Hypoglycemia unawareness -- is it possible if you're new?

Type 1 and LADA New to Type 1 Diabetes
1

Ok, now this is probably just me getting stressed over nothing, but is it possible to have hypoglycemia unawareness if you’re a new (honeymooning) type 1?

I’ve been on insulin for a month now almost, and I haven’t experienced a hypoglycemic episode yet ( i don’t think). There have been a couple times though where my meter read under 70 but when I retested (immediately) it was above 70 so I put it down to error in the meter. But just now it was definitely below 70 – I tested 3 times and it was all in the 60s (lowest was 62). I didn’t feel anything (except stressed after seeing the meter reading). I ate an apple though because I’m supposed to treat under 70.

I’m guessing I’m just overreacting, but is it possible to have hypoglycemia unawarenss if you’re a new type 1 diabetic???

2

I don’t know the answer to your question- I hope that someone else does!

But I can just share my experience of my first low. My first noticed low was around 45. That means that I had been low for a while without recognising anything (partly because i didn’t know what to pay attention to). At 45, I felt shaky. Now that I am more aware of that feeling (just a general feeling of being “unsteady” or poor motor skills), I know when to check my blood sugar and usually catch lows before they go below 50. Perhaps once you experience a couple more lows, you will get to know that feeling and be able to recognise it?? For me, the “feeling” (sorry to be so vague about it- it’s hard to describe) is a subtle, not a dramatic one, but I do recognise it.

3

Hi, Laura,
I am a honeymooning Type 1 also and my initial A1C was 7.2 which looks similar to yours. I don’t think you can have hypoglycemia unawareness unless you have had repeated low episodes. My guess is that you caught it before you got really low. For me, 60 is not low enough to have symptoms. I haven’t had many hypos but I usually don’t feel much until I get down below 50. Sometimes I feel the drop when it happens quickly. I might feel slight symptoms - a bit shaky- but not be low. Then I test again in 15 minutes and I AM low. I have only been in the 40s a couple of times and I felt sick, had cramps in my stomach and broke out in a cold sweat. Technically, between 60 and 70 is still in the normal range. I think it also depends on how high your BG has been. For someone who spends a lot of time above 180, 100 can feel low. If your fasting level is high, going down to 80 can seem scary. My fasting level is routinely between 77 and 85 so I feel comfortable at those levels. One thing you might want to pay attention to is that you can get a rebound high if you over-treat your lows. If I am just a little low I usually eat 5g which brings me up about 20 points. An apple can be unpredictable so you might want to pick something that is a standard number of grams. You also need to take into account whether you still have active insulin which is going to take you down even further and factor that into how much you eat. I test after 15 minutes to check. I had a scary low last week at school. Luckily the school nurse was there and she helped me through it. I had taken my usual 2 units of insulin and started to eat my lunch a little later than usual. I started to feel really sick and dizzy and tested myself. I was 42. I kept eating a little more and testing and it seemed like hours before I was even up to 60. In fact it was only about 45 minutes. The nurse told me to just wait and not eat more since my BG was inching up slowly and she knows I hate to go high. I felt lousy for the rest of the day and had to take a nap when I got home. I used to think I hated highs the most but after that experience I’m not so sure. I have to be careful not to get sidetracked after I do my shot. In fact I stopped taking insulin at work and just do a lower carb lunch since it is really hard to predict what is going to come up and distract me. I’m a first grade teacher and it can be very hectic. I am not yet completely insulin dependent so I can manage fine without insulin, it’s just nice to be able to eat more than 12 g for a meal. Hope this helps a bit!

4

Thanks, Kristin/Libby! You’re probably right and I just don’t get symptoms above 60, or my blood sugar wasn’t changing fast enough to make me feel bad. I keep trying to remind myself that its probably good that I haven’t experienced a low yet, but it can be a little frustrating when the nurse tells me I need to learn what lows feel like and I’m not having them to help me find out.

I think I just needed a little bit of reassurance :-).

5

Hi Laura! I can understand your worry!

Libby’s comment gave me another idea-- when many of us were diagnosed, our A1c was above 10 (mine was 12.9). That meant that my body was used to blood sugars above 300. Because you caught your type 1 so early, perhaps your body is not as shocked by a 60??

Okay, I’m not a scientist so perhaps these ideas only make sense in my head :slight_smile: Just a thought…

6

I don’t think it is possible to have hypoglycemia unawareness so soon.It usually happens to people who have been a diabetic for a long time because they use up their reserves of adrenaline in the liver that gives them a warning that they are low.There is a way to fix it though.You have to have blood sugars that are normal or slightly above for a while then the reaction will happen.

7

I don’t like to disagree with people, but in this case, I will have to say that Libby and Dee are mistaken about something, which unfortunately, is a very common mistake: hypoglycemia unawareness is not necessarily due to repeated lows (although that can make the situation worse). Hypoglycemia unawareness is more appropriately described as being the result of the interplay of insulin excess and impaired glucose counterregulation. What does that mean?

To understand this issue, you must understand a few basics. First, the basic difference between type 1 and type 2 is relevant here, because as you probably know, type 1 is caused when the body’s immune system mistakenly attacks (and ultimately destroys) the pancreatic beta cells (which make insulin and amylin). While the inflammation ultimately destroys the beta cells, all of the cells found in the Islets of Langerhans are impacted, therefore the alpha cells which produce glucagon are also damaged and can therefore no longer properly respond when glucose levels start to fall (this is not the case in type 2 diabetes, as even when the beta cells ultimately fail and the patients require insulin, virtually all still have a fully-functional counterregulatory response). That’s strike one.

Next, in patients with type 1 diabetes, as glucose levels decline, insulin levels do not decrease – they are simply a passive reflection of the injected insulin, which is strike two. As a result, the body’s first two defenses against hypoglycemia are lost. The one remaining defense is the epinephrine (sometimes called adrenaline) response, and unfortunately, that is also impaired.

Sometimes, lows can reduce this response even more, which is why many people tend to mistakenly blame the patient for hypo unawareness. It is true that the reduced glucose threshold for the epinephrine response is shifted to even lower glucose levels following a hypo, but it is factually inaccurate for anyone to claim that avoiding lows will "restore " the symptoms of a low, rather it may help shift the level a bit higher (therefore you get symptoms sooner), but the epinephrine response will still be reduced.

Although it is not as likely, the fact is that hypo unawareness has little to do when you were diagnosed, and everything to do with the extent of alpha cell damage your Islets have endured, as well as other things like the speed in which your blood glucose levels drop.

While the “symptoms” of hypoglycemia can be characteristic, particularly for the experienced individual with diabetes, the symptoms and signs of hypoglycemia are nonspecific, and may vary with each occurrence. Symptoms of hypoglycemia are idiosyncratic and may also be unique to a given individual. Thus, many people with diabetes learn their unique symptoms based on their experience.

I would add that symptoms of hypoglycemia may occur but not be recognized as indicative of hypoglycemia, particularly when your attention is focused on other issues. For example, a large number of patients report that they are less likely to recognize hypoglycemia while at work than during leisure activities.

Let me just add that your educator, quite frankly, sounds like she is reading from a textbook. The next time, you should ask her how many hypoglycemic events she has ever experienced and if they were the same each time. I would bet she cannot answer that!

8

I agree with what eveyone has said. I don’t think it’s possible to be unaware yet. My endo says that everyone has a different threshold for when they start to feel low (probably also has to do with what sugar levels your body is used to.) If I was at 60, I might have started to feel something but I think depending on what I was doing, it might have to be lower for me to really notice. When you’re a lot lower than that, you’ll know. Don’t panic though…just eat something fast acting and try to relax. You’ll probably have low experiences that leave you stressed and drained. Unfortunately, I think it’s just part of the learning curve of diabetes but I do think that good control will aid greatly in mimimizing the bad times.

9

Julie,

One suggestion, instead of eating a food when you are heading low, get into the habit of using glucose. The reason is that it is MUCH faster, and if you ever find yourself in a real bind, the speed of a food might be to slow to keep you out of trouble.

Smarties candies and hard Sweetarts candies are glucose, so you can usually grab them at any convenience store. There are 2 g per Sweetart disc and 6 g per roll of Smarties.

Take enough to raise yourself 50 mg/dl and test in 15 minutes. If still low, take more. The to use amount varies by weight. For me at around 140 lbs, 2 g raises me 10 mg/dl.

You want to avoid getting a rebound high which may make you more insulin resistant and put you on an up and down seesaw.

10

Hey Laura-
I’m sure most of the people had the same response, but I wanted to share my knowledge with you. I’ve been diabetic for just over two years now. I had NO idea what they were talking about when they told me about hypoglycemia and I personally thought my symptoms were going to be more severe. I would say that unawareness is possible, but it’s more likely that you are too new to diabetes to have learned what symptoms will prompt you to check if you’re hypoglycemic. I had my first “knowing” episode more than a month after I was diagnosed so I say pay really close attention to your body for the next month, and if still nothing, talk to your doctor.
The first symptoms I exhibited were uncontrolled hot flashes, clammy hands, a feeling that if I relaxed everything would fall apart, very slight shakiness, and a gnawing hunger in my stomach.

11

Well, as an update, its now been about 8 weeks since I was diagnosed. I’ve now gone low 5 times (all in two days – apparently I entered the honeymoon phase last week…! I thought i was already in the honeymoon phase, but my insulin needs have suddenly halved). My lowest number was 51, the rest were high 50s and low 60s. Still, I can’t detect any symptoms. My endo says that I just might have a lower threshold than most people, but I honestly didn’t feel anything, although I was sweating a little when I was at 51 (but I had just been rushing to get somewhere, and it was a hot day). It seems like, whatever my symptoms are, they are either really subtle, or don’t show up until I am really really low. :expressionless:

12

Laura, You might also consider using a different meter. The fact is that most meters are not very accurate at levels less than 70 mg/dL. For example, the package insert for Johnson & Johnson’s One Touch Ultra strips discloses that the precision varied as much as 4.4% at levels of 44 mg/dL compared to 2.0% at levels of 77 md/dL, 2.1% at 129 mg/dL, 1.8% at 220 mg/dL and 1.6% at 364 mg/dL. This means the precision accuracy of One Touch Ultra test strips declines the lower you go on the scale. Most other brands are similar in the inverse relationship between accuracy precision and hypoglycemia (which is dangerous, but the FDA wants them accurate at levels of 800 mg/dL but could care less if they are less accurate at the low end of the scale). However, if I recall, Abbott’s Freestyle meters are slightly more accurate at the lower end, although I don’t have numbers for any of Bayer’s test strips. I will tell you that the one meter I have tested which is more accurate is the Agamatrix WaveSense meter, as the precision accuracy is remarkably consistent even at the low end of the scale. Unfortunately, it is not (yet) widely covered by many insurance formularies, but depending on your insurance, you may be able to make a convincing case for covering them … after all, what’s cheaper, paying an extra dollar per box of test strips each year, or 2 trips to the ER in an ambulance for treatment of hypos you were unable to detect?

13

I am a fairly new diabetic, T1,a little more than a year. I started the pump in Oct.I do not feel my lows…mine have all been recognized by others—I get “drunkish”-slurring my words…all have been in the 40-45 range by my meters (I have a bd/paridigm and a couple of one-touches-depends where I am which I use)

Trying to get CGMS; but, well, insurance companies suck!