HypoAware for the HypoUnaware

I know that many of us struggle with being hypo unaware. Those pesky hypos can sneak up on us. And what is sad is that the medical system has let us down. They have offered us very little help when it comes to this problem. And the sad thing is that there are some things that can help. In particular, efforts at the University of Virginia developed something called Blood Glucose Awareness Training (BGAT) some 25 years ago and a study in 2008 found that an internet versions of the BGAT was both effective and efficient. Despite that, BGAT failed to attract even minimal funding from organizations like the ADA for deployment and today the valuable technique sits almost totally unavailable.

Despite that setback, Joslin claims to offer BGAT training. And while there is no materials on the internet, thanks to Joslin there is at least a valuable presentation with a medical view of what the training is all about. And the researchers continue efforts to continue the work.

I know that in my case I will have traditional symptoms that indicate a hypo such as shakiness. sweating, chills and clamminess. And while I am hypo aware I don’t really feel these till I drop below 70 mg/dl and I can often get false hypos. But I have noticed there are other symptoms that I feel when hypo such as getting light headed when standing up and my legs all the sudden feeling clumsy and slightly numb. These are the types of symptoms that BGAT helps you with. It helps me by suggesting that I need to test.

Do you have certain things which are unique to you which you use as an indication of going hypo? Has it helped you? Would you be helped by training on how to better identify these symptoms and recognize them?

Aside from most of the things you mention, I have two other distinct symptoms: spots and blotches in my field of vision, and a tingling in the tongue and lips as though they were going to sleep. But by the time those symptoms appear, I’m usually below 50.

The real joker is that the mixture of symptoms isn’t consistent. It isn’t always the same mixture and they don’t always appear in the same sequence or at the same BG level. YDMV, yet again . . . . :worried:

I’ve found that the more usual symptoms reappeared when I stopped having a high rate of hypos. When I adopted a carb-limited diet and the number and depth of the hypos went down, my awareness of hypos increased. My adrenaline response is pretty dependable now and I start to sweat when I drop below 65 mg/dl.

Before my carb-limited days, I battled hypos quite often. My adrenaline response didn’t happen; I guess I wore it out. I also noticed more insidious symptoms that could trick me almost every time. At the initial stage of hypoglycemia I became a little more alert and if I was reading or engaged in a project, my curiosity heightened and I would become further distracted from detecting and treating the hypo. Hypos had a certain irresistible Siren quality.

My hypo awareness comes and goes depending upon how many recent hypos I’ve had. I’ve had a hypo as low as 30 with being totally unaware that I was having one until I took my BG at a normal testing time. I’ve read that sometimes “the elderly” don’t have the same adrenaline responses as younger folks to a hypo, and whether it is my age, the fact that I’m on a beta blocker or something else, I never have had very strong responses since becoming diabetic at age 70. I never get sweaty, actually shaky or ravenously hungry, for example.

When my awareness is good, my first sign is anxiety or nervousness for no external reason, which alerts me to test. When I’m less hypo aware, the first signs are often just a very faint tingling or numbness of the tongue, lips or cheeks. Sometimes it is just a vague feeling of something not feeling right which prompts me to test. These last symptoms usually appear in the 50s, 40s or even 30s. Thankfully, I haven’t had any hypos in the 30s yet this year. But I’ve just gone through a streak of hypos - eight in the last nine days. And five of those were in the 40s.

After a streak like that I know it is time to run my numbers a bit higher, take fewer chances with foods hard to carb count and generally eat lower carb for a while. After avoiding all lows for a couple of weeks, I can typically get my awareness back to a more reasonable level again.

I saw a website about this BGAT program years ago and was sad I couldn’t find any additional information about it. It’s too bad it’s not published somewhere, as it coud probably be helpful for many people.

I grew up with true hypoglycemia unawareness. My blood sugar could be 1.5 mmol/L and I’d walk around feeling totally normal. There were many times where I didn’t know I was low until I became incapacitated and had to wait until someone discovered what was going on to get treatment. I’m not sure what caused this, as it took effect within about a year of my diagnosis, so it wasn’t long-term diabetes or my counterregulatory system wearing out. It could be from having too many lows, since lows were unavoidable when aiming for tight control on two shots per day.

As an adult, my hypoglycemia awareness has improved; either that, or I’m just more aware of how my body is feeling. If I’m running high, I can feel low at 3.5 mmol/L. But if I’m not running high, I can easily get down to 2.8 mmol/L or lower before I feel like something is off. And the symptoms I do get are very vague—no shaking, sweating, or clamminess for me. It’s more like a vague sense of weakness and an inability to concentrate and subtle diminishing of fine-motor control. Recently I’ve had several times where I’ve felt really hungry, ate food even as I was wondering why I was doing so, and then five minutes later my CGM alarms that I’m low; so I’m realizing that hunger alone may be an early-warning symptom for me even though I don’t get others.

I constantly scan my body to assess how it’s feeling, and I think this is why I’m often able to pick up lows earlier than I could as a kid. I do sometimes have symptoms such as my lips going numb, but this usually happens once I’m around 2.2 mmol/L or lower, so not good if this is my first symptom (which it sometimes is). Before I got the Dexcom I didn’t wake up for overnight lows until I was down to 2.2 mmol/L or lower, but once I hit that level I’d often wake up, sometimes sweaty and shaky, but often just a sudden awakening from sleep. I used to wake up in the middle of the night or morning with a low sometimes and feel a sort of tingling numbness all over my body have my vision look as if there was static in front of my eyes, but have no other symptoms. I suspected that when this happened it meant I’d been sleeping through a low for hours on end. Unfortunately, since getting the Dexcom and discovering that I can indeed sleep through a low for hours on end, I’ve confirmed it’s hours-long lows that cause these symptoms. Scary.

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I don’t usually feel symptoms of lows. A while back I started using a Dexcom CGM and that has helped a lot. Most times I just feel like I am really weak. I have had times when I was down to 20 and just felt a little tired. My Dexcom was in the other room and I was trying to clean. So I have definitely grown to rely on my Dexcom. I am Type 1 and have had it for over 20 years.

Type 2 off meds (from an a1c of 12.0)
Now that I consistently have BG readings 80 to 120 I am much more sensitive to under 80 (use to be I noticed under 70). Not true lows, my lowest 52 I did notice. Now when I get under 80 I loose a bit of energy and get a sensation of something pressing on my head? When running just feels like started running through a liquid. Again nothing but an annoyance goes away when I eart 4 to 8 carbs.
The 52 was during a race, just did it all wrong and just needed to sit by the side of the road. ( wont do that again.

I have the same. Black spots in my vision and a feeling around my mouth and lips as if I had received an anaesthetic at the dentist’s. Also, I become unable to read words, I can see the letters but I cannot put them together. This will happen when I am at around 3 mmol and if I go lower than that I get a sensation as if straps were being ratcheted tighter and tighter around my rib cage. If I have a low for a length of time during sleep I wake up with a hell of a migraine that lasts for several hours after I correct the low. Lows never make me hungry. I would have appreciated a heads-up on this at diagnosis but I learnt on my own like we all do, I guess.

for t!'s without hypo awareness that can’t be fixed, you still treat 70 as a low. but keto diet gives a wider buffer zone.because the brain uses alternate fuels. They gave insulin drip to subjects in ketosis and reduced their BG a lot, without symptoms. .
They took a pig down to no blood glucose

the science, the important bit.
the application, The same goes for T1 athletes