What is Hypoglycemia Unawareness and Can It Happen to Me?

If you’ve never heard of the term “hypoglycemia unawareness”, you’re not alone.  However, you’ve likely heard about events that can be caused by hypoglycemia unawareness, such as “insulin shock” or “diabetes coma". Learning about someone with diabetes passing out or being nearly unresponsive because of low blood sugar can be very scary.  Here’s the nitty-gritty on hypoglycemia unawareness and understanding if you’re at risk of it happening to you.

What is hypoglycemia unawareness?

Hypoglycemia unawareness is when your body stops giving you signals that your blood sugar is too low. Or gives you signals at a much lower blood sugar level than it should. That means you can fall into a coma or have a seizure from an extremely low blood sugar much more easily. This also increases your chance of sudden death from diabetes.

How does hypoglycemia unawareness happen?

In my experience, one of the biggest causes of hypoglycemia unawareness is frequent low blood sugars. Your body has a set point that it considers to be a healthy range for your blood sugars. That set point can adjust up or down if your blood sugars run higher or lower for a long period of time.

For example, imagine your body’s set point is 70-140 mg/dl. Now image you’re having 4-6 low blood sugars every week. Slowly your body starts to assume that you should be running 50-110 mg/dl. It stops giving you low blood sugar signals at 70 mg/dl because that’s now considered “normal”. Your blood sugars may have to be closer to 50 mg/dl or below before you’re alerted about hypoglycemia.

In extreme hypoglycemia unawareness, signals for low blood sugars may no longer happen until you’re as low as 20 or 30 mg/dl, or they disappear altogether.

Am I at risk of hypoglycemia unawareness?

You’re at risk for hypoglycemia unawareness if you take diabetes medications that can cause low blood sugars and you’re having low blood sugars on a regular basis. If this sounds like you, work with your healthcare team to determine if you’re having hypoglycemia unawareness. Here's a way I often ask people to screen for hypoglycemia unawareness:

The next 3-4 times you feel a low blood sugar symptom, check your blood sugar. If most of the blood sugar readings are 60 mg/dl or less than you likely have hypoglycemia unawareness. Your body has stopped sending signals at the first signs of danger (a blood sugar around 70 mg/dl).

Also, if you find you're often surprised by a low blood sugar when your checking on your glucometer, hypoglycemia unawareness should be on your radar.

Is there anything I can do about my risk for hypoglycemia unawareness?

Hypoglycemia unawareness can be treated in most cases. The best way to do so is to work closely with your healthcare provider or diabetes care and education specialist (also known as a CDE). You’ll need to change your diabetes self-care plan so you decrease (ideally stop having) low blood sugar events. Also, your team will ask you to let your blood sugars run above your goal for a long period of time (a general rule of thumb is 1-2 months). Your blood sugar set point will slowly adjust upwards. This eventually helps you regain your blood sugar signals at the appropriate levels.

For example, to round out our previous scenario, remember your blood sugar setpoint had dropped to 50-110 mg/dl. Let’s say your diabetes team helps you modify your diabetes plan. Your goal is to run your blood sugars between 110-160 mg/dl over the next few months. Your body slowly adjusts its set point back to 70-140 mg/dl. Ideally, you begin getting your low blood sugar signals back around the 70 mg/dl mark.

Final thoughts on hypoglycemia unawareness

Hypoglycemia unawareness is a big deal, but it’s not a risk for everyone with type 2 diabetes. It’s important you know your risk. If you believe you are experiencing, or at risk for, hypoglycemia unawareness it’s important to use a medical alert bracelet. This alerts others in the event you’re unable to treat a low blood sugar yourself.

In many cases, there are steps you and your healthcare team can take to address hypoglycemia unawareness and get you back on a healthier path to living with type 2 diabetes.

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