Reversing hypoglycemia unawareness

Has anyone had any experience with this? I've tried running a little higher for a few weeks at a time before, without any measurable success. Sure feels unconducive to good health. Physically I feel fine running higher than I'd like to but mentally it worries me. Just feels like rubbing diabetes against the grain. While I haven't really set a ceiling I try and keep it over 8 mmol/l (145). Could the worry but causing me to not run high enough (yikes)? Does it take more time? Or have I just let my BG drop too much to make the process worthwhile? I really feel like I'm drinking the coolaid on this one.

I don't know what the science is on this but I've read here and other places that eliminating/greatly reducing the number of lows will restore low BG symptoms. This year I made a lot of changes to my diabetes regimen (low carb diet, everyday exercise, testing and establishing effective basal rates) that reduced the number of lows I was experiencing from several each day to a few each week. When I go low now I almost always feel an adrenaline response; I get hot and sweaty. I had lost that response prior to the large recent changes I made.

I found that reducing the incidence of low BGs comes hand in hand with reducing glucose variability. Less variability = less lows. It also meant that my BG average could run lower, say at 110 (about 6 mmol/l) instead of at 145 (about 8 mmol/l). In other words, I found that the best way to reduce/eliminate the lows was to concentrate on reducing the height and depth of the "BG roller coaster" ride. A flat BG line is ideal (and often not attainable nor sustainable) but lower highs and higher lows will give you a good benefit. Does that make any sense?

What I outlined above is easier said than done. The only way that I could do that was to eat low carb (<70 grams/day) and thus use less insulin. Less insulin meant smaller errors (Bernstein's law of small numbers).

No, you're not drinking the Kool-Aid on this. What you've discovered, I suspect, is because of higher BG variability, you're having to run your average BG pretty high. I don't know about you but my body/brain/emotions feel much better with an average BG of 6 mmol/l than at 8 mmol/l. I also feel better when I'm not having to vigorously defend against plunging BGs three or four times every day. And the lows that you aren't aware of create a three-ring metabolic circus!

I don't think there is a rule of "they have to be such and such high" to restore hypo awareness. The only point of running a bit high is just to guarantee a significant amount of time without any lows. So now that you've been doing this for awhile have you tried returning to your usual tighter management and have you experienced any lows? If so did you feel them?

This is what I have learned over time ..be especially careful to avoid another low for at least two days following a reaction as this will increase unawareness ; I started to test more often just prior to going on the pump in 2001 and I noticed the drop in numbers and was able to treat before below 3.7 ( the number I picked for me ) When you talk about unawareness are you referring to requiring " assistance " ?
A bit " on the side " I just completed a Medical Drivers Exam with my GP ( BC Superintendent of Motor Vehicles Branch's request ) ;one of the things I mentioned to her, that I do not get behind the wheel when BG is lower than 5.6 and she recorded this on the form ...her comment also on the form :" does not require a Medical Drivers exam for 5 years "( will then be 77 ).

Nel - Were you confident that the driver examiner would react appropriately to your statement regarding driving and your BG? Good for you for being such a good citizen!

I would have been worried that she would have interpreted your offered info in a negative light. There's so much ignorance out there regarding diabetes, even in the professional medical ranks. Glad that it worked out well for you

I was told that running a little bit higher than normal would help me regain my hypo awareness. But I was also told that avoiding hypos at all costs could also help me regain the awareness. So instead of letting myself run high, I just do my very best to avoid the lows and so far this has proven to be beneficial. I am beginning to get the nervous, sweaty, hypo feeling of dread after missing lows for the last 10 years or so. Of course it helps that I just got a CGM a couple of weeks ago and can watch what is going on 24/7. But I had started the hypo avoidance long before I got the Dexcom.

Estimating BG before each test is a good idea. I'll try making a consious effort before each test. The goal has just been to run over 145, or 8mmol. Usually not making corrections until over 215 (12). Lately it seems to feel "fine" or "anxious" which I can't tell if it's a low or just anxiety. I think perhaps the feeling for a low has changed and doesn't occur until 35mg/dl (2 mmol/l). Never needing assistance, just worried it might come to that. I'm still unsure about this process as it seems as though improving stability and general control would fix alot and encompass this issue at the same time. I still aspire to become sweatty, shaky and cranky if I get low.

Hi Terry , the person who performed the medical exam is my Doctor and we have a good relationship ;she also deals with Gestational Diabetes patients ...me excluded :) .I have a sense she is knowledgeable and helpful with my treatment , besides diabetes . ( CAN 5.6 x US 18 )

I now get the sweaty, shaky, cranky low feeling around 45-50 (2.5mmol/l)previously I could be in the mid 30's and literally feel "fine". And be able to carry on a perfectly lucid conversation. Improving blood sugar control and keeping it off the roller coaster and on a straight line will definitely help a lot with the hypo awareness, and pretty much everything else.

Terry and Clare it all makes sense to me. I too suffer bigtime from hypo unawareness. Running higher did not work for me and I would love to have the shakes rattles and rolls back for symptoms.

One thing I have noticed is that my low symptoms have changed, and once I figured that out they changed again.

With diabetes less is best, less carbs, less insulin, less lows and highs.

What do you usually eat for lunch (low carb)? Terry, Clare?

I usually have roasted beet salad with goat cheese which is fairly high fiber and low carb. Or spinach salad with mushrooms, stilton cheese, dried edamame or sunflower seeds, sometimes sweetened dried cranberries all with a bit of balsamic, or sugar free balsamic dressing. I make my own pulled pork which is also pretty low carb. Some greek yogurt with blackberries. Over all it is about 20-30 grams of carbs for lunch. There are a bunch of good tasty low carb options but you really have to search the grocery store. I eat at work, so it also has to be something I can either heat in the microwave, or cook in the toaster oven. Sometimes I'll throw some chicken sausage on the Foreman grill its' satisfying and super low carb. Tofu noodles with peanut sauce is another option.

my experience that has helped is this:

a) the bad lows occur because the external insulin circulating in your blood system lasts longer than the glucose output from gut so that if gut/intestine runs out eralier, the body is driven lower than needed. Disturbances in gut/intestine from food/pests can disrupt the glucose output cauasing a bad low. Here the CGMS is handy watching for glitches in process and jumping in with the glucose tablets - been there done that.

b) dosing is a trick art requiring one to dose not for the peak glucose levels but down from peak and watch the time to live of that insulin. CGMS is great help here watching the digestion cycles and their cycle times.

Basically, one has to balance digestion/glucose ouput cycle time with the time to live absorption rate of the insulin so that when digestion cycle time over, there is not much insulin left either to drive one nuts.

c) insulin really does not get consumed in the reactions but keeps circulating kicking butt until yanked out by liver/kidneys. This is why most critical to track injection times, dose and to live time on your body of a particular fast acting insulin.

d) basil/slow acting insulins are there to keep some positive pressure on the insulin/glucose storage cycle and balance out the regular liver low level glucose output cycle otherwise it creeps getting higher on the blood glucose level.

e) amazingly , the body no better guesses the meal bolus size than a human does externally, neither have a spectrometer to accuartely get the carbs. The body does not care since when body working correctly will if it was over guessing carbs - kick the liver into action or if not enough shoot in more insulin. Diabetic has no choice but to manually adjust and pray ok.

Good luck and best wishes.

thank you

okay, praying :)

Today I had two slices of Tillamook sharp cheddar cheese and 1 ounce of barbeque pork jerky. Total carbs = 9 grams.

are you starving?

No, not in the least. I eat a low carb, medium protein and high fat diet. I rarely feel hungry. I ate lunch four hours ago and I still feel satiated.

I recently spent some time on vacation with a few of my siblings. I was surprised at their appetites just two hours after breakfast, but they don't have diabetes. They eat the typical high carb diet. I could skip most meals and still feel satisfied.

That being said, today's lunch was minimal. I could have added a Wasa cracker and tomatoes or instead, half of an avocado with tuna fish and mayo.

When I went on this diet last May, I was truly surprised how my in-between meal food cravings just dropped away.

jimms ...does Gastroparesis get into the picture at all ?????? ...just asking

Anything like what you describe and I looked up would result in delay to see glucose production startup and while not an expert, seems to suggest to me you have insulin hotted up/injected at start or before eating meal and be out of sink with digestion in intestine to see glucose out.

I have seen weird crap whereby pasta on me cranks in, starts some digestion and see some glucose out then the whole process stalls for an hour and blood sugar droops low till gut/intestine back up.

Have watched that riot on cgms and I am forced to load some glucose tablets till digestion gets rip snorting again on the pasta.

First I would like to say that in the past most of my Hypos where caused by mistakes and after many years of trial by fire I finally decided to take the time to study my habits and how my body reacts to food, activity, illness, and insulin. Raising my BG targets would have covered up most of my mistakes but just as soon as I lowered my targets back to 70-140 my Hypos would have come back, that's not a fix...JMHO

I started pumping insulin because of Hypo unawareness and low BG events, shortly after that I started using a (CCMS 5 years). I have maybe 1/2 doz hypo events in a year. Sometimes I catch them and other times I'm completely oblivious, clueless, and get down to -30mg/dL without any warning , it really depends on what I am doing at the time . My pump and CGMS have changed the way I manage my BG and I feel safe but I cannot say with any certainty that my Hypo awareness is any better after eliminating most of my Hypos, it's certainly not fixed.

I would rather take my chances with a occasional low blood glucose event...I'm sure that if I raised my BG targets that my body would quickly start falling apart.....

I will just "slap the bull" and take my chances, I believe the payoff out weighs the risk....JMHO