variability appears to be genetic in origin and that a person whose A1c higher or lower than predicted from glucose monitoring will usually maintain the same difference. This can be confirmed with the fructosamine test which measures something that corresponds more closely to plasma glucose than does the A1c.

What isn't clear from research is whether the A1c or glucose is more predictive of complications. There are conflicting findings there.

Thanks.

What is clear to me is the word relative.

An A1C for me at 5.4 and heading down is better than an A1C of 9.3 that I started with almost a year ago when diagnosed.

Getting BG measures frequently during the day is equally important and keeping these BG in a lower narrower band of measures approaching that of a non-diabetic is the goal.

All of this is relative. While the research goes on and the medical society continues to become more educated themselves on the topic, what this points out in so many cases, is it isn't how you diagnose the issue or how accurate you are but it is what you do to help improve your physical condition.

I need to lose weight and I am doing so.

I need to monitor my BG levels frequently and do my best to have a steady state reading under 100.

I need to keep my BG levels from getting over 120 one to two hours post prandial and I am doing pretty well with this. I only get in trouble when I have too many carbs and I don't match my Novolg injection to what I actually consumed.

Yes, is is all relative.

I need to stay low carb as much as possible. The ideal target, I believe is Dr. B's 6-12-12 and perhaps one more 12 in the evening. I definitely try to stay between 30-60. This helps keep the BG levels in a tight range. The theory of small numbers is so critical in managing this disease.

Ralph