When I saw my endo recently, she suggested resensitizing my low blood sugar (LBS) awareness. I usually tell her my awareness starts at 80, but sometimes I don’t wake up until it is lower, in the 60s or even high 50s. I tried researching this but couldn’t find the right words to get a precise search result.
Any ideas on how to resensitize?
Gemini AI result (edited for brevity, and I do all of these already)
Resensitizing your feelings after experiencing low blood sugar (hypoglycemia) involves regaining awareness of your body’s warning signs. Here are some strategies to consider:
Work with your doctor
Frequent blood sugar monitoring
Pay attention to subtle cues
Practice mindful awareness
Educate yourself
Consider continuous glucose monitoring (CGM)
Remember, everyone experiences hypoglycemia differently. By working closely with your healthcare team and practicing mindful awareness, you can improve your ability to recognize and respond to low blood sugar episodes.
Rephrasing it to “how can i regain low blood sugar awareness?” returned an additional item:
Hypoglycemia unawareness training: Work with your diabetes team to undergo specific training that helps you identify your personal low blood sugar symptoms and practice responding to them.
How do you train your endocrinologist when you have 1% average very low G7 CGM readings and try to explain to her that CGM BG readings in the high 30’s to low 40’s are not an issue when a finger stick during those times show BG levels above 90? My endocrinologist says that I do not need an A1C in the 5% range, and I can solve this issue by running my BG’s higher and getting my A1C in the low 6% range. This has been a running battle for years. I just ignore her and get the lecture again next visit. When my BG’s occasionally are really in the low 40’s, it hits me like a ton of bricks. During the day, I am fully aware and deal with it. At night, I wake up feeling like I just had 5-6 beers (I normally drink about 6 beers a year total) and muscle memory makes me grab my candies which starts fixing my problem within about 15 minutes. A sugar pixel clock on my bedside table lets me know my BG level, trend and therefore I easily know how many candies (Swedish Fish) to eat.
This “wisdom” offered by many endos bugs me on many levels. Good for you for resisting over time the unhealthy advice being offered. Your long-standing CGM data that gives continuing evidence of only 1% very low readings (including false lows) does not offer any comfort to your endo?
Does she not realize that you as a patient has an important perspective and stake that should temper her legal and clinical fears. Your extensive experience with this situation dwarfs her perception and judgment by orders of magnitude! It’s ironic that the circumstance requires that the patient supply some comfort and reassurance to the clinician.
I found that pointing out my low glucose variability (as evidenced by a low standard deviation and %CV of the CGM data) means that I do not drop quickly into dangerous hypo territory. This affords me ample time to avert the low trend.
Also, my total daily insulin usage shows that I only take about 0.42 units of insulin per day for each kg of body weight, about 28 units for my 147 pound body. I understand that metabolically healthy people produce about 0.5 units of insulin total daily for each kg of body weight.
What does this mean for hypo vulnerability? It means that the times I am low will likely have a low number of units of insulin on board. That’s a much less risky situation. My lows are not fueled by a high IOB hard charging into becoming highly risky.
I have been able to relax more than one endo given this explanation over a few years, 90 days at a time. Give yourself credit, however, for expressing a generous amount of patience and tolerance managing an endo resisting “getting it”!
Is it possible to start sensing the symptoms of low blood glucose again after developing hypoglycemic unawareness?
It’s possible to get your early warning symptoms back by avoiding any, even mild, low blood glucose for several weeks. This helps your body re-learn how to react to low blood glucose levels. This may mean increasing your target blood glucose levels or adjusting your treatment plan. It may even raise your A1C level in the short term, but regaining the ability to feel symptoms of lows is worth the temporary rise in blood glucose levels. It is extremely important to work with your diabetes care team on a plan to manage your hypoglycemic unawareness. Signs, Symptoms, and Treatment for Hypoglycemia (Low Blood Glucose) | American Diabetes Association.
I’ve done it and it worked for me. The unawareness returned serveral weeks after completing what I call “the reset”. I haven’t yet tried to figure out exactly how long I have to stay above 80. Hey Beyond and Breakthrough foundations, there’s a n>1000 clinical trial that needs to be done.
@JamesIgoe I’m enjoying your educational series why we need to look past the AI summaries. Keep up the good work.
It doesn’t sound like hypoglycemic unawareness to me if you can feel a low around 80. I would have thought that the not waking up issue until you were in the 60s or even high 50s would be a reflection of how deeply you sleep as much as it would be of how aware you are of lows.
Before CGM, I usually woke up before I got into the 50s but it depended. Sometimes, I had nightmares that to me indicated my brain knew I was low but was evading the waking urge. (Darn brain.) Now, CGM alarms wake me.
Nobody has mentioned that to a large extent it is not about the number, it is about the delta and that is why the experience varies between individuals. Someone the runs their BG’s in the 200+ range most likely feels hypoglycemic at 150, An individual that runs an average of 100, may not feel hypoglycemic until being below 60. When asleep, some people can sleep through anything including dangerously low BG’s while others like myself get many hours of light sleep with just a couple of hours of deep sleep and REM and wake up at the slightest noise or change in body condition.
Not sure I buy that. Isn’t there a physiological reaction — adrenaline etc — to low blood sugar that can dull when someone’s been diabetic for a while? I’ve had not great control at times but I never felt low at 150 or 120 or anything like that. I’ve often felt low because of anxiety/panic but that’s a whole different kettle of fish.
She wasn’t thinking I was unaware so much as concerned because my overnights were consistently dipping close to my 80, and they worried I might slip into excessive lows. We also had a discussion about the negative effects of lows on mental abilities - one of her mentors did a lot of work there - and not that I suffer, but in some ways, hypoglcemia can be worse than hyperglycemia, particularly on the brain.
Plus, they might misinterpret findings about lows on mental abilities, as the studies I’ve seen showing effects are usually looking at people that require ER visits, or at a minimum, require help from others. Something that has never affected me.
Perhaps your endo is hypophobic, a condition that many medical professionals suffer from. 80mg//dl is not hypoglycemic. According to the Mayo Clinic 70mg/dl (3.9mmol/L) is when we could be entering hypoglycemia. 80mg/dl is perfectly normal.
When i had chronically higher than normal BG levels and was bringing it down, I would have hypo symptoms much higher than 80mg/dl, After I gained better BG, hypo symptoms at 80-85mg/dl,
The way I understand it is that hypo unawareness is the body getting use to lower than 70mg/dl, just like when I was high it was used to being high and a drop to still high levels would cause symptoms.
My understanding that the way to become hypo aware is to have tighter control, less lows and less highs - basically keeping within the correct time in range. The Goldilocks range.
After some time of having fairly stable BG levels in the correct range, hypo awareness will return.
