Nighttime hypoglycemia question

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Julie G
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Nighttime hypoglycemia question

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Hey brilliant people, I need your help. I was going to ask Jason Fung, but figured I'd try our smart group of citizen scientists first.

I work with people in many different stages of metabolic health, all trying to achieve mild ketosis. They often experience nighttime hypoglycemia and are alerted by their CGMs at night. When insulin resistant and symptomatic, it makes sense to treat. But what about insulin sensitive folks, who have no symptoms? My guess is that this is a normal physiological phenomenon; glycogen stores are depleted and they are simply shifting into ketosis. IMHO, treating in this case would be counterproductive. TIA for your thought.
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Tincup
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Re: Nighttime hypoglycemia question

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Julie G wrote: Fri Jun 17, 2022 8:00 am I work with people in many different stages of metabolic health, all trying to achieve mild ketosis. They often experience nighttime hypoglycemia and are alerted by their CGMs at night. When insulin resistant and symptomatic, it makes sense to treat. But what about insulin sensitive folks, who have no symptoms? My guess is that this is a normal physiological phenomenon; glycogen stores are depleted and they are simply shifting into ketosis. IMHO, treating in this case would be counterproductive. TIA for your thought.
I concur with not treating insulin sensitive folks, especially if they are making at least a modicum of ketones. I responded to someone here about that as their CGM was set for an alarm when glucose dropped below 70 mg/dL (3.89 mmol/L). This person was making ketones and was obviously fine. My suggestion is to turn off the alarm! It is what I do if I wear a CGM. Wednesday was an air travel day for me. My habit is to always fast till at least the next day as BHB will protect against radiation (per the late Dr. Richard Veech of the NIH). The next morning (36 hours fasted), my glucose was 57 mg/dL (3.17 mmol/L) and ketones were 1.7 mmol/L.
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Julie G
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Re: Nighttime hypoglycemia question

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Tincup wrote: Fri Jun 17, 2022 10:28 am I concur with not treating insulin sensitive folks, especially if they are making at least a modicum of ketones. I responded to someone here about that as their CGM was set for an alarm when glucose dropped below 70 mg/dL (3.89 mmol/L). This person was making ketones and was obviously fine. My suggestion is to turn off the alarm! It is what I do if I wear a CGM. Wednesday was an air travel day for me. My habit is to always fast till at least the next day as BHB will protect against radiation (per the late Dr. Richard Veech of the NIH). The next morning (36 hours fasted), my glucose was 57 mg/dL (3.17 mmol/L) and ketones were 1.7 mmol/L.
Thanks, Tincup. As you know, the group I work with can be elderly and insulin sensitivity falls on a spectrum, so it's difficult to provide definitive instructions... and we always have to err on the side of safety. I checked with an endocrinologist yesterday and he suggested setting the CGM alarm to 55. If it goes off and the user is asymptomatic, he says to wait 10-15 minutes and repeat a finger glucose check and treat if truly below 55 at that point. I wonder if checking ketones makes more sense? I may still reach out to Jason Fung to see what he recommends.

Because I'm a little weird, like you :D I've conducted experiments to see what happens to my BG while shifting into ketosis. I check both BG and BHB every 15 minutes. I've seen my BG drop below 50 mg/dL before ketosis kicks in. Strangely, once I'm ketotic, my BG bumps up and remains steady at 70-80 mg/dL. Not sure what's going on there.
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Re: Nighttime hypoglycemia question

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Julie G wrote: wonder if checking ketones makes more sense?
I would think ketones would be protective. You’d need to talk to a doc that understands that. Also making sure they aren’t on hypoglycemic meds. However I understand metformin isn’t an issue.

I recall George Cahill’s study from the 1960’s where they water fasted obese seminary students for 6 weeks, then gave them insulin. Average glucose was 1 mmol/l. (18 mg/dL) lowest was 0.5 mmol:L (9 mg/dL). There were no cognition issues. Lowest I’ve dropped mine is 32 and my 4/4 wife is 39. All without issue.

Can’t set hypo level < 70 on my Abbot meter. Not sure about the phone app.
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Re: Nighttime hypoglycemia question

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I also find that the CGM seems to less accurate at lower levels. I've had my alarm go off a few times and when I check with a pin prick it is 90-100.

I also find that at my levels of insulin, if I go below what the brain is comfortable with, I will see a rebound. I'm assuming a little adrenalin.
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