Hypoglycemia Unawareness: Strategies for Treatment and Prevention

For anybody who lives with diabetes, the opportunity of hypoglycemia, or low blood sugar ranges, could be a fixed concern. An additional layer of complexity is added when folks can’t detect that their blood sugars are dropping, a situation generally known as hypoglycemia unawareness. 

It’s each extra frequent — and probably extra harmful — than many individuals suppose.

This text will clarify every thing you could find out about hypoglycemia unawareness, easy methods to deal with it, and steps you may take to assist stop it.

What’s hypoglycemia?

Hypoglycemia, generally known as low blood sugar, happens when the focus of glucose within the bloodstream falls under regular ranges. That is typically a results of an imbalance between components that elevate blood glucose, similar to meals consumption, and those who decrease it, similar to insulin or different glucose-lowering drugs. 

Whereas everybody with diabetes typically experiences low blood sugar ranges, individuals who use insulin expertise episodes of hypoglycemia extra incessantly. 

What is taken into account low blood sugar will range by the particular person based mostly on well being historical past, well being targets, and what blood sugar ranges you’re most comfy setting as your goal vary. 

The U.S. Facilities for Illness Management and Prevention (CDC) considers low blood sugar ranges as something beneath 70 mg/dL (3.9 mmol/L). Many individuals with diabetes take into account something beneath 80 mg/dL (4.4 mmol/L) a low blood sugar. 

Severely low blood glucose ranges are thought-about to be something beneath 40 mg/dL (2.2 mmol/L). This may require instant therapy with both fast-acting glucose or glucagon (if the particular person can’t chew or swallow). 

Be taught extra about hypoglycemia in: Signs of Low Blood Sugar (Hypoglycemia).

What are the signs of hypoglycemia? 

Frequent signs of hypoglycemia embody:

• Shakiness
• Dizziness
• Fatigue/lethargy 
• Disappointment 
• Confusion
• Sweating
• Speedy coronary heart fee 
• Nervousness
• Starvation
• Hassle concentrating
• Irritability 

Signs of extreme low blood sugar embody:

• Slurred speech
• Confused pondering
• Lack of consciousness 
• Seizures
• Coma
• In uncommon situations, dying 

Name 911 if somebody you realize is experiencing severely low blood sugar. When severely low blood sugar is left untreated, it may be deadly. 

Learn extra about hypoglycemia signs in: Signs of Low Blood Sugar (Hypoglycemia).

What’s hypoglycemia unawareness?

Hypoglycemia unawareness is a situation wherein somebody doesn’t get the standard bodily warning indicators their blood sugar ranges are going low. 

It’s way more frequent than many individuals suppose and is estimated to have an effect on about 40 p.c of individuals with kind 1 diabetes. It additionally impacts 10 to fifteen p.c of individuals with kind 2 diabetes who use insulin or a category of medicines generally known as sulfonylureas, each of which may trigger low blood sugar. 

Taking insulin will increase the danger of experiencing low blood sugar ranges, and frequent low blood sugar ranges improve the danger of creating hypoglycemia unawareness. 

Hypoglycemia unawareness considerably will increase the danger related to low blood sugar episodes by impairing an individual’s potential to acknowledge and reply to the early warning indicators of hypoglycemia. 

This will result in hypoglycemia turning into extreme, which, with out quick therapy, has the potential to lead to acute issues similar to lack of consciousness, seizures, and in excessive circumstances, life-threatening outcomes. 

Moreover, recurring episodes of extreme hypoglycemia can contribute to long-term issues, similar to cardiovascular and cognitive points.

The chance and incidence of experiencing severely low blood sugar ranges improve dramatically for individuals who have hypoglycemia unawareness. 

What are the danger components for hypoglycemia unawareness?

There are a number of recognized threat components for creating hypoglycemia unawareness, together with the next:

• Being handled with insulin
• Having diabetes for a very long time (one examine discovered that half of people that had used insulin for over twenty years developed hypoglycemia unawareness, whereas solely about 20 p.c of those that have been on insulin for fewer than ten years skilled it) 
• A historical past of current and/or recurrent low blood sugar occasions (similar to lows at evening, when you could not be capable of detect or deal with the low)
• Superior age

What causes hypoglycemia unawareness? 

The precise causes of hypoglycemia unawareness usually are not fully understood. Nonetheless, a number of key components are thought to contribute to its growth:

• Frequent episodes of hypoglycemia can result in a situation generally known as hypoglycemia-associated autonomic failure (HAAF), the place the physique’s regular alert system to low blood sugar turns into much less delicate. Primarily, the physique and mind begin to adapt to decrease glucose ranges, diminishing the notion of hypoglycemic signs.
• Tight blood sugar management, whereas essential for managing diabetes and stopping long-term issues, can paradoxically improve the danger of hypoglycemia unawareness. It’s because aiming for decrease blood sugar targets could result in extra frequent episodes of hypoglycemia, thereby growing the probability of HAAF.
• The usage of steady glucose monitoring (CGM) programs makes tight diabetes management simpler by offering real-time suggestions on blood glucose ranges. Whereas CGMs can alert customers to impending lows, the general threat of hypoglycemia unawareness should still be influenced by the aggressive pursuit of tight glucose targets.

Not everybody who takes insulin will expertise hypoglycemia unawareness, however the probability will increase with the size of time somebody has had diabetes. Those that have lived with diabetes for an prolonged interval, and particularly those that persistently purpose for very tight blood sugar management, are at an elevated threat of creating this situation.

Can drugs trigger hypoglycemia unawareness? 

Sure — sure drugs, together with beta-blockers, can masks the signs of hypoglycemia, similar to coronary heart palpitations and tremors, making it tougher to detect an oncoming low. It’s because they block the motion of adrenaline. 

Though these drugs deal with situations like angina (a sort of chest ache), coronary heart failure, and hypertension, this impact on adrenaline could make it tougher to detect the early indicators of hypoglycemia.

Selective serotonin reuptake inhibitors (SSRIs), used to deal with melancholy, might also masks low signs, though their influence is much less clear.

Moreover, alcohol can intrude with blood sugar regulation and masks signs of lows. And this substance may be doubly problematic as a result of it may additionally improve your probability of going low within the first place. 

Are there issues from hypoglycemia unawareness?

Having hypoglycemia unawareness considerably will increase the danger of each short- and long-term issues.

With out the everyday early warning indicators of low blood sugar, the scenario is extra prone to be extreme by the point it’s acknowledged and therapy is tried. These extreme lows can impair important features, making it troublesome to carry out on a regular basis actions similar to driving, studying, and dealing, and might cloud judgment and cognition. 

In the event you don’t deal with your low blood sugar rapidly sufficient, it might even lead to extra severe issues, similar to lack of consciousness, seizures, coma, and mind damage. Over time, recurring extreme hypoglycemia can even contribute to cardiovascular issues and cognitive decline.

How are you going to stop and deal with hypoglycemia unawareness? 

Speak to your physician when you discover that you’re now not detecting signs of low blood sugar.

Most individuals with diabetes ought to be capable of really feel low blood sugar ranges once they attain 70 mg/dL (3.9 mmol/L), though this degree can range for folks with a historical past of frequent lows.

There could also be no method to fully stop hypoglycemia unawareness, however there could also be methods to grow to be extra delicate to your blood sugar ranges falling. 

Your physician could counsel reducing your every day insulin dosage, barely growing your goal blood sugar vary, or modifying your bodily exercise routine to stop low blood sugar ranges within the first place.

You may additionally be capable of catch low blood sugars sooner by checking your blood sugar ranges extra incessantly or carrying a steady glucose monitor (CGM). Carrying fast-acting carbohydrates with you to right away deal with lows can also be advisable, as is having a glucagon equipment available within the occasion of a extreme low (glucagon is a hormone that helps elevate glucose ranges). 

For some, a diabetes alert canine (DAD) could present a further layer of safety by alerting to low blood sugars. Nonetheless, this feature requires consideration of the coaching and dedication concerned.

Moreover, some folks have discovered that switching to slower-acting insulins, like R, N, or NPH, may be useful in the event that they expertise persistent hypoglycemia unawareness. These insulins have a slower launch time, offering a extra predictable blood-sugar-lowering impact, and so could assist stop extreme lows. 

For many who have entry to the expertise, utilizing an automatic insulin supply (AID) system can considerably assist in stopping hypoglycemia. 

These programs use values out of your CGM and run them by way of an algorithm to find out how a lot insulin to ship by way of a pump. Insulin is lowered or paused as blood sugar ranges lower, serving to to stop hypoglycemia.

In the US, a number of AID programs can be found, together with the Medtronic MiniMed 770G System, Medtronic MiniMed 780G System, Tandem Diabetes Care t:slim X2 with Management-IQ Know-how, and Omnipod 5 Automated Insulin Supply System.

Chances are you’ll not all the time be capable of reverse hypoglycemia unawareness, however you may improve your sensitivity, principally by avoiding low blood sugar ranges for some time. 

Work intently together with your physician to tailor these approaches to your particular wants and circumstances.

Suggestions for stopping low blood sugars

When you can’t stop low blood sugar in all circumstances, you may reduce how typically you expertise them with the next methods: 

• See your physician or endocrinologist often for remedy changes. 
• Use a meals scale for extra exact carbohydrate counting. 
• Eat meals and snacks on a schedule. 
• Don’t train with a blood sugar beneath 100 mg/dL (5.6 mmol/L) or while you’ve just lately taken insulin to scale back the danger of exercise-induced hypoglycemia.
• Don’t fall asleep with a blood sugar beneath 100 mg/dL (5.6 mmol/L) to scale back the danger of in a single day hypoglycemia.
• Take all insulin and different drugs as prescribed. 
• In the event you’re liable to low blood sugars after meals, take your insulin midway by way of consuming and even after you eat. 
• In the event you dose for a sure variety of carbohydrates, be sure to eat all of the carbohydrates that you simply’ve dosed for. 
• Drink alcohol sparsely, if in any respect.
• Don’t drink alcohol with a blood sugar beneath 100 mg/dL (5.6 mmol/L).
• All the time carry fast-acting glucose with you to deal with lows.
• Put on a CGM.
• Set your CGM low and predictive low alerts to “on.” 
• Deal with low blood sugars early, earlier than they grow to be probably harmful. 

Last ideas 

Managing hypoglycemia unawareness requires a wide range of methods. Common monitoring of blood glucose ranges, particularly with the assistance of a CGM system, performs an vital function in early detection and administration of low blood sugar episodes. 

Adjusting insulin doses and therapy plans in session with healthcare professionals can even assist reduce the dangers related to hypoglycemia unawareness.

Way of life modifications, together with meal planning, cautious monitoring of bodily exercise, and accountable alcohol consumption, are moreover vital for managing blood glucose ranges and avoiding lows. In some circumstances, the assist of a diabetes alert canine can present a further layer of security by detecting low blood sugars even while you can’t.

In the event you’re experiencing hypoglycemia unawareness, it’s vital to talk together with your healthcare supplier to discover methods tailor-made to your particular wants. With the appropriate mixture of medical suggestions, self-care, and assist instruments, it’s attainable to handle this situation successfully and scale back the danger of great issues.