Yes. Realistically, it is difficult to reach a bad end from a single, isolated hypo event.
But I have myself made the mistake of underestimating hypoglycemia. Growing up, I always had issues of under-dosing insulin, because my bodyweight was always increasing; it seemed like I could always get away with giving a bit more insulin. When I stopped growing in my early 20s, I kept on with the aggressive dosing (got frustrated with the high BG feeling!) and had a string of severe hypo incidents. I had no idea what was happening during these events, but not only that, my neurological response changed and I had hypoglycemic unawareness. And, since I was so aggressive with insulin, my counterregulation was gone, so doses and meals that used to end in 80mg/dL were now ending in 30 mg/dL. And because my neuro response changed after the first few, I would slip into complete unawareness even during a mild 55 or 60 mg/dL.
Unawareness feels like: gosh there is something going on but I don't know what. There's something that I urgently need right now (sugar), if only I could place it. I have to be somewhere (work) this morning, but I don't know where... Imagine having a vivid dream, in which something in the room (like a person talking next to you or a fan turning on or something) affects the dream. Now, while you're in the dream, try to figure out what and where that thing actually is. It can be very very difficult, because it's like, the bug is in the operating system.
You can easily die from this, and many people do, I think the common figure is 1 of 20 t1d end up dying this way. Overaggressive treatment after the honeymoon period ends, when growth stops, or when changing insulins (like moving from long-acting to the pump), or even just having a bad flu -- there are many ways to make this mistake. And it is not obvious at all when you are making this mistake.
But I have myself made the mistake of underestimating hypoglycemia. Growing up, I always had issues of under-dosing insulin, because my bodyweight was always increasing; it seemed like I could always get away with giving a bit more insulin. When I stopped growing in my early 20s, I kept on with the aggressive dosing (got frustrated with the high BG feeling!) and had a string of severe hypo incidents. I had no idea what was happening during these events, but not only that, my neurological response changed and I had hypoglycemic unawareness. And, since I was so aggressive with insulin, my counterregulation was gone, so doses and meals that used to end in 80mg/dL were now ending in 30 mg/dL. And because my neuro response changed after the first few, I would slip into complete unawareness even during a mild 55 or 60 mg/dL.
Unawareness feels like: gosh there is something going on but I don't know what. There's something that I urgently need right now (sugar), if only I could place it. I have to be somewhere (work) this morning, but I don't know where... Imagine having a vivid dream, in which something in the room (like a person talking next to you or a fan turning on or something) affects the dream. Now, while you're in the dream, try to figure out what and where that thing actually is. It can be very very difficult, because it's like, the bug is in the operating system.
You can easily die from this, and many people do, I think the common figure is 1 of 20 t1d end up dying this way. Overaggressive treatment after the honeymoon period ends, when growth stops, or when changing insulins (like moving from long-acting to the pump), or even just having a bad flu -- there are many ways to make this mistake. And it is not obvious at all when you are making this mistake.