Hypoglycemia Awareness

A condition called hypoglycemic unawareness develops after repeated episodes of hypoglycemia (low blood sugar) occur. The body is no longer able to provide the usual warning symptoms of a low blood sugar: anxiety, nervousness, sweating and rapid heartbeat. As a result, the risk for severe hypoglycemia increases.

The autonomic nervous system normally helps your body respond to low blood sugar levels.
It gives you symptoms when your blood sugar gets too low. It causes you to sweat, shake or have a fast heartbeat. The autonomic nervous system also sends signals to your liver, by way of certain hormones, telling it to release more sugar when blood sugar levels drop too low. When these nerves are damaged from diabetes, you may not have symptoms until your blood sugar gets really low (40-50 mg/dl or lower).

• Often the only symptoms you feel are from too little glucose in the brain.
• You may get confused, tired, or cranky.
• You may even pass out.

Although high blood sugar levels may cause this nerve damage, other factors play a role.

• The longer someone has diabetes, the more likely this nerve damage will occur.
• Also, people who have frequent low blood sugars tend to lose their classic symptoms. In these people, their symptoms may return if they avoid low blood sugars for a while.

How to improve the situation?

• If you have hypoglycemia unawareness, test your blood glucose levels frequently.
• Check with your doctor about appropriate blood sugar goals. Sometimes they need to be increased to keep you safe.
• Always test your blood sugar before you drive and every 1-2 hours on extended trips.
• Wearing diabetes identification is important for your safety.
• Teach family and friends signs and symptoms and treatment for hypoglycemia.

Take these steps to prevent nerve disease:

• Keep your hemoglobin A1c at 7% or less (a 3 month average blood sugar test).
• Control blood pressure
• Don't smoke
• Eat a healthy diet
• Exercise most days
• Avoid or limit alcohol

Questions?
If you have further questions about treatment for hypoglycemia unawareness, contact your diabetes healthcare team.

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