Hypoglycemia Unawareness: Strategies for Treatment and Prevention

For anybody who lives with diabetes, the potential 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 often called hypoglycemia unawareness. 

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

This text will clarify every part you could find out about hypoglycemia unawareness, find out how 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 beneath regular ranges. That is usually a results of an imbalance between components that increase blood glucose, reminiscent of meals consumption, and people who decrease it, reminiscent of 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 continuously. 

What is taken into account low blood sugar will fluctuate by the particular person primarily based on well being historical past, well being objectives, 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 contemplate 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). It will require quick therapy with both fast-acting glucose or glucagon (if the particular person can not 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 embrace:

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

Signs of extreme low blood sugar embrace:

• Slurred speech
• Confused considering
• Lack of consciousness 
• Seizures
• Coma
• In uncommon situations, demise 

Name 911 if somebody you understand 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 by which somebody doesn’t get the same old bodily warning indicators their blood sugar ranges are going low. 

It’s far more frequent than many individuals assume 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 often called sulfonylureas, each of which might 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 growing hypoglycemia unawareness. 

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

This will result in hypoglycemia changing into extreme, which, with out quick therapy, has the potential to end in acute problems reminiscent of lack of consciousness, seizures, and in excessive circumstances, life-threatening outcomes. 

Moreover, recurring episodes of extreme hypoglycemia can contribute to long-term problems, reminiscent of 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 identified danger components for growing hypoglycemia unawareness, together with the next:

• Being handled with insulin
• Having diabetes for a very long time (one research 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 latest and/or recurrent low blood sugar occasions (reminiscent of lows at evening, when you could not have the ability to detect or deal with the low)
• Superior age

What causes hypoglycemia unawareness? 

The precise causes of hypoglycemia unawareness will not be totally understood. Nonetheless, a number of key components are thought to contribute to its improvement:

• Frequent episodes of hypoglycemia can result in a situation often called hypoglycemia-associated autonomic failure (HAAF), the place the physique’s regular alert system to low blood sugar turns into much less delicate. Basically, 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 problems, can paradoxically improve the danger of hypoglycemia unawareness. It is because aiming for decrease blood sugar targets could result in extra frequent episodes of hypoglycemia, thereby rising the probability of HAAF.
• The usage of steady glucose monitoring (CGM) techniques makes tight diabetes management simpler by offering real-time suggestions on blood glucose ranges. Whereas CGMs can alert customers to impending lows, the general danger 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 goal for very tight blood sugar management, are at an elevated danger of growing this situation.

Can drugs trigger hypoglycemia unawareness? 

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

Though these drugs deal with circumstances 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, may masks low signs, though their influence is much less clear.

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

Are there problems from hypoglycemia unawareness?

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

With out the standard early warning indicators of low blood sugar, the state of affairs is extra more likely to be extreme by the point it’s acknowledged and therapy is tried. These extreme lows can impair vital capabilities, making it tough to carry out on a regular basis actions reminiscent of driving, studying, and dealing, and might cloud judgment and cognition. 

In the event you don’t deal with your low blood sugar shortly sufficient, it might even end in extra critical problems, reminiscent of lack of consciousness, seizures, coma, and mind harm. Over time, recurring extreme hypoglycemia may also contribute to cardiovascular problems and cognitive decline.

How will you stop and deal with hypoglycemia unawareness? 

Discuss to your physician if you happen to discover that you’re not detecting signs of low blood sugar.

Most individuals with diabetes ought to have the ability to really feel low blood sugar ranges after they attain 70 mg/dL (3.9 mmol/L), though this stage can fluctuate for folks with a historical past of frequent lows.

There could also be no technique to utterly 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 day by day insulin dosage, barely rising your goal blood sugar vary, or modifying your bodily exercise routine to forestall low blood sugar ranges within the first place.

You may additionally have the ability to catch low blood sugars sooner by checking your blood sugar ranges extra continuously or carrying a steady glucose monitor (CGM). Carrying fast-acting carbohydrates with you to instantly deal with lows can also be really useful, as is having a glucagon package readily available within the occasion of a extreme low (glucagon is a hormone that helps increase glucose ranges). 

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

Moreover, some folks have discovered that switching to slower-acting insulins, like R, N, or NPH, will 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 know-how, utilizing an automatic insulin supply (AID) system can considerably assist in stopping hypoglycemia. 

These techniques use values out of your CGM and run them via an algorithm to find out how a lot insulin to ship through a pump. Insulin is decreased or paused as blood sugar ranges lower, serving to to forestall hypoglycemia.

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

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

Work carefully along with your physician to tailor these approaches to your particular wants and circumstances.

Suggestions for stopping low blood sugars

Whilst you can not stop low blood sugar in all circumstances, you may reduce how usually you expertise them with the next methods: 

• See your physician or endocrinologist recurrently 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 cut back the danger of exercise-induced hypoglycemia.
• Don’t fall asleep with a blood sugar beneath 100 mg/dL (5.6 mmol/L) to cut back the danger of in a single day hypoglycemia.
• Take all insulin and different drugs as prescribed. 
• In the event you’re susceptible to low blood sugars after meals, take your insulin midway via consuming and even after you eat. 
• In the event you dose for a sure variety of carbohydrates, be sure you eat all of the carbohydrates that you just’ve dosed for. 
• Drink alcohol carefully, if in any respect.
• Don’t drink alcohol with a blood sugar beneath 100 mg/dL (5.6 mmol/L).
• At all times 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. 

Remaining 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 necessary function in early detection and administration of low blood sugar episodes. 

Adjusting insulin doses and therapy plans in session with healthcare professionals may also 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 necessary 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 not.

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