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Diabetes Knowledge

Blood sugar levels – lower is not necessarily better

8/23/2018 by Michèle Theißen

Blood sugar levels – lower is not necessarily better

You might see a summary of your blood glucose levels in the mySugr app and think, "Wow, my blood sugars are in the lower target range. That's great! I’m doing amazing!” But beware: lower is not always better! Flying so low can sometimes be dangerous.

Of course, it’s great when your blood sugar levels are on target. But diabetes management is a delicate dance! For those who don’t yet enjoy the technology solution of closed-loop systems, it’s a real challenge to balance everything (such as food, stress, activity) and stay safely in range. 

Typically, the lower you try to keep blood sugar levels, the more hypoglycemia you bargain with. That’s a risky trade-off that you should consider carefully. This is especially so if you aim to run on the low end of normal for fear of complications. Strict targets of 100 mg/dL (5.6 mmol/L) and lower are common.

Hypoglycemia is nothing to mess with! Often it comes with a series of unpleasant symptoms that make you feel terrible, and in the worst case, can cause unconsciousness. But even if you avoid the worst, there are long-term effects to consider.

What is the problem?

Hypos beget hypos! One big problem with low blood sugars is that it increases the risk of future hypoglycemia.

The more often your sugar level drops below 70 mg/dL (4 mmol/L), you increase the risk of hypoglycemic unawareness, which means that you do not feel the symptoms of low blood sugar levels. Imagine this: in someone without diabetes, when blood sugars drop to around 65-70 mg/dL (3.6-4 mmol/L), the brain is short on glucose and triggers the hormone glucagon. Glucagon then triggers the release of stored sugar reserves from the liver, and your blood sugar rises again. Unfortunately, that glucagon response doesn’t work as well for many people with diabetes.

Thankfully, your body has another way to react! At blood sugars around 60-70 mg/dL (3.3-4 mmol/L), the body is stressed, and adrenaline is released. Adrenaline triggers those unpleasant symptoms of trembling, sweating and restlessness, etc. Adrenaline also helps to increase blood sugar by stimulating the release of sugar from the liver and inhibiting the consumption of sugar in the muscles.

Attention, important, warning!

Here comes the problem: that adrenaline release only works if you don’t go low ​​too often. If you do, your body starts to think it’s normal to be that low and will not trigger the adrenaline response correctly.

For people who have lived with diabetes for a long time and experience hypoglycemia often, the adrenaline response may be blunted or not happen at all. There are hardly any noticable signs of hypoglycemia and no early counter-regulation help from your body. Welcome to the vicious cycle – the less you feel your low sugars, the harder it is to prevent them.

The good news

If you have lived with diabetes for a long time and struggle with hypoglycemic unawareness, you may want to talk with your diabetes coach and care team about raising your blood sugar levels and targets for a while. I know, it is not easy, especially if that old diabetes training of long ago is deeply ingrained! 

Your adrenaline response is likely to recover when your blood sugar levels are less likely to drop below 70 mg/dL (4 mmol/L). And perhaps it will also reassure you to run a bit higher instead of battling with so many lows. Temporarily, an increased target range is not uncommon, but you need to talk to your care team for specific targets.

The mySugr website does not provide medical or legal advice. mySugr blog articles are not scientific articles, but intended for informational purposes only.

Medical or nutritional information on the mySugr website is not intended to replace professional medical advice, diagnosis or treatment. Always consult a physician or health care provider with any questions you may have regarding a medical condition.

Michèle Theißen

Michèle Theißen is our Head of Diabetes Coaching and has been a dedicated mySugr monster tamer since 2017. She is a certified dietician and certified diabetes educator DDG (German Diabetes Association).

For her, learning is a never-ending process. Which is why she is currently studying Health Care Management at WU Executive Academy in Vienna on a part-time basis.

Michèle found her specialization early on in diabetology.  She has supported people with diabetes in all forms of therapy for many years already. Before diving into building up the online coaching department at mySugr, she gained editorial experience working for Burda Publishing House.

You can listen to her talk about the mySugr coaching project in an episode of the German Zuckerjunkies podcast.

When Michele isn’t helping tame the diabetes monster, you’ll find her recharging in the outdoors or cooking.