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Diabetes Day by day has in necessary interview with Dr Steven Edelman on hypoglycemia (significantly in kind 1 diabetes) and the necessity for injectable glucacon to deal with it. This might simply apply additionally to kind 2 diabetes that’s handled with insulin or different medication that may trigger hypoglycemia. People with kind 1 diabetes appear to be extra liable to hypoglycemia unawareness. That’s, the blood sugar is dangerously low, however not acknowledged or handled promptly, doubtlessly ensuing dying. Dr Edelman notes that harmful hypoglycemia has been considerably lowered by means of steady glucose monitoring (CGM).
Notice that CGM measure glucose ranges within the the fluid in between the cells of subcutaneous tissue (AKA interstitial fluid). Your acquainted fingerstick glucose is measuring capillary fluid ranges. Capillaries are tiny blood vessels on the finish of arteries. After going by way of the capillaries, blood enters veins for the return journey to the lung and coronary heart. Glucose ranges within the interstitial fluid and capillaries might not be the identical as within the giant arteries delivering glucose to the mind. Most CGM gadgets will present the person with an alert when the glucose degree drops too low, in order that remedial motion will be taken.
An excerpt from Diabetes Day by day:
What are some ways in which the CGM can most successfully assist keep away from hypos?
Properly, one of many issues I do in clinic is to actually examine the place folks set their higher and decrease alerts. I had a affected person yesterday in clinic who has had kind 1 for 60 years. Her A1C is unbelievable, however she does have hypo unawareness and her decrease alert was 65. You need to persuade folks that the additional alerts are value it to you.
Quite a bit of individuals mentioned they put their decrease alert at 65 and so they don’t understand this scenario referred to as the “lag time.” So, when your blood sugar is dropping, even when you may have a diagonal arrow down in comparison with, even worse, one arrow down or two arrows down, taking a look at the Dexcom arrows, they don’t understand that the glucose in your circulation might be a lot decrease than it seems on the Dexcom monitor or your telephone. As a result of the Dexcom sensor and different sensors too, they measure the glucose within the subcutaneous tissue, and there’s a lag between the subcutaneous tissue and the circulation.
When your Dexcom goes off or when your CGM goes off at 65, and in case your development arrow’s happening, you could possibly be 45 or 40. In order that’s actually an necessary concern, particularly for those that their signs aren’t as apparent anymore. You possibly can be caught off guard. And I had a number of sufferers that has occurred with. After which sadly, as , the vast majority of T1Ds on this nation don’t put on a CGM and that’s the subject of an entire different story.
Does this lag time concern apply to an everyday glucometer as properly?
Sure. In case your blood sugar is dropping, your meter or CGM could also be completely correct of the subcutaneous tissue at 65. For those who checked your blood sugar with a meter, it’s nonetheless going to say 65, however your circulation that’s going to your mind is likely to be 45. So, the lag time is essential. You might have essentially the most correct meter or CGM on this planet, it doesn’t have an effect on the lag time.
Click on for my five-year-old article on medication that may trigger diabetes.
Click on for my transient article on hypoglycemia unawareness.
Click on for my common article on recognition and remedy of hypoglycemia.
Steve Parker, M.D.
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