Your body normally works to keep your blood sugar within the normal range<\/a> by releasing insulin to lower blood sugar and breaking down glycogen (sugar stored in your liver) to raise blood sugar. Despite this feature of your autonomic nervous system, there are times when blood sugar levels go too high and too low.<\/p>\n\n\n\n There are different levels of hypoglycemia, which correlate with how severely low the blood sugar levels are.<\/p>\n\n\n\n Hypoglycemia occurs for many reasons. One of the most common causes of hypoglycemia is taking too much medication that lowers blood sugar levels in people with diabetes. <\/p>\n\n\n\n Insulin comes with the greatest risk of hypoglycemia among diabetes medications, along with sulfonylureas.<\/p>\n\n\n\n Hypoglycemia can also occur from not eating enough carbohydrates, especially if you\u2019re also taking blood sugar-lowering medications. Exercise can also cause low blood sugar<\/a> because it uses up stored sugar in your liver called glycogen.<\/p>\n\n\n\n There are several symptoms of hypoglycemia to watch out for. If you take a blood sugar-lowering medication, especially insulin, you and your support team (family, friends, etc.) should familiarize yourself with the symptoms of hypoglycemia so you can quickly treat it.<\/p>\n\n\n\n Some of the most common symptoms of hypoglycemia are:<\/strong><\/p>\n\n\n\n You might not always notice hypoglycemia symptoms<\/a>, especially at nighttime. Low blood sugar at night is called nocturnal hypoglycemia<\/a>. This can be even more dangerous because you\u2019re less likely to notice the symptoms. <\/p>\n\n\n\n Signs of nocturnal hypoglycemia include:<\/strong><\/p>\n\n\n\n If hypoglycemia isn\u2019t corrected, it can become an emergency that warrants prompt medical treatment. <\/p>\n\n\n\n Signs and symptoms of severe hypoglycemia include:<\/strong><\/p>\n\n\n\n <\/p>\n\n\n\n Hypoglycemia symptoms result from your adrenal glands (located on top of the kidneys) releasing both epinephrine and cortisol in response to hypoglycemia. These stress hormones are responsible for the symptoms of low blood sugar.<\/p>\n\n\n\n Some people don\u2019t notice the symptoms of low blood sugar. This condition is called hypoglycemia unawareness, and it increases the risk of developing severe hypoglycemia or complications from hypoglycemia, like falling.<\/p>\n\n\n\n You might have hypoglycemia unawareness if your blood sugar is low when checked, but you didn\u2019t notice any hypoglycemia symptoms. If you don\u2019t develop symptoms of low blood sugar until it\u2019s severely low, you might also have hypoglycemia unawareness.<\/p>\n\n\n\n One of the best ways to determine if you have hypoglycemia unawareness is to use a continuous glucose monitor (CGM)<\/a>. This device measures your blood glucose levels every few minutes. <\/p>\n\n\n\n You can set an alarm on the CGM to notify you when your blood sugar levels fall below a set threshold. If the alarm sounds and you don\u2019t have any physical symptoms, that\u2019s a sign of hypoglycemia unawareness. <\/p>\n\n\n\n Hypoglycemia unawareness is dangerous because your body cannot sense that your blood sugar levels are falling. Without experiencing these symptoms, you won\u2019t be able to correct the low blood sugar promptly. This then increases your chance of having severe low blood sugar and related complications.<\/p>\n\n\n\n Severe low blood sugar can cause clumsiness, dizziness, and fainting. If you have hypoglycemia unawareness, you might develop these symptoms at dangerous times, like while driving or operating machinery, which could cause a serious accident.<\/p>\n\n\n\n When it\u2019s untreated, severe hypoglycemia can lead to coma and death.<\/p>\n\n\n\n The mechanism behind hypoglycemia unawareness isn\u2019t very clear. One of the potential causes is impaired epinephrine secretion. Epinephrine is one of the hormones that help you feel symptoms of low blood sugar. Without enough epinephrine, you might develop hypoglycemia unawareness. This is more common in people with type 1 diabetes.<\/p>\n\n\n\n While the exact physiological mechanisms aren\u2019t as clear, there are several known risk factors for developing hypoglycemia unawareness, which we\u2019ll cover next.<\/p>\n\n\n\n Having diabetes for a long time is one of the risk factors for hypoglycemia unawareness. If you\u2019ve had diabetes for many years (especially if you have type 1, which tends to show up during childhood and adolescence), you\u2019ve probably experienced low blood sugar many times. This can dull your body\u2019s ability to recognize the symptoms. People with type 1 diabetes experience hypoglycemia unawareness more than those with type 2 diabetes. Around 40%<\/a> of people with type 1 diabetes have hypoglycemia unawareness.<\/p>\n\n\n\n Having repeated episodes of low blood sugar seems to dull your body\u2019s response to hypoglycemia. This means you won\u2019t be alerted to the low blood sugar as strongly as someone without hypoglycemia unawareness.<\/p>\n\n\n\n People over 65 tend to have more hypoglycemia unawareness compared to younger patients. Part of the reason is from normal cognitive slowing with age, which can interfere with your ability to perceive hypoglycemia symptoms. Low blood sugar while you\u2019re sleeping can decrease your hypoglycemia awareness since you\u2019re unaware of it.<\/p>\n\n\n\n Beta-blockers<\/a> are a type of medication used to treat heart arrhythmias and high blood pressure. Beta-blockers block the impact of stress hormones (like epinephrine\/adrenaline) on increasing your heart rate, which slows your heart rate. <\/p>\n\n\n\n An increased heart rate is one symptom of low blood sugar (along with palpitations), which beta-blockers can mask.<\/p>\n\n\n\n The good news is that improving your ability to sense hypoglycemia is possible. The best way to reverse hypoglycemia unawareness is to avoid having low blood sugar. The longer you go without having a low, the more likely you\u2019ll be to sense when you have low blood sugar.<\/p>\n\n\n\n Setting higher blood sugar goals (to avoid having low blood sugar) for 7-21 days can be enough to help improve hypoglycemia sensitivity.<\/p>\n\n\n\n Temporarily setting the target blood sugar range higher than it was can help \u201creset\u201d your sensitivity to hypoglycemia symptoms. Depending on the frequency and severity of hypoglycemic events, some healthcare providers might recommend permanently loosening the strictness of blood sugar targets, especially in older people.<\/p>\n\n\n\n If you experience hypoglycemia unawareness, there are some simple tips you can follow to help get your hypoglycemia awareness back.<\/p>\n\n\n\n Discuss your medication regimen with your healthcare team and see if you can adjust it to reduce the risk of low blood sugar. You might be a candidate for some of the newer long-acting insulins, which have a lower risk of hypoglycemia.<\/p>\n\n\n\n If you can\u2019t perceive low blood sugar symptoms, then you should check your blood sugar to determine when you\u2019re getting low blood sugar levels. Once you know when you\u2019re most likely to get hypoglycemia, you can better adjust your lifestyle and medication regimen to help prevent it.<\/p>\n\n\n\n Continuous glucose monitors can alert you when your blood sugar level is falling if your body isn\u2019t able to tell you. Knowing when you\u2019re experiencing hypoglycemia gives you useful information that can help you work to prevent hypoglycemia and improve hypoglycemia unawareness. Preventing hypoglycemia is the ideal route to avoid hypoglycemia unawareness. While it isn\u2019t always possible to eliminate bouts of low blood sugar, you can prepare yourself with the following tips.<\/p>\n\n\n\n Taking insulin is one of the biggest risk factors for developing low blood sugar. Never increase your insulin dose (or other diabetes medication dose) unless your healthcare team recommends it. <\/p>\n\n\n\n If you take insulin on a sliding scale (the dose depends on your blood sugar), you must check your blood sugar to know which dose to inject. For example, some people might be on a sliding scale where they inject 5 units if their blood sugar is above 150 mg\/dL before a meal. If you don\u2019t check your blood sugar first then you might inject too much or too little. You can\u2019t always prevent low blood sugar, but being ready to treat it can help prevent it from becoming a severe case of hypoglycemia.<\/p>\n\n\n\n You can treat mild low blood sugar with things like fruit juice, glucose tablets, sports gels, and hard candies. If you\u2019re prone to low blood sugar or take insulin, keep these foods and drinks on hand at home, in your car, at work, and while out exercising. <\/p>\n\n\n\n More severe low blood sugar is treated with a glucagon injection, which helps your body release stored sugar (glycogen) to raise your blood sugar levels. You can get a prescription for a glucagon injection if your healthcare provider thinks you\u2019re a good candidate.<\/p>\n\n\n\n Carbohydrates are a type of nutrient that raises blood glucose levels. If you don\u2019t eat enough carbohydrates throughout the day, you might experience low blood sugar, especially if you take insulin and\/or exercise.<\/p>\n\n\n\n When you start to exercise, your body uses up glycogen to help fuel your cells as they take up sugar for energy. You\u2019re more likely to develop low blood sugar if you exercise for long periods (over one hour), and after exercise is completed. <\/p>\n\n\n\n If you\u2019re prone to low blood sugar, be sure to eat a snack containing carbohydrates before exercising. It\u2019s a good idea to have carbs on hand during exercise if needed, as well as for a post-workout snack to help prevent post-exercise hypoglycemia. <\/p>\n\n\n\n Checking your blood sugar before and after exercise (or using a continuous glucose monitor) will help you determine how your body responds to exercise.<\/p>\n\n\n\n Hypoglycemia unawareness occurs when your body cannot recognize the symptoms of low blood sugar. You\u2019re more likely to experience hypoglycemia unawareness if you\u2019ve had diabetes for a long time, have type 1 diabetes, have a history of frequent low blood sugar episodes, and\/or are older.<\/p>\n\n\n\n The best way to improve hypoglycemia awareness is to avoid low blood sugar. You can do this with more frequent blood sugar monitoring and by reducing the strictness of blood sugar targets.<\/p>\n\n\n\n\n
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<\/li>\n\n\n\nWhat are the symptoms of hypoglycemia?<\/h2>\n\n\n\n
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What is hypoglycemia unawareness?<\/h2>\n\n\n\n
Do I have hypoglycemia unawareness?<\/h2>\n\n\n\n
Why is hypoglycemia unawareness dangerous?<\/h2>\n\n\n\n
What causes hypoglycemia unawareness?<\/h2>\n\n\n\n
What are the risk factors for developing hypoglycemia unawareness?<\/h2>\n\n\n\n
Having diabetes for a long time<\/h3>\n\n\n\n
According to a study<\/a>, around half the people who were on insulin for over 20 years (like those with type 1 diabetes who must inject insulin several times per day) developed an inability to detect hypoglycemia.<\/p>\n\n\n\nHaving type 1 diabetes <\/h3>\n\n\n\n
Frequent episodes of low blood sugar<\/h3>\n\n\n\n
Age<\/h3>\n\n\n\n
The risk of hypoglycemia unawareness and increased risk of falls in older people is one reason why many healthcare providers set less strict blood sugar goals for older patients with diabetes.<\/p>\n\n\n\nNocturnal hypoglycemia<\/h3>\n\n\n\n
Taking beta-blockers<\/h3>\n\n\n\n
Can you reverse hypoglycemia unawareness?<\/h2>\n\n\n\n
Getting your hypoglycemia awareness back<\/h2>\n\n\n\n
Adjust your medications to prevent hypoglycemia<\/h3>\n\n\n\n
Check your blood sugar levels often<\/h3>\n\n\n\n
Consider getting a continuous glucose monitor<\/h3>\n\n\n\n
Insurance companies might cover a continuous glucose monitor, especially if your healthcare provider writes a letter documenting your history of hypoglycemia and\/or hypoglycemia unawareness.<\/p>\n\n\n\nPreventing low blood sugar<\/h2>\n\n\n\n
Take medications as prescribed.<\/h3>\n\n\n\n
It\u2019s ideal to check your blood sugar before administering fast-acting insulin, which quickly lowers your blood sugar level. You might not need to inject fast-acting insulin if your blood sugar is low enough.<\/p>\n\n\n\nBe ready to treat low blood sugar.<\/h3>\n\n\n\n
Eat carbohydrates consistently.<\/h3>\n\n\n\n
Plan snacks around exercise.<\/h3>\n\n\n\n
Conclusion<\/h2>\n\n\n\n
Explore More<\/h3>\n\n\n\n
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