Type 2s: Understanding False Hypos

Here's a piece of very important information that doctors rarely give people with Type 2 diabetes which can make a huge difference in the success you have controlling your blood sugar.

If you are not injecting insulin or taking a sulfonylurea drug you do NOT have to worry about hypos!

The word "hypo" is short for "hypoglycemia", which in tern is mangled medical-Greek for "low sugar". A true hypo is an emergency when it strikes someone who is injecting insulin or using a sulfonylurea drug because too much insulin, whether injected or provoked by a drug that overstimulates your beta cell, can make your blood sugar drop so low that your brain cannot function.

But if you are not using insulin or insulin stimulating drugs, you are not at risk for dangerous hypos. Neither Metformin, Byetta, Januvia, Precose, Avandia nor Actos provoke hypos nor can you experience a true hypo if you cut way back on your carbs. What you are likely to encounter if you use these drugs or carb restriction to bring your blood sugar down to normal levels, is a "false hypo."

The false hypo is the feeling of being hypo, which, while it is uncomfortable, is not a crisis, and is, in fact, a well-understood phenomenon that can happen if your fasting blood sugar has been more than 20 mg/dl over true normal levels for any period of time.

To understand the difference between a real hypo and a false hypo, you need to understand that a truly normal fasting blood sugar may range from 70 mg/dl (3.9 mmol/L) up to the low 90s (5 mmol/L). In fact, doctors recommend that pregnant women keep their blood sugars between 60 mg/dl (3.3 mmol/) and 90 (5 mmol/L) mg/dl and consider any blood sugar over 95 mg/dl (5.3 mmol/L) dangerous to the baby.

Clearly, then, a blood sugar in the 60-70 range is not a life-threatening emergency!

Hypos do become dangerous when blood sugar starts to drop into the 40s or lower and if your blood sugar drops into the 20s for any extended period of time you can become unconscious. This kind of hypo can be a huge problem for people who inject too much insulin or take too much of an insulin-stimulating drug, but the only time it will happen to anyone else is if they have a very rare kind of tumor that causes uncontrolled insulin secretion.

The reason people not on insulin don't have to fear real hypos is that your body has an exquisitely sensitive feedback system whose job is to push blood sugar back up as soon as it senses that the blood sugar has dropped to more than 20 or 30 mg/dl (1.7-2.2 mmol/L) below your usual fasting blood sugar level. When this happens, this system kicks in with dramatic effect.

It does this by secreting "counter-regulatory hormones" which are your old friends the stress hormones. One good burst of counter-regulatory hormone and your blood sugar will surge back into the safe zone. Unfortunately, the burst of counter-regulatory hormone may also get your pulse pounding, your sweat pouring, and your body feeling as if you'd just narrowly escaped becoming a predator's lunch.

What makes the counter-regulatory response so hard to deal with for Type 2s--and what adds to the confusion about the danger of hypos--is that the body does not have a set, absolute threshold for responding to perceived hypos. It does not say to itself, "Uh-oh, blood sugar approaching 55, time to do Hypo Repair!".

Instead, it uses a relative threshold based on the fasting blood sugar level it is used to. If you've been running a fasting blood sugar of 180 mg/dl (10 mmol/L) for a while, and cut back on your carbs for a few days, when your blood sugar drifts down to 120 mg/dl (6.7 mmol/L), your body may scream, "Blood sugar 60 mg/dl below normal! Hypo! Hypo!" even though your blood sugar is now, for the first time in months, barely approaching a normal level.

When your heart is pounding and you are feeling shaky and faint, it is very tough to do nothing, especially since your body is helpfully suggesting that all would be well if you'd just scarf down some nice, high carb food to "fix" the problem.

It is not unusual to experience the symptoms of a false hypo, rush to your blood sugar meter, test, and discover that your blood sugar is actually higher than your usual fasting level.

The reason this happens is that by the time you feel the impact of those stress hormones, they have already signaled your liver that it needs to dump a load of glucose into your blood stream to raise your blood sugar to correct the false hypo. And when this happens, you may find you are even more insulin resistant than usual for the next couple hours--to say nothing of feeling very jangled!

This response can be a major barrier on the road to achieving normal blood sugars. If you aren't prepared for it, you may end up sabotaging yourself by reacting to the symptoms of a false hypo by gobbling carbs in the belief that you are fighting a life threatening hypo.

The only way to cure his problem is to know that the body resets its glucose "thermostat" over time and that if you don't treat a false hypo as if it were an emergency your body will eventually get used to a new, lower, fasting blood sugar and only give hypo signals when you are truly hypo--which if you are a Type 2 not using insulin or insulin-provoking medications will be never.

It may take a few weeks for this to happen, and it may happen even if your fasting blood sugar was not all that high. I was experiencing overwhelming "hypo" symptoms when I dropped my fasting blood sugar dropped from about the 110 mg/dl it had been permanently set to for many years to 85 mg/dl. The symptoms were so disturbing, I went to see a doctor who instead of explaining that my "hypos" were normal, took me off the drug that was "causing" the hypos!

I have heard from many people who have had similar experiences, including a few who visited nutritionists who warned them that blood sugars under 100 mg/dl (5.6 mg/dl) were "dangerous" and urged them to drink orange juice to bring up that "dangerous" blood sugar level, stat!

If you've been the victim of such advice, it helps to understand that the nutritionist or nurse who gave this poor advice it to you does not understand that the guidelines they were taught apply ONLY to people injecting insulin or overstimulating their beta cells.

A blood sugar of 100 mg/dl is only an "emergency" if you have injected or stimulated far too much insulin and that 100 mg/dl might be an early stop on the way to a blood sugar of 25!

But if you are controlling with diet or safe drugs, when you feel "hypo", grab your blood sugar meter and test your blood sugar. Unless you see a blood sugar level under 70 mg/dl, you need do nothing. If you feel like you need to do something to deal with the unpleasant symptoms you may experience when your blood sugar drops below 80 mg/dl, please visit Treating Mild Hypos without Creating Rebound High Blood Sugar.

Eventually, when your fasting blood sugar arrives at a normal level, you'll find you feel far better than you did in the past when it was high, and the only "problem" you may then encounter is that the very high blood sugar levels you got used to in the past may now start to feel horribly toxic, which is good, because that unpleasant feeling will help motivate you to keep yourself from experiencing those damaging highs.