And now a word about...

Hypoglycemia Unawareness

Anyone who has known me for any amount of time knows that after 35 years of this diabetic thing, hypoglycemic unawareness remains one of my biggest problems. The flippin' irony here is that the major instigator of this problem is tight control over your blood sugars and keeping sugars low (the primary goal of the most prudent diabetics) to avoid damaging other essential body parts like the heart, the eyes, the KIDNEYS, etc.

In fact, one of the most distressing problems in diabetes is hypoglycemia unawareness. Normally, a person will feel warning symptoms when their blood sugar goes low, such as shaking and sweating caused by release of stress hormones. However, those with hypoglycemia unawareness have reduced warning signals and do not recognize they are low. Even if they happen to do a blood sugar test they may not realize what they need to do to treat the low. (I test my blood sugars 6-8 times a day and yet this can sneak up at the most unexpected times). It can be soooo sneaky that  a person suffering from HU can be sitting in a chair holding a candybar and not have wherewithal to put it in their mouth. Sometimes, stress hormone release is adequate enough to eventually raise the glucose level, although this may take several hours to work.

That hypoglycemia unawareness could occur during sleep is not surprising since people wake up for less than half of the lows that occur at night, but it happens with equal frequency when people are awake. Unless recognized and treated by someone else, serious problems, such as grand mal seizures, can occur. If you have witnessed seizure activity or bizarre behavior, you have some idea of the danger that hypoglycemia unawareness can present. Fortunately, research and clinical experience has shown that this condition can be reversed.

What Causes Hypoglycemia Unawareness?

Hypoglycemia unawareness is not rare, occurring in 17 percent of those with Type 1 diabetes. Symptoms of a low become less obvious after having diabetes for several years because repeated lows impair the body’s release of stress hormones. The major counter-regulatory hormone that causes glucose to be released by the liver to raise the blood sugar is glucagon. Glucagon secretion is reduced in most people who have Type 1 diabetes within the first two to ten years after onset.

Brain desensitization to hypoglycemia: If a person has frequent episodes of hypoglycemia (even mild ones), the brain becomes "used to" the low glucose and no longer signals for adrenalin to be released during such times. More specifically, there are glucose transporters located in the brain cells (neurons). These transporters increase in number in response to repeated hypoglycemia (this permits the brain to receive a steady supply of glucose even during hypoglycemia). As a result, what was once the hypoglycemic threshold for the brain to signal adrenalin release becomes lower. Epinephrine is not released, if at all, until the blood glucose level has dropped to even lower levels. Clinically, the result is hypoglycemic unawareness.

Since repeated hypoglycemia is common in people with diabetes who strive to keep their glucose levels near normal, the incidence of hypoglycemic unawareness becomes more prevalent in patients who follow 'intensive treatment' protocols.

The most common treatment for this condition is to liberalize the patient's target glucose levels, in an attempt to decrease the frequency of hypoglycemic episodes. Hypoglycemic unawareness will sometimes disappear when the frequency of hypoglycemic episodes has declined, but this is not always the case.

Hypoglycemia unawareness may be triggered by:
A recent history of frequent low blood sugars A rapid drop in blood sugar Having diabetes for many years Stress or depression Situations where self-care is a low priority A previous low blood sugar in the last 24 to 48 hours Use of certain medications like beta blockers

Severe hypoglycemia occurred in 40 percent of people with Type 1 diabetes in one Danish study. Of those who experienced it, it occurred about once every 9 months with coma occurring once every two and a half years. The lower a person’s average blood sugar, the higher the risk for hypoglycemia unawareness. Hypoglycemia unawareness was three times as common in the intensively controlled group compared to the conventionally controlled group in the Diabetes Control and Complications Trial, with 55 percent of the episodes in this study occurring during sleep. Most people do not wake up during most nighttime lows. And recent low blood sugar depletes the stress hormones needed to warn them they are low again. The second low becomes harder to recognize.

A person's actions during Hypoglycemia Unawareness can be bizarre with:
irrational thought big time confusion anger or irritability running away insisting they "feel fine" in the midst of very unusual behavior high stress high emotions laughing and silliness

So.....be patient....and understanding....these people are not....normally hostile....not skitzo....and not drunk.

Try your best to get some sugar into them - high sugar soda, Powerade, orange juice, or  any type of simple sugar. Try to humor them and don't be too controlling or overly aggressive. With the ingestion of a descent amount of sugar, things should return to 'normal ' (hmmmmmm) in about 20 minutes or so. After this quick sugar stabilization, have them eat some more complex carbs, as the simple sugars will take glucose level up quickly, but then they fall rapidly also.

And, as always, ....Thank You for your help and understanding.