I've always been good about feeling my lows but lately the signs have been changing. I don't get shaky, which was my number 1 clue. What are the reasons for this? Why would this be happening now?
Stephanie,
I am not a healthcare professional, so my thoughts are only my own. Have you been sick lately as illness can change the warning signs of an oncoming 'low'? Have you had a number of lows recently? I encounter this situation sometimes when I've had a low and then another low within 24-48 hours after the first low. In my case I try to be careful and not let my blood sugar fall low again. Have you changed your insulin doses recently?
Sometimes the hypo warning signs change when there have been hormonal changes too. Everyone is different. If possible when you think you might be low, test and find out. Do take care and I wish you the best.
After riding low, say 55-70, a person can have hypo unawareness. Put your average at 110 and know exactly what one unit of insulin does to your blood glucose. I've jumped to the usual reason.
When you're at 160-180 and haven't eaten for awhile, give one unit of short acting insulin and see where it falls to after 3 hours.
After riding up at 110 for a couple weeks you'll have your awareness back.
My low symptoms have changed over time. I don't consider this unusual. For several years, I could reliably tell I was low by checking if my left hand was shaking. That doesn't work anymore. I also used to sweat right through my shirt. The weirdest symptom I ever used to get was feeling like I was talking too fast. Nowadays a racing heart or "sunspots" in my vision when I close my eyes are my most reliable indicators. Every once in a while I just feel a deep weariness.
I just had this discussion with my endo. Repeated lows reset the brain's notion of what "low" is and your body will stop reacting to lows - that's what hypounawareness is. Your brain stops setting off the counter-regulatory actions, like releasing adrenalin (which is what causes the shaky feeling).
One of her mentors at Yale is studying this and can actually see the changes that occur in the brain with fMRI.
Hypo-awareness can be restored by not having any lows for 3 weeks or so. Stay above 100 or so and the brain will reset its BG "alarm level"
Leo2 above has it right.
I've been having this same problem too. Recently, I've been hitting the 40s and 50s and not even knowing it. About 2 days ago, I forgot to take my Lantus 2 days in a row, so I called my doctor for advice. He told me to check my sugar and take the Lantus that I would have taken later that day. Anyways, my sugar was a whopping 54. I wasn't even shaking D: No confusion, no fast heartbeat, no anxiety. I've been told that since I'm low so often (3 or 4 times a day, honeymooning with a vengeance LOL) my body has become accustomed to them. Now, I'm more sensitive to when I'm low, although I'm not shaking when I do have them. The main signs that tell me I'm having a low: anxiety and (weird, but) a feeling like my heart is floating on water o.O It's just a matter of keeping you blood sugar at an acceptable level consistently so that you know that you're falling.
I think it is different for everyone. I've never been shaky (unless it is an extreme low, like in the 30's and 20's). But if I'm "normal" low (40's, 50's, and 60's)I'll just get REALLY hungry (like the Zombies from Walking Dead type hunger, minus any cannibalism). So before I start stuffing my face I test just to make sure. That way I can treat the low instead of feeding it.
I have a CGM - Dexcom G4 and it is literally saving me lately for this reason. In fact, this morning, I had to reset my sensor during which there is a period of time when it doesn't read BGs, I dropped my son off at school, started to feel slightly off, so I tested as I was walking back to the subway and I was 42. No clue at all. By the time I got to work, after eating 5 glucose tabs, I was 82. But getting on the subway I felt really faint. Hate this! But the CGM has been a lifesaver for me. Literally.
I am volunteering to be a Yale lab rat. I have experienced this phenomena after a series of lows (lowest = 29). My endo told me the same thing and it did reset. Thank goodness, because he said he would put me on a CGM if it didn't.
Here is the link to Professor at Yale doing the hypoglycemia and brain studies:
http://medicine.yale.edu/intmed/endocrin/people/robert_sherwin-3.profile
By the way, I like the CGM - I don't view it as a punishment. It actually is a very useful tool for fine tuning things to avoid hypos.