I have been using an insulin pump with carbohydrate counting for about four years, I exercise faithfully three to four times per week, and my last A1c was 5.7% (normal for my lab is 6.5%). A friend told me that her endocrinologist said that it was okay to have one to two hypoglycemic episodes per week, but I have two to three per week which I always recognize, and now I am feeling that I am not in good control because of the lows. Can you please tell me how many hypoglycemic episodes are acceptable?

There is no published study indicating the number of lows that are acceptable. The number of low sugars increases significantly as patients approach normal hemoglobin A1c levels and, since your value is almost 1% below the upper limit, it may be worthwhile to reexamine your situation to see if you can prevent the lows before they occur. The reason this is important is that the longer you have diabetes, and the more low sugars you have, these episodes put you at increased risk of developing hypoglycemia unawareness. Therefore, it is important to try to minimize lows at every step of the way. I would recommend speaking with your physician about an approach to avoiding hypoglycemia and what is acceptable.

JTL

[Editor’s comment: Your situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what’s happening in more detail. See The Continuous Glucose Monitoring System. With an A1c in that range, you may be having more lows than you are aware of. Please ask your diabetes team about using this device.

SS]