Hypoglycemia unawares

Can anyone tell me about hypoglycemia unawares. I guess my biggest question is once you start not feeling your lows, will you stay that way forever or can you try to prevent the lows so that your body will adjust and get back to feeling them again? Maybe that sounds stupid but I’m just so worried about my daughter (age 14) and I don’t want her to fall into this condition if we can prevent it. For the last two weeks she has not been feeling her lows and ended up having two severe ones. The endo doens’t seem very hopeful but yet isn’t giving me very much information either. We’ve been checking her sugar constantly! So any info that anyone can share is greatly appreciated. Thanks.

hi Lisa, I have been diabetic for 31 years and I can tell you once in a while a hypo can sneak up on you.

Hypoglycemic unawareness can be a form of neuropathy, it can be fleeting (like mine) or it can come from being very low all the time. If it’s #3, doctors will tell you to to raise your target blood sugars for 3 weeks. I know only of a couple of folks (who typically have had diabetes a long time) who cant feel lows anymore. In those cases the best bet is a “CGMS”

since she’s 14 I would guess that she may be ignoring symptoms, is very distracted, or is adjusting to hormonal stuff, which can make sugar control really difficult and unpredictable. I good “therapy” is to make a habit of “guessing” your blood sugar before a bs test. Once you get in tune with the feelings of a low - predicting a real low gets easier.

I don’t know what kind of insulin she’s on or if she pumps. mid-acting insulin like NPH is still used sometimes and can have a real unpredictable peak that can really fool you. basal insulin rates need to be adjusted with the seasons (for me anyway) and if she pumps, basal rates will change and need adjustment too due to a change in season or growth - as will carb ratios esp. around her period.

even the stupid time change has big effects and I seriously cant just “change the time” on my pump in one shot, even though it’s only an hour.

good luck and I hope things level out for your daughter.

Thanks for your response Joe! She is on the pump and takes novo (Lantus did almost nothing for her so the pump has been great). Today the endo agreed to let her run a little on the “high” side for four weeks max and then start “tweaking” her back down to normal.

She is a competitive dancer and the week prior to her first severe low she had extra rehearsals that were very strenuous. But usually, she has the 24 hour residual effect and that’s it. However, this time she’s been battling lows for the past two weeks, even without the vigorous exercise. So we’re thinking that something may have changed that she is not requiring as much insulin as before, but it’s still to early to say for sure. But my main concern (of the moment) is the hypoglycemia unawareness obviously. Before it would only happen to her while she was sleeping. But while awake she always felt the lows (till recently).

What really bothered me today at her endo appointment was their casual attitude about the lows. And after reading your response, I see that they did not mention the possibility of neuropathy. There (a local Children’s Hospital) attitude was pretty much “…well, this is just something that you’re going to have to learn to live with.” You should of seen the look on the nurse practitioners face when I said “That is not acceptable!” This is our third endo only because of insurance changes and also that we live in an area where our choices are limited and we have to travel for a minimum of an hour to see any pediatric endo (which I don’t mind the drive, we need all the help we can get).

Also, the time change was not that long ago. They never once mentioned that to me either. I don’t recall being told anything about it actually. Thank God I found this site. I should of looked for help online a long time ago, but I’m hard headed and mistakenly think we can handle it ourselves. But you know - I’m tired. I’m so tired, and frustrated and worried. I just need help for this girl and it seems like getting answers are hard. So thanks again for your time and thoughts.

well the time change can be a “nothing” for some people, or if you are like me it screws me up for 2 weeks. Pls don’t panic about my neuropathy comment, esp. if her A1c is higher than 8, better control will most likely reverse it.

I am still guessing then the lows are a result of a change in her weight, the temperature warming up, or too high basal rates from workouts. Do you use a special basal pattern for working out? I have a “B” pattern wich is 25% of my normal basal for when I work out and I only turn it back up when I see my bs climb.

good luck.


I already posted something related to hypoglycemia unawareness on another thread you might find worth reading. Hypoglycemia unawareness can be caused by neuropathy, but the fact is that it’s a bit more complex than that, and while symptoms may “restore” themselves by avoiding lows, they may not – so while I recommend trying, don’t beat yourself up if the solution doesn’t work! Avoiding lows does not guarantee a restoration of symptoms!

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.

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.

My personal recommendation is that if it does not work, ask your CDE about Blood Glucose Awareness Training (BGAT) which was developed by the University of Virginia Diabetes Research Team in Behavioral Medicine. A good CDE should be aware of it, if they aren’t, print the Diabetes Care article (its available as a pdf document) and bring it to him/her. The program is best when done with others who have been through the same experience, but they were working on an online version of the program which can be found here.

I hope this helps!

Scott that was a very interesting study - thanks for the link. I believe that my personal issue, however, seems to be an occaisional “Recovery of the Hypothalamic-Pituitary-Adrenal Response to Stress” issue with me.

I am typically very aware of my blood sugar, including hyperglycemia. After prolonged or repeated stress cycles and repeated hypoglycemic cycles I don’t react the same way and I can sometimes miss or misinterpret a hypo.

…and I am by no means a doctor =) I just know that my body can do this sometimes!

Wow, I never expected so much education regarding this topic and I’m afraid that my medical terminology is limited after reading Scott’s response. But I am going to check out the links that you provided - thanks. I may not be interpreting the response accurately, but I am wondering why many people are completely aware and have no problems with unawareness. I am looking forward to checking out the BGAT to see what help it may offer us.

Joe, my daughter (Jamie) is on the Animas pump and when she has a vigorous rehearsal we do a temporary basal reduction. But the two particular severe lows that she had were not related to dance at all. There was no vigorous activity of any kind 24 hours prior to. We’ve started keeping a journal of every activity and some details of the days events in hopes that if it happens again we’ll see something. I’d like her to start keeping a journal of her own personal feelings but she’s a teen and I don’t think she would be willing to share. We’ll see. Btw, her A1c is 9.7 right now.

Also, if anyone out there who is currently on CGMS share with me any experiences they have been having with lows I would greatly appreciate it. This is something we are beginning to discuss with the endo. Thanks guys:)

When I was teen (12 to 15) I got a lot hypoglycemia unawares: at school, in holydays. It was a bad time for me, hypoglycemia went suddenly and I could’nt feel my lows. It was a long time ago and my parents had no glucometer to see how low I was . But I must tell you that this bad time has gone and after my body changes I was feeling very well my lows. Today I feel them before it will be too low ( near 50, if I’m sleeping at night I wake up). So please, wait and don’t worry too much . ( It’s so hard to don’t worry for parents). Hope your daughter is well. Brigitte

Brigitte - thanks for your words of encouragement! It is hard not to worry. Worrying is something I just do anyway lol. Jamie has felt her lows till now, except when she is sleeping. I’m hoping that this is not a permanent thing. She likes her independence and I just can’t let her go as she used to with this happening. How did you handle going out with your friends? She is coming up on 15. This is a time when she should be gaining a little more independence from us (note I said a “little more”:). She is really handling this with a good attitude, but I know that she just wants to go to her girlfriends and hang out or spend the night again.

One of the many frustrating things about type 1 is how it varies for each person. It sure doesn’t make it easier.

If your daughter has very good friends who know her diabetes I think she can go with them. When I was 13 years old, it was my worst year because I was such afraid by those lows that I refused to go outside my home! My parents were so much worried about my health that they took me away from school during one year. My teachers didn’t know and don’t want to know what was type 1. I was the only diabetic in my “lycée” and they tought I was disturbing the classes! So you see, it was very hard for me. After I used to eat more and I really think that it helped me to go out again, first with my mother, with my family after. Friends were like the teachers, they didn’t understand my lows. After I was getting better and I felt again my lows. This time was great changes in my body and I think that made those lows (and highs). My parents let me go out with very good friends who knew that I needed sugar ; they had trust in me. It was a long time ago, in a strange world without glucometer! I don’t want to know how much was high my A1C at this time because no doctor told me to have this exam!My diabetic life started in 1967, I was 10 years old. I just want to tell you one more thing: my mother, who is 81, is still worry about me… Brigitte

This generation is blessed regarding advances in medical technology. Especially where diabetes is concerned. Obviously a cure is the answer though.

When I read your story I just can’t imagine what life was like. As a mom, I often think of homeschooling and those reasons have nothing to do with diabetes lol. I am so protective of them. Sometimes I wish they didn’t tell me half the things that went on in their day, but I wouldn’t tell them that. I also enjoy the fact that they share with me.

So I am curious, after years of not having a glucometer and probably using the old methods of treatment, how are you today? If you don’t mind my asking of course.

Well, how am I today? I’m very happy, very busy and I think, very strong. But of course I have complications : retinopathy (2 eyes treated by lots of lasers), and a big open heart surgery in september 2003. I was in holydays in my countryhouse at 200 kms of my town where I live ( Lyon) and no doctor of “cardiologie”, the town near my home is too little and the hospital is very poor. So They sent me to Lyon by helicopter to be in a very good “clinique” to have such a big operation. 8 days after I was sending to a center of reeducation and 3 weeks after I was in my home. And in november I was in a big concert of David Bowie with 20 000 persons! Yes, my year of homeschooling was very nice and it helps me to forget my fear (about taking a low outside of my home).
I forget one more complication: I’ve a frozen shoulder since one year but I’m a little guilty about this: two summers ago I restarted to play badmington and it was a little too much. See the photos of myself on my page. The mountain you see I climbed it many times: it’s very hard and when I was young in 1975 for my first climbing I was climbing without a glucometer! Diabetics are wonderful persons, trust in them. A bientôt.

I loved the pics on your page! I’ve always wanted to visit France. Thanks so much for all of the information. How is the diabetes awareness over there in France? Are the schools and teachers better about it then when you were in school?

In France, there are few type 1 diabetics and more and more type 2.I think we are 140 000 type1. So we still are strange persons! there’s nothing for us: the glucometers are American, needles are Americans… No product from France. Maybe it’s why I love America. When I was 10 the nurse who came everymorning during the first 3 months had horrible very long needle and glass syringe, it was a nightmare to see them and I was thin. My parents found BD syringes and after that Gillette (from UK) syringes and needles altogether and half the size of the nurse’s. And it was 1968 and because they couldn’t buy those syringes from UK, found the same from BD… Now I used a wonderful pen (autopen from UK) and Unifine pentips or BD. The diabetics association in Lyon : only old people with type 2! Sometimes there are informations about type1 but it’s so far from our lives; It’s made by people who don’t know type1! And French are strange persons: I met another diabetic type 1, he was living near my flat and nobody knows that he was diabetic. And in 2003, he knew that I was really ill and asked my mother about my health and told her that he was also diabetic type 1!!! After that I spoke to him and told him about a great thing to help us for the travels: Frio. And he said to me I don’t need this product. You know, I like to have products to make my life easier! About the schools: teachers know more now about type 1 children. But they are afraid if they made sports. And children can’t eat at school because scholls don’t care about our meals. And what about Jamie? I saw the photos. Is she the nice blond girl? Does she go to school and which school? It’s very different from France ( primaire(6 to 11) college (11 to 15) lycée (15 to 18) and university if children want to go. Sorry for all my mistakes but I’m French!

No need to apologize. Most American’s think it’s cute. Besides, you would not want to read my french lol! Yes, Jamie is the blondie in my photos. She does go to what we call Junior High (only 7th and 8th grade). Next year, she will go to High School and then hopefully college after 12th. But she is totally into dance, so I’m not sure where she’ll end up. She excels in science and math so I, personally would like to see her follow a career in one of those fields. I feel like, dance is fun - yes, but there are so many dancers! Our world needs more young, brilliant minds to help us get through some of the challenges our societies face. But she is still young, and wants to have fun. Dance is fun. Math and science are not as fun or popular. Despite all that, I will support her no matter what she decides to do with her life. She is still young and has plenty of time to think about it.
I have often thought about how us American’s take for granted the privileges we have simply by living here in the US. But after hearing what you’ve gone through, and so young, it really makes it sink in. You must be glad to have found this wonderful website that allows you to talk with other type 1’s!