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Hi fellow bloggers,
Last week I shared with you a patient story about "hypoglycemia unawareness" — a condition in which a person with diabetes doesn't experience the usual warning symptoms of hypoglycemia. This week I'd like to share some risk factors and possible treatment strategies for such hypoglycemia unawareness.
Long-standing type 1 diabetes. Reduced awareness of hypoglycemia is common among people who have long-standing insulin-dependent diabetes. Many of those who've had diagnosed diabetes for 15 to 20 years report having lost their ability to perceive low blood glucoses and to often failing to treat and prevent severe hypoglycemia.
Severe hypoglycemia is an episode in which the person with diabetes is unable to treat him or herself and needs the assistance of another person. This includes prompting by a relative or friend to drink juice or eat.
Being an older adult and having type 2 diabetes. There also have been an increasing number of hypoglycemia unawareness episodes in those with type 2 diabetes; adults older than 65 seem to be most at risk.
Strict avoidance of hypoglycemia. Strict avoidance of hypoglycemia for several weeks to months can restore at least partial awareness of warning symptoms. Strategies for avoiding hypoglycemia when you have hypoglycemia unawareness or don't experience the warning symptoms include:
Glucagon for emergencies. Glucagon is the treatment of choice if someone with diabetes is unconscious or unable to swallow. The length of time a person is unconscious, is more of a concern than how low the blood glucose number is.
Ask your health care provider for a prescription for Glucagon or GlucaGen and for instructions on how to use it. Instruct your family members or friends on how to use this in an emergency and on how to access the emergency response team, such as calling "911."
Have you lost any awareness of symptoms of low blood glucose? How have you coped?
Regards, and have a good week.
Sara J. Carlson, R.N., C.D.E.
Peggy Moreland, R.N., C.D.E.
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Hi Sara and Peggy,
My husband who has had a Whipple's done and his pancreas entirely removed is going through severe hypoglycaemia unawareness. This is sadly happening at odd hours of the night maybe 2 or 3 AM. Its scary what if i don't wake up and realise he is in this state. I read your post on this and what we need to give a patient at such times.
Having said this could you please suggest how can I prevent this from happening in the first place as its happening at a very dangerous time when all are asleep? His diet is fine and rich in proteins. Your advice will be most appreciated
My Doctor gave me a Hypoglycemic test of a extremely high Glucose drink. My blood sugar jumped to over 300 in no time and I was feeling "Wired". Two and a half hours it started down and dropped to 60. I felt like laying down and resting. He explained I hit a High from the Glucose intake and my Pancreas Dumped a lot of My Own Insulin into my Blood Stream to combat the HIGH. Thus causing my Glucose to DROP heavily to near Fainting Levels. He advised I eat / Snack 5 to 6 times a day and Avoid Sugars and High Carbohydrates thus avoiding the "Glucose Swing". I become light headed / woozy when I have Low Blood Sugar and Weak / Stumbling around. I find snacking on Low Fat String Cheese between Smaller Meals Helpful. I'm not much on juice but Love Fresh Carrot Juice. for years they told me I was a Type 2 Diabetic managed by diet. My Glucose Meter said "Do You Need A Snack" when I had low B/S. I had advised the Doctors but they didn't listen until 5 months ago. Finally I am getting some relief. JERRY
Dealing with my dad who is 57 years old. 20+ years a type 1 diabetic. Sudden adult onset. Not drug/alcohol abuse related, just happened. He was misdiagnosed with type 2, lost significant amount of vision(far-sight), and subsequently re-diagnosed as Type 1.
He seems to have the worst most destructive and horrible hypoglycemic unawareness. Two severe car accidents, several hospitalizations, broken leg from sudden seizures(while in the kitchen getting food), Dozens of calls to ems, and hundreds of close calls over the past 7 years.
I am glad I found this article. Maybe this is something I can present to him and maybe get him back to being able to tell when it's going down
The symptoms of hypoglycemia can be caused by other things besides being on diabetes medications. Not eating enough or fasting can bring on symptoms of low blood glucose; eating a healthy balance of protein, fat, and carbohydrates at each meal will help give you fuel or energy lasting 4-5 hours.
As far as I know I do not have diabetes, however this shakiness, sweating a d feeling I must eat something very quickly seems to on me when I have carbs for breakfast. So therefore I thought I should be eating more protein. I don'tknow exactly what I should eat to avoid this
i have hypoglcemic unawareness that is why i always check my blood suger and make sure i always carry a snack with me when i am away for long periods of time when my blood sger is too high or to low i cannot even tell i feel fine my suger was down to 74 and i did not even know it then it was 266 and i could not even tell
I have been reading your blog entries because I am experiencing more hypoglcemic episodes lately which scare me. ALSO, I am quite unaware of symptoms at times. I have had episodes where I feel nothing until I get up from bed, at which time I have fallen, almost passed out, & had to crawl to fridge to get cola or juice etc. I take medications for chronic pain daily. These meds can also make me tired, sometimes have headaches, & feel unaware. I am oftentimes alone, & there is nobody who can always be with me. I am only 45 years old & take care of myself regularly. But with these happening more frequently, I am fearful of what will happen if my sugar drops when I am alone if I do pass out. What are strategies for those in my situation where being alone at times is simply unavoidable along with being symptomatically unaware? We have a cat in the household who despite never being trained to do so, awakens my husband when he has a low blood sugar, however, she does not do this with myself & I do not know why, except for possibly that my husband is a brittle diabetic who sweats A LOT on lows, & I do not. Also, Bandit has just always been basically a 1-master pet since a kitten. My cat, Smokey, is just a cat, not a hero, which is fine with me. But I could use some suggestions to the concerns I have touched on here. Thank You in Advance
Thank you for the suggestions on retraining your body/mind to recognize low blood sugars. I have suffered from Hypoglycemic Unawareness for 15 years. I've had type 1 diabetes for 24 years. I'm retired from law enforcement, after 20 years, due to having suffered several serious injuries while on the job.
I have been working rotating shifts the past 5 years, while working in security as a patrol officer with a port authority. The combination of working rotating shifts and suffering with hypoglycemic unawareness has brought significant challenges with glycemic management. I have had a blood sugar of 16, 17, 24 etc on several occasions with absolutely no symptoms. I've lost consciousness on two occasions and during the last episode, I was driving and it took 6 police cars to get me to stop. Not only was this embarrassing, I also lost my drivers license for over 2 months and had to change my diabetes management.
I'm now using the Medtronc continuous blood glucose monitor along with my current insulin pump. It is tedious at times but it saved my job and allowed me to drive again. The sensors used to monitor my blood sugars work accurately 75% of the time and alright the remainder. The system is continually getting easier to utilize and as a result, more accurate. I'm grateful to have this tool. I have tried to maintain higher ranges with my blood sugars and avoid eating poor food choices. I would like to do more research and in operate the suggestions you mentioned.
I'm surprized that setting an alarm to remind you to eat the correct things at the proper intervals is not suggested. But maybe you would learn that at "blood glucose awareness training education programs"?
I travel for my job, alone, and spend a week at a time in a hotel, alone and have fallen and injured myself due to low BS. I am 7 years post Gastric Bypass and have kept my weight off, but still have diabetes with this new complication. I am completely unaware of when my BS is getting so low. The cost of a service dog is 12 thousand dollars. I have done the research and located a trainer and would love to get a dog. I take Acarbose and eat as directed by my doctor, and still have those low readings...it's horrible. I get so confused and then I start crying, and then the shaking is so bad by the time I realize how low my BS is, I sometimes cannot use my glucometer, or a telephone. And when I am alone, I am so afraid I will die. I am sad and my boss may not accomodate me for my health needs. I have a teenager at home, so at least when I am home, I am not alone.
I check my bg at least 7 times a day but will still have problems with it going low. Never know it when it is going one. Any way to change this?
Very concise and educative
Lately I have been having episodes of low blood sugar that I don't recognize until I'm so confused, and I know something is wrong but I'm not quite sure what it is. This morning it happened and I thought it might be low blood sugar, so I took it it and it was 30. I did the usual with the glucose tabs , followed by some protein. There have been times when my husband has recognized the symtoms and given me the glucose. I was very glad to read that this is not just me, and that other people are having these symptoms too.
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