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    Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.

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  • Living with diabetes blog

  • Aug. 10, 2011

    Understanding hypoglycemia unawareness

    By Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.

17 comments posted

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A patient shared the following story:

She was in a grocery store and felt that something was wrong, so she walked over to the checkout lane and grabbed a couple candy bars off the shelf. She stood there in a daze, clutching the candy bars in her hands but not eating them. She must have looked like she needed help, because a woman walked over to her and asked if she had diabetes. The woman told her to open the candy bar wrapper and eat the candy right away. My patient was in such a confused state that she hadn't thought to do that herself. The woman stayed with her until she felt better and told her that she had a family member with diabetes, who she'd assisted before when he or she was in a similar confused state of low blood glucose (hypoglycemia). My patient was lucky to have received this assistance and avoided the need for an emergency medical response team (911) call for the seizures or unconsciousness that could have occurred with severe hypoglycemia.

Is this scenario familiar to you or a family member or friend with long-standing diabetes? This story is an example of "hypoglycemia unawareness" — a condition in which a person with diabetes doesn't experience the usual warning symptoms of hypoglycemia.

Usually, when a person's blood glucose drops, the body tries to raise it by releasing the hormones glucagon and epinephrine. Glucagon spurs the liver to release stored glucose from the liver into the bloodstream. Epinephrine signals the liver to produce more glucose and also causes the typical early warning signs of hypoglycemia — sweatiness, shakiness and weakness.

If you experience hypoglycemia unawareness, you skip these warning symptoms. Instead, without warning, you can lapse into severe hypoglycemia, becoming confused, disoriented or unconscious. This is because when you've had diabetes a long time, or experienced frequent, extreme swings of high to low blood glucose levels, you can lose the epinephrine response to low blood glucose.

In the next blog, I'll discuss more features of hypoglycemia unawareness, including the predisposing factors and possible treatment strategies for this condition.

Until next time, have a good week.

Nancy

17 comments posted

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  • March 27, 2013 11:55 p.m.

    Please, please, please don't stop there!!! I suffer from this all the time. I feel like a dork every time. I am not diabetic. I have suffered from severe reactive hypoglycemia since I was in my late 20's. My father was a Type 1 insulin dependent diabetic. I've just been told I'm pre-diabetic. I'm 63 and I feel my life is over.

    - Jill

  • February 18, 2013 8:15 p.m.

    Im a triathlete and since September starting having issue with hypoglycemia. I passed out in tranistion with a blood sugar of 38. I had never had a problem or if I did was unaware. I went to the endo and had blood work, 5 hour fasting twice. First time told I was hypoglycemic ,second time an hour after drinking the sugar, I passed out with a sugar level over 397. I was told not to ecercise for two months. I recently started running again and while running a half marathon got to mile seven and had heavy arm/legs, vision blurred, could barley speak...I'm frustrated as I have eaten as told and test as told. What am I doing wrong and why am I affected the most while running? I also had blood work indicating that my muscles were not recovering after exercise as well as they should. When I do exercise now it takes me several days to recover. This is all new as I had been running about 25-30 miles a week, swimming 10 miles and biking in between. I want to get back to being able to compete at the level I had been , up to September. Any suggestions as to what else could be wrong?

    - shannon

  • June 17, 2012 6:17 p.m.

    i'am glad to find this information lets say the doctors did not give me enought information here believe or not my parmist got my doctors to get on the ball i've been dio. hypoglcemic for years just told to drink orange juice the doctor just resently put me on metoforman twice a day said i might want to take this nothing about testing nothing about changes i may have to do since my parmasist said to really get the doctors attention i will be starting 2 diabetic classes very soon . my symtomos have been worse at times but are better controlled now my worst 1 was before i knew what was happening i was driving i lost my train of thought went threw a red light. was very lucky no wreck or ticket .

    - lois

  • April 25, 2012 4:08 p.m.

    I keep experiencing lightheadedness along with shakes. I feel out of sorts like Im confused. This happened at work the other day so I ate some fruit, but didnt feel better. Normally, I eat a banana and drink a bottle of water and start to feel better, but it takes a while. I dont know if its my Potassium levels or my blood sugar. Diabetes runs in the family. Im concerned.

    - Jamie

  • March 4, 2012 10:03 p.m.

    I feel I should also mention this happened once in my sophomore year in highschool and I actually passed out. I got tested but they said I was fine. Since then I haven't gone to the point of passing out, but im still concerned

    - stephanie

  • March 4, 2012 10:01 p.m.

    I get symptoms similar to these. First, my stomach will growl when I breathe in and out for several minutes. I then become hungry. Not long after I get shaky, sweaty, and weak. Becoming more hungry, I get very irritable. My boyfriend can tell when im hungry because I guess I get very quiet and move slowly. He calls it my "hunger stare" which continues when im eating. If I eat too fast at this point, its hard to swallow. Should I be concerned? The days where this doesn't happen seem to be getting fewer and fewer

    - stephanie

  • January 24, 2012 10:29 a.m.

    My wife has had type 1 diabetes for about 40 years. Her hypoglycemic unawareness gets worse periodically. My question: sometimes she can be as low as 25 and function rather well and other times she can be higher than that and be in rather bad shape. Why? Thank you.

    - Howard

  • January 17, 2012 6:37 p.m.

    I have been a type 1 diabetic for the past 37 years. In October 1988 I had a very severe hypoglycaemic bout - I was comatose for about 4-5 hours.Since then I have had severe problems with my memory and only about 3 to 4% of the time i am aware that I am having a hypoglycemic bout. In March of last year I was made aware of thae fact that a gradual unstoppable degeneration of my brain was taking place. Aside from three prolonged and near-fatal hypo bouts and the problems with my memory, one can lead a relatively healthy, happy and productive life. Education and awareness are the key watchwords here. i have been a type 1 diabetic for the past 37

    - Trevor

  • November 5, 2011 12:22 a.m.

    Not sure what hypoglycemic unawareness is. I was diagnosed with hypoglecemia and was told not to eat any sugar. I would think if my sugar was low,I'd need more sugar. Not the case but was told by Canadian diabetic assoc..that we all need some sugar and there's some sugar is lots of things we eat..my question is, let's say I had a carrot muffin in the afternoon,then at 11pm had toast with some maramlade..is that too much sugar? Should I avoid all muffins,cakes,candy etc with the exception of sugars already in food? Can't ask my doctor because she'll say not to eat any and all sugars,I'll fall asleep...well after my muffin today I was far from asleep... just askin.

    - Ann

  • September 16, 2011 11:36 a.m.

    My wife has hypoglycemic unawareness. It happened this morning at 4am. She is totally unaware of her surroundings, can't walk, talk etc. I travel for my job which leaves her alone at times during the week. This concerns me as she is unable to fend for herself. The episodes don't happen all that often but I'm worried it will be fatal if I'm not there to get her the carbs she needs. I suggested she eat a small amount just before bed to get her through the night. Will this help? Also, I read below about the CGM monitor by Dexcom. Would this be a good recommendation for her? Thanks!

    - Al

  • August 21, 2011 2:59 p.m.

    My daughter was in a warm gym feeling week from not eating. She got dizzy, sweaty and had to sit down. We think she is hypoglycemic. She does not do well, mood wise, waiting long periods without eating. More than 2 hours in between. Could she also be prediabetic?

    - trisha

  • August 19, 2011 10:05 a.m.

    I too have severe hypoglycemic unawareness and recently began wearing a continuous glucose monitor. It helps as my sugar levels look like a roller coaster. What I don't like about the monitor is iv site dressing irritates my skin and then the site becomes really uncomfortable!

    - lou

  • August 17, 2011 11:48 p.m.

    Thanks for bringing this issue up. i am diabetic type-2 and my sister is type-1. we are completely unaware of "hypoglycemia unawareness"

    - Krishna

  • August 17, 2011 8:09 a.m.

    I have recently purchased and am using a CGM by Dexcom. It has assisted me with those times when I just don't get the response of ephinephrine into my blood and I just drop! My job is stressful and I have been caught in the middle of a presentation to clients and started to realize I was talking funny. Definitely have to say that my CGM has made a huge difference. It warns with a beep or a vibrate that I'm having issues with BS below a specified point that I set in the machine. It's wireless and ultra easy to use and the sensor is small and painless to insert! You might try that.

    - Sue

  • August 15, 2011 2:22 p.m.

    Vicki: Your son needs to discuss his frequent hypoglycemia episodes with his diabetes care team for assistance in adjusting his insulin doses. For his unawareness, he may be eligible for a continuous glucose monitoring sensor.

    - Nancy and Peggy

  • August 11, 2011 3:32 p.m.

    My doctor told me to eat small meals thru out the day to prevent low sugar attack.He suggested peanut butter in the afternoon so I won't get low sugar. I always have a soda with me where ever I go. I know its not good for me but it really brimngs sugar level up quickly. Its hard to carry around orange juice which is the best, however it will sour in the car and soda won't.

    - Jean

  • August 10, 2011 9:00 p.m.

    does anyone know of any devices on the market that can signal or warn of hypoglycemia? My adult son lives alone and is experiencing severe hypoglycemic reactions, black outs, seizures, unaware that his blood sugar is dropping. Usually happens when he's asleep and he can "be out" for hours. Looking for something that could send a signal some way to call for help.

    - Vicki

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