Creeping Hypo Unawareness?

In the last 2 or 3 days, I have caught 2 mild hypos (58 and 66) on my meter, because it was time to calibrate my CGM, which gave me NO clue that they were happening. And my body gave me no clue, either. While they were not severe hypos, and I was easily able to treat them, I’m still a bit scared, because I live alone, and if I had a severe one, there is no one to help me. I wonder if this is a sign of impending hypo unawareness, or if it has already arrived, and whether it is connected to my efforts at tight control. How tight is TOO tight?

And just for curiosity’s sake, are there any Type 2’s out there with hypo unawareness? I know it’s not rare in Type 1’s, but don’t know about Type 2’s.

Sometimes when we talk on here about “hypo unawareness” I think it sort of begs the question if people who don’t have it are aware of every single low they have. From what I gather on here, and from my own experience, I don’t think that’s the case. I catch some lows and miss others. I don’t treat if it’s not under 60 so the 66 wouldn’t count for me as a low and the 58 is just under my cutoff point, so yeah, I would miss those some of the time. I definitely feel all more serious lows, like in the 30s and 40s, but for the 50s I’d say it’s more subtle and sometimes I catch it and sometimes I don’t realize it has slipped down until I routinely take my blood sugar. Also, some activities for me are more likely to catch those mild lows. If I’m doing something that takes a lot of mental attention, I can pick up when I’m not functioning at my best cognitively. If I’m walking somewhere and feel really tired and like it’s an effort that’s another sign. But if I’m just relaxing at home, reading a book or whatever, I’m more likely not to notice.

All that just to say that I think it’s not as cut and dry as (completely) hypo aware and (completely) hypo unaware. I live alone as well so I understand your concerns. But if those two experiences were isolated and you felt other hypos last week or whenever, or feel some in the next week ahead I would see no reason to think you were developing hypo unawareness. If you NEVER felt any, including more serious lows, then I would think it would be more reason for concern. Just my two cents. I don’t know the Type 1/Type 2 breakdown, but just off the top of my head I would think because type 2’s (not on insulin) experience less hypos in general that there would be less opportunity to develop hypo unawareness which seems to develop with clusters of hypos in the same timeframe. (and seems to be alleviated for many people by going for a period of time without any).

I had a bad bout of hypo unawareness a while ago. I also have tight control. I ‘loosened’ my control for a week, letting myself run just a bit higher (but not too high) and I regained my ability to sense them.

I agree with ZOE, My hypounawareness varies with the activitiy… I aim for tigh t control but I generally catch my lows… Caught a 33 the other day that had I frankly ignored, as I felt the loopy, I am agitated feelings over and hour before I checked, as I was on the /internet and did not want to stop. Of course I was not wearing the CGM. I treated it with some low-carb capir sun waited about 20 minutes ;Came to 68, so I could keep on surfin’ the net.
. I too live alone and I have had some scary lows. I do wake up from the grand majority of sleep lows, but I know now not to EVER head for the bed or the couch if I have not checked my blood sugar first… Hypo unaware, I think , if you never feel lows and just drop off…I have had lows where I was barely concsious, but I cannot say I did not feel them, I just did not have the wherewithall to do any thing about them ( which is under 35 for me). I am agitated , and sometimes really silly in the 40’s and 50" but can self-treat.
Natalie, I think the fact that you routinely calibrate and check your BLood glucose will aid you… I sometimes miss a calibaration ( bad Brunetta!!!) and just look at the Isig, remembering the ratio from the initial calibration and just multiply ( lazy way to avoid a blood sugar stick)…But you tak very good care of yourself… Do not fret… You will be pk.

God Bless,

God lLess,

I don’t typically start to feel low until my blood sugar is around 3.0 mmol/L (55 mg/dl), and even when I get symptoms they are usually quite subtle (none of the shakiness, sweatiness, confusion most people talk about), and I don’t really consider myself hypo unaware, although I think my parents and my endocrinologist might. I woke up this morning at 3.2 (58 mg/dl) and felt perfectly fine, and I’ve never really considered that a bad thing because I DO (usually) feel lows before they get to dangerously low levels.

As a kid I definitely had hypo unawareness and could get to levels like 1.9 (34 mg/dl) routinely without feeling bad at all, and this led to some really bad lows where I’d be semi-conscious or unconscious because I didn’t pick up on the symptoms until they were so bad that I couldn’t understand what was wrong. But then again, my A1c back then was in the 6s and 7s using R and NPH, so I probably had a LOT of lows compared to today.

Part of my barrier to really tight control (like an A1c in the 6s) is that when I get to that level my “hypo awareness” really drops off and I can get blood sugars of 2.5 (40 mg/dl) and lower without any symptoms, or very mild symptoms when I do have them. This seems to happen if I go low more than two or three times a week, and it’s obviously not something I like at all! This is actually probably the same issue I had as a kid, so maybe I have always had hypo unawareness and just see it as “normal.”

I’d be curious what others’ thoughts are as to when someone is really considered “hypo unaware” and when they are not.

I don’t usually get like sweaty and totally zonked the way I used to but there’s certain activities so I’d say that I’m less hypo aware than I used to be? At the same time, there are other symptoms, like being more challenged reading or playing guitar or running, that seem to be reliable clues? I can tell that it’s more like a ‘buzz’ than being ‘wasted’ which is sort of convenient as I don’t have to go change my shirt!

My ability to feel lows really varies. Sometimes I feel them hard, even when I’m just in the 60s, and sometimes I’ve had lows down into the 40s and 50s and been completely fine (although once I started to treat and come back up, the symptoms hit me pretty hard). Like Zoe describes, I too notice hypos during different situations. If I’m lazing around, I don’t tend to notice them, but if I’m doing something that requires physical strength or mental concentration, they are more apparent.

I have hypounawarness now. It’s NOT fun! I can fall to the mid 20’s and still not show a sign of being low. Many times I have fallen out in a seizure and taken a gluagon shot. I’ve done this without doing much phyical exercise AND after checking my bs like 30 minutes b/f falling out. One time Iwas in my drs office doing fine as he talked to me. My husband was there with me (pretty unusal b/c I usually do this on my own) but he said as soon as the dr turned his head from talking to me he saw the blank stare in my eyes ( now my new warning system to others) and he knew what was up. They gave me gluagon at the drs office then sent me across the street to the er. At the drs office I was 21 when I got to the ER I was 312. WHOOPS!

What’s happening to you is exactly what I’m afraid of. Nobody to rescue me!

And my CDE is concerned about any BG below 70 – no, the 58 and 66 weren’t severe lows, but my fear is where are they heading? I HAVE had more hypos than usual during the last 2 weeks, and maybe I need to adjust my basals or my carb intake, so I have a lot to think about.


What do you have your settings on, … for hypo, rate of fall, and do you have the predictive alarms turned on? I think that you probably have your settings, not set properly or set too low, on the cgm.

I’ve been trying for 8 years to get any hypo signals back, and have not done so yet. My Bg can be below 20 and I can still function, (just barely sometimes) - as long as I’m awake. A couple of years ago, I did go into a hypo coma during the night. I also run tight control as much as I can, for my age, and due to other health issues - ie:, heart, and kidneys. I have several complications in the diabetic autonomic category, as told me by my physicians. Last year, due to the autonomic neuropathy orthostatic hypotension, my BP crashed to 59/38, and the 911 was called. That time, however, my Bg was ok, but it could have been on the way back up. My nephrologist told me once, that my BP can also fall, when I go hypo.

Last week, I had an extended hypo (42) that concerend my doctor. It took two hours to get in the 50’s and 60’s, and at the third hour, finally made it up to 70. I had a total of about 90 carb grams uncovered, to get to the 70. This was also a day that we had high 100teens heat index. I do get post-hypo wicked ■■■ bad headaches, though.

Check your settings, and make sure you have them set, to where you will at least have the alarms go off, so you will know quicker. One more thing, does your basal rate need to be changed on your pump? And, there are a lot of hypos and hypers, that we all miss, due to the fast fluctuations.


Natalie to answer your question, I have type 2 diabetes and I’m somewhat hypo unaware. It’s new just the past two or three years that I’ve been aware of it. I’ve had diabetes a long time though at least 23 years that I know of.

Mine also seems to be a function of developing neuropathy as minimizing the lows and wearing a sensor full time hasn’t helped much. I just don’t seem to feel them any more in terms of being shaky, sweaty, ravenous, etc. I still get stupid though and can’t think or have trouble with words, headache, etc so I watch for those symptoms. They’re not early enough though.

Anyway I’ve been following the other thread started by Kelly with interest too.

Thanks for your input, Trisha. My pump is a MM 722, so no predictive alerts. The CGM will show arrows for rate of fall, and alarm for hypo, but is not accurate enough – it has given me a lot of false hypo alarms, and lately has NOT caught the hypos. I’m not sure why I continue to use the darn thing! Actually, I do know why – it does let me know when I’m going high, and I like to catch them before they go TOO high. But lows are another story! :frowning:

I’m thinking about lowering my basals, and running a little higher, just for my own safety. Maybe I’m making a mountain out of a molehill, but better safe than sorry? (using AR’s question marks!)

Isn’t your cgm the Guardian? I agree with lowering your basals, and running higher, for awhile. It is always better to be safe than sorry. No, you are not making a mountain out of a molehill. It is called preventive measures.


No, it’s the Real-Time, which is connected wirelessly with my pump.

And I really appreciate your moral support! :slight_smile:

Ok, mine is the Real Time Guardian, but no pump here. So, in other words, you have one device which serves two functions? Or two devices that work together? You’re losing me here, so help me out! :slight_smile:

If your cgm is the same as mine, it should have the predictive alerts. I’m not referring to the pump having predictive alerts, just the cgm. I’m dumb (for the most part) when it comes to pumps. :frowning:


I used to regularly have hypos, mostly during the night, under 40. I live alone too so it was frightening, and the main reason I wanted a CGM. I’ve noticed that the tighter my control is - and it’s pretty tight - the more quickly I notice highs (anything over 170ish). I feel if I’m dropping or rising fast - I get woozy. If I’m under 45 I start to get disoriented, confused, unable to think clearly.

I’ve also wondered if I should set my target a little higher. I sleep with my dex under my pillow set to vibrate/beep, so it never fails to wake me even when it’s wrong!

The pump and the CGM work together. In a way, it’s like the Guardian, because you have a device with a screen that tells you what’s going on, right? Well, my screen is on the pump.

However, my pump is almost 4 years old, and at the time, there was no program for predictive alerts. The Revel, which is the pump that came out after mine, does have predictive alerts. It’s your monitoring device, not the transmitter, that is programmed for the alerts.

Hope this makes sense! :slight_smile:

Yes, it does make sense now. I wonder why they didn’t have predictive alerts then? (just thinking while writing). Thank you for clearing that up for me. Sorry I can’t be of more help then. :frowning: Do please check your hypo settings, ok? nite nite.


It is not impossible for Type 2s to get it. I am told (because I have it too) that it is because, in my case because of my allergy to the “human” insulins. I have done some research via, and they state many cases of people on these.
They campaign for more consultant and nurse awareness of the problems of unawareness and patient choice in how their diabetes is treated - ie if one thing does not work, then they should have the choice to try pork insulin which is smoother and more natural.

It could also be because of tight control. I have had terrible unawareness and will only know that something is wrong at about 2.0mmols or lower! Apparently there are subtle signs - loss of concentration, irritability at things that would not normally bother you, pale skin etc but these are only noticed by people who know you well and know what to look for.

I too live alone. I keep sugary snacks around the house in my room, in my bathroom, in the kitchen and the living room and make sure that I get something to eat, even a snack at regular intervals during the day. I have been told also to aim my sugar levels a bit higher than the norm so that I will regain awareness. This sometimes works - I occassionally get a warning (physically) that something is not quite right in the high 4’s, but I am a work in progress.

Sometimes I will find that I am missing signs if I am concentrating on other things - like a deadline etc. One way to keep track is to set your alarm on your mobile or computer if you are on it a lot to remind you to test your blood sugar levels.

You will definitely know about the lower ones as you will start the sweating and dizziness and can treat with your sugary snacks dotted around the house. I keep mine - small sweets, not in wrappers, in those little plastic boxes so they are always at hand. I am known as the bag lady at church!

Keep testing frequently and certainly test and have a snack before you drive, if you do.

And wear some form of ID - a chain, a bracelet etc.

Hope this helps.

I just started insulin last December, but I’ve already developed some mild hypo unawareness. I used to feel hypo in the 70s and definitely in the 60s. But for years I had fasting blood sugars well into the 100s. With insulin that changed, I was able to get my daytime fasting into the 80s and it is now common for me to go hours just sitting in the 70s. What this means is that the 60s just feel fine. I still feel hypo in the 50s and below, but I don’t feel hypo at the point I need to treat. And I treat everything below 70. That is part of my strategy to preserve my hypo awareness. I treated a 69 last night, but I only knew I was 69 because I happened to test.