WHAT IS HYPOGLYCEMIA UNAWARENESS?
Hypoglycemia often happens once blood glucose levels drop below 70 mg/dl and known symptoms alert us to indicate our body is crashing. The hypoglycemia unawareness definition is when a person’s blood glucose levels fall below this level but they do not feel or sense the symptoms of hypoglycemia.1
The sympathoadrenal response, which is the responses in the brain that prompt known symptoms like; sweating, shaking, disorientation—is interrupted and hindered.2 The brain no longer sends out signals to the body to bring about the symptoms of hypoglycemia,3 so the person does not recognize the warning signs.2 As with hypoglycemia, the body does not release hormones as it normally would in order to combat the dramatic drop of glucose levels.
With unawareness, the person will crash without warning and the result could mean severe hypoglycemia or very serious symptoms.4
Severe hypoglycemia happens when blood glucose levels drop so low that a person cannot treat themselves without assistance from another person—due to disorientation, confusion, or unconsciousness. This could mean a family member, friend, stranger or emergency responder encourages the person to drink a juice, eat something, or if the person is unconscious, inject them with glucagon.5 Serious symptoms may include; loss of consciousness, seizure,4 coma, or in rare cases, death.
If a person is disoriented or becomes unconscious, they could injure themselves or others. A severe episode could cause someone to fall down stairs, hit their head, or endanger others, as well as themselves, by having a car accident while driving. These are all very dangerous possibilities which could be fatal. Experiencing seizures or unconsciousness because of severe hypoglycemia can cause brain damage since the brain is being deprived of glucose, the fuel that it depends on to function.6
Hypoglycemia unawareness may happen more often in people who have repeatedly experienced low blood glucose levels, have had diabetes for an extended period or who tightly control their diabetes. This can desensitize a person from detecting or noticing early warning signs of an oncoming hypoglycemic crash.1
While asleep, it may be more difficult for people with hypoglycemia unawareness to wake up if they experience hypoglycemia.1 A continuous glucose monitor or CGM, is a device that monitors blood glucose levels during the day and nighttime hours and is a solution for people who are at risk or already have hypoglycemia unawareness. CGMs will alert you with an alarm if blood glucose levels fall too low.7 People who have this condition should check blood glucose levels often, notably before driving.8
Managing hypoglycemia so glucose levels remain balanced and episodes do not occur for several weeks or months may bring back some sensitivity to warning symptoms.
A plan of action could be too;
- Aim for a higher blood glucose target
- Work on counting carbohydrates with more accuracy
- Do not overcorrect or buildup insulin doses
- Check blood glucose levels more often and change insulin doses
- Look into education programs on blood glucose awareness training
- Learn about continuous glucose monitors, (CGM)
- Think about pursuing a service dog trained to recognize low blood glucose5
In an emergency when a person is unconscious or not able to swallow, administering glucagon is ideal. Talk with your physician about options for managing this condition and about a prescription for Glucagon or GlucaGen. Educate family and friends about glucagon and how to use it if you choose to use this product.5 (Check out my review of HealthTap, a service where you can speak with a doctor directly.)
Published March 10, 2017
If you have any thoughts, questions, concerns, or want to share a piece of your personal experience with unawareness, please feel free to post a comment below!
1. Hypoglycemia (Low Blood Glucose). American Diabetes Association. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html?referrer=http://google.diabetes.org/search?site=Diabetes&client=diabetes&entqr=3&oe=ISO-8859-1&ie=ISO-8859-1&ud=1&proxystylesheet=diabetes&output=xml_no_dtd&proxyreload=1&q=hypoglycemia%20unawareness. Updated July 1, 2015. Accessed March 10, 2017.
2. Andrew Curry. Going Low: Hypoglycemia: How the brain responds to low blood glucose. Diabetes Forcast. http://www.diabetesforecast.org/2015/may-jun/going-low-hypoglycemia.html. Published May 2015. Accessed March 10, 2017.
3. Mayo Clinic Staff. Diseases and Conditions: Hypoglycemia. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/hypoglycemia/basics/complications/con-20021103. Published January 20, 2015. Accessed March 10, 2017.
4. Nancy Klobassa Davidson, RN; Peggy Moreland, RN, CDE. Living with diabetes blog: Understanding hypoglycemia unawareness. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/diabetes/expert-blog/hypoglycemia-unawareness/bgp-20056549. Published August 10, 2011. Accessed March 10, 2017.
5. Nancy Klobassa Davidson, RN; Peggy Moreland, RN, CDE. Living with diabetes blog: Avoiding hypoglycemia unawareness. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/diabetes/expert-blog/hypoglycemia-unawareness/bgp-20056569. Published August 19, 2011. Accessed March 10, 2017.
6. Is Low Blood Glucose (Hypoglycemia) Dangerous?. Joslin Diabetes Center. http://www.joslin.org/info/is_low_blood_glucose_hypoglycemia_dangerous.html. Accessed March 22, 2017.
7. Low Blood Glucose (Hypoglycemia). National Institute of Diabetes and Digestive and Kidney Disease. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood-glucose-hypoglycemia. Published August 2016. Accessed March 10, 2017.
8. Hypoglycemia. Diabetes Forecast. http://www.diabetesforecast.org/diabetes-101/hypoglycemia.html. Published October 2013. Accessed March 10, 2017.