What is Hypoglycemic Unawareness?

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What is Hypoglycemic Unawareness?

Question:

Hi fellow DiabetesSisters,

This past weekend, I had a very frightening experience that I would like to share with you in hopes of making everyone more aware. As a person with Type 1 diabetes, I have certainly had my share of low blood sugar. Technically, low blood sugar is defined as any number less than 70 mg/dl. Hypoglycemia is the result of excess insulin in the blood which causes the sugar level to drop. Symptoms can vary from person to person as well as in severity but most commonly people feel shaky, sweaty, rapid heart rate, and anxiety, irritability. We all are usually aware of our symptoms and treat with the appropriate 15 grams of carbohydrate and within 10- 15 minutes, we feel better and the hypoglycemia goes away. If the symptoms are ignored, or no treatment is given, blood sugar could continue to fall, which can result in behavior change, confusion, stupor, and unconsciousness. Usually when a person’s blood sugar drops, the body releases the hormones glucagon and epinephrine. Glucagon spurs the liver to release stored glucose and epinephrine signals the liver to produce more glucose. These hormones are also responsible for the warning signs of hypoglycemia.

Answer:

Some of us may no longer have these typical warning signs of low blood sugar. We do not feel them either at all or not every time. This situation is called hypoglycemia unawareness - simply you are not aware of the low sugar. It can be caused by nerve damage that affects the body’s ability to secrete epinephrine. People with type 1 diabetes can have impaired epinephrine secretion. Often people with very tight blood glucose control may also lose their ability to sense low sugars. Often, we healthcare people will advise our patients with hypoglycemia unawareness to let their blood sugars “run a little higher” to help reestablish those symptoms of hypoglycemia. With out those warning signs, again, a person may end up with a severe low leading to confusion, disorientation or unconsciousness. Sometimes, the symptoms may come back after a period of higher blood sugars but sometimes they do not. People with hypoglycemia unawareness need to be very vigilant about checking their blood sugar to protect themselves and those around them. 

Here’s my story. As you may know, I’ve had diabetes for 41 years and again have had my share of low sugars. I also do not always feel my lows so yes I too have hypoglycemia unawareness. I have found myself many times needing someone’s help when I have been “out in the north 40” so to speak. This past Sunday, I had to get up very early as I was going to be in a horse show. So at 4:30 am I awoke, checked my BG which was high at 200mg/dl. I took my usual correction dose and changed my pump site as well. I packed my car with all I would need for the day, let the dog out and was on my way to the barn to load my horse on the trailer and get to the show. I checked the time in my car and it was 5:38 am. I drove about a mile down the road and that’s the last thing I remember until I found myself on a dirt road trying to back up my car. Two people were out side my car window telling me I was about to run into a ditch. I rolled down the window and asked them where I was. They thought I was drunk and tried to take my keys away from me. I told them I had diabetes and needed to check my blood sugar. One of them said his grandmother had diabetes. My blood sugar at that time was 40mg/dl. They gave me some Gatorade and I found some glucose tabs in my purse which I also ate. My blood glucose rose to 75 mg/dl within about 15 minutes. By this time it was about 6:10 am. I had driven about 10-15 miles from my house pretty much unconscious and somehow ended upon a dead end street in another town. Thank God I didn’t hurt anyone or myself and that these two people were so nice to me. They led me back to the main road and off I drove to the barn to try to make it to the horse show. I admit I was a bit disoriented by this whole thing but made it to and through the horse show and even won a few ribbons. But by the end of the day, the gravity of this situation hit me. Wow I really need to pay closer attention especially when I am going to be driving. I already check my blood sugar about 10 times a day but I just need to remember even when I am in a hurry, trying to get a million things done that with diabetes not everything happens the same way every time so double checking blood sugar before getting behind the wheel of a car is my new rule.