Hypo-unawareness

Complications & More
1

Not sure we have many threads on hypo-unawareness. Didn’t want to spin Allison’s thread into another direction, so I am starting a new thread on the topic.

This is what got me to thinking about the topic.

I wanted to mention a little anecdotal story that helped me understand the idea of hypo-unawareness a little better. I could post a bunch of boring science links, but these conversations I had with two different wives actually made it much clearer to me. So skipping the science for this one, and just relaying some personal discussions I had…

This happened in conversations with two different people. The amazing similarities between them made me connect the dots! I had a lightbulb moment on the second conversation.

Years ago, a friend of mine who was a middle-aged man was diagnosed with T2. His BG had been high for a long time and finally got diagnosed and started medicine and doing BG checks.

His wife relayed a story of how he was finally taking his medicine and getting is BG back down (after who knows how many months or maybe even years of elevated BG).

His wife told about how one time he was in the kitchen and nearly passed out from being sooooo low. He did a BG check. He could barely stand! His wife told a very animated story of how low his BG was. He felt absolutely horrible and almost fainted! Oh no! Dramatic story! His BG was…70!!!

OMG!!

My wife and eye were kind of rolling our eyes at it :roll_eyes:, thinking “70?!!? What is wrong with him? That’s not low!” We really were kind of secretly laughing at the story, but not saying anything mean. Just consoling the poor concerned wife. We didn’t mention anything about my BG numbers. We didn’t understand why he almost fainted from being 70!

Years later, another adult friend was diagnosed with T2. And months after his diagnosis, his wife told us about how dramatic it was for him. How difficult it was when he had a low one time. He almost fainted! He checked his BG, and it was…70! OMG!!!

Anyway, I finally figured it out!

For someone who is used to elevated BG, being 70 feels really low. After months or years of high BG, their low is not the same as my low. I am so used to 70, it doesn’t feel low.

Hypo-unawareness is simply being used to the feeling of being low, that is feels normal.

My 70 doesn’t feel like their 70.

That doesn’t mean I have hypo-unawareness. I certainly feel it if I am 70 and dropping. And I can feel a low at 60 or 50 or 40.

But for someone who has never been below 70 (and for non-diabetics, their alpha cells kick out glucagon at 68), 70 feels really bad. Much worse for them than it does for me.

So that’s kind of a non-scientific explanation for hypo-unawareness

Anyway, here are the obligatory boring science links!

Clinically it manifests as the inability to recognise impeding hypoglycaemia by symptoms, but the mechanisms and mediators remain largely unknown.

ncbi.nlm.nih.gov/pmc/articles/PMC4499525

+++++++++++++
The easiest way for me to understand it was that I am used to 70, so it doesn’t feel low. But my friend who hadn’t been below 150 or 200 in months or maybe years - for him 70 felt completely disabling.

Personally, I don’t want 70 to feel horrible. But I also don’t want a 60 to be invisible to me. So the fine line we have to balance is good BG numbers, where a 70 doesn’t knock us on our butts, but 60 lights the warning flares so we know to get something to eat.

  • Getting used to being too high, and 70 feels really crappy.

  • Getting used to being too low, and a 60 can become invisible.

So that :arrow_up: is the balance we need to try for. And the best way to achieve that balance is spending as much time as you can in normal range, neither too high or too low.

8 Likes
2

I’ve been stuck around 200 for months and I did not feel bad at all going from 112 to 59. That’s what bothers me. My Dexcom hadn’t even caught it yet. It was still reading 112 when I tested before dinner. My meter said 68…then my Dexcom caught up and posted 80 and the lowest Dexcom showed was 59 as I was waiting for the juice box to catch it.

So…yeah…I’m apparently on another end of the spectrum. I would have thought with my consisten highs for the last 6 months I would have felt the drop or the low…but nope! Neither!

2 Likes
3

Yes, this is kind of odd!

But keep in mind, the Dexcom numbers may have been lagging or off. And there are other things that may prevent feeling the symptoms.

My story is just anecdotal because it really helped me understand it better when I had those discussions about their disabling 70 BG!

Then later in conversations with endos and so-forth, I have heard the idea of “getting used to” a low.

So there are probably more factors at play as to whether you can feel it. Can you discuss it with Gary Scheiner and see if he has some thoughts on it?

4

I’ve emailed it to IDS this morning to see what they think on it, for sure! Will let you know what I hear…in the meantime, thank goodness for my anal retentive testing yesterday bc this Dexcom sensor or Dexcom site has taken a bit longer to dial in than the usual spots. Otherwise I would have pre-bolused for dinner and then really had a worrisome situation.

5

Along those lines, my wife can recognize my generalized slowing and slurred speech patterns when I am 60’ ish, but I feel just fine, able to do complex calculations.

A CDE told me years ago that it all depends on “where you live”. If you live at 60, you’ll feel fine at 60. This is not hypo unawareness, this is just your normal physiology.

4 Likes
6

I can’t visually pick it up in my daughter until she is in the 20~40 range.
However she can feel it much sooner probably when she hits 65 going down.

If she starts getting super silly then I know it is becoming pretty urgent and likely she may be past rational and higher level thinking which is probably closer to the 20.

If she is comfortable at 65 and the cgm shows it pretty stable then I am fine with that.

I get pretty uncomfortable when it goes below 50.

4 Likes
7

@docslotnick
Doc, that is interesting. I can understand the “feeling fine” but I thought that complex calculations would become slower and eventually (almost) impossible and which had nothing to do with how you feel. As well, if you have slurred speech but are still able to do mental math - that is surprising. Even if you are a Math Whiz !!!

My perspective as a parent is obviously different. It is being on the outside looking in and trying to gain a better understanding.

8

She recognizes small changes. Really a perceptive person. She can predict my Bg just by looking at me.

I’ve been like this since Dexcom has come on the scene, about twelve or thirteen years. Maybe that has something to do with it.

9

Sometimes when I am yelling at my kids, they ask me if I have low blood sugar.

And I have to tell them, “No, I am not yelling at you because of low blood sugar. I am yelling at you because I am really mad at you!”

It helps them understand - sometimes I am just mad at what they did!
:grinning:

7 Likes
10

Ahhhh, you mean life does not revolve around ones Bg? Unlimited!

6 Likes
11

It is a comical thing when I am yelling at them for something bad they did, and they think, “Maybe Dad isn’t mad at me, maybe he has low blood sugar. Maybe it’s not the fact I did this horrible thing…”

And then they get disappointed when they realize, "Nope. I really am in trouble. :frowning_face: "

6 Likes
12

@Eric
You are killing me.
Too funny.

3 Likes
13

Had a 56 last night and didn’t feel it at all. Dexcom was late to that party!

I really wish I felt lows like I used to. My average bg is high enough I should be feeling anything below 80 or 70…

1 Like
14

I’m with you, @T1Allison. I’m just spotty on feeling my lows. I was just reading the thread from the beginning, and I definitely was one of those people whose blood sugar was so high, and this will sound ridiculous, but even a 200 could make me feel shaky and low. On the flip side, I didn’t feel symptoms of a high until I was up between 500-600. That part has changed drastically over the last few years, as my control has improved. I can feel a rising blood sugar by a 140 now, depending on how fast it’s climbing, and can be SICK by a 200. My lows though just haven’t done the same.

I will tell you that I had a doctor somewhere along the way tell me that the way to “reset” it is to avoid lows at all costs for like… 4-6 weeks or something of the sort. At all costs. I haven’t been able to, so I have no idea if there’s any truth in it.

I have no idea if that’s completely bogus or not, but maybe it gives you another angle to consider. As I said, I’ve got nothing really because I can test in the 20s and not have felt it. Until I figure out how to tackle that, I’m just working on not letting myself drop to the 20s.

Sorry to hear your frustration. :tulip:

1 Like
15

Maybe I just have to be much lower to feel it? I’ve avoided lows other than a handful for years. The reset ain’t working on me! :scream:

2 Likes
16

I didn’t have much faith in it to begin with. Have you tried cinnamon? :grin:

What are you doing up right now???

2 Likes
17

LOL! Yes. Cinnamon. That will work for sure.

What were YOU doing up? Mine was against my will. Being a semi-responsible parent or something…I guess they should eat something before school…and maybe throw a little water their way…

1 Like
18

Being a semi-responsible parent. You beat me though. Mine got food— but no water.

Unless you meant to drink. To drink, or to wash the sleep off their face? Because mine went with serious sleep on their faces. :grin:

Pondering a “reset” nap for myself now. With all that sleep talk…

1 Like
19

I’m not sure hypo-unawareness is all that straightforward. After I was diagnosed and discharged from hospital, I spent weeks with blood sugars of 20-32 mmol/L (350-575 mg/dl) before we got my insulin doses right. Yet, I’ve always had quite significant hypo unawareness. As a kid, I could test at 1.9 mmol/L (34 mg/dl) or even 1.2 mmol/L (21 mg/dl) and feel totally fine. It caused me a number of severe lows where I didn’t realize anything was wrong until I was too incapacitated to seek help.

As an adult, I’ve gotten better at scanning my body. But even now, I typically don’t feel low until I’m around 3.0 mmol/L (52 mg/dl), and symptoms at that stage are very vague. Basically feeling a little weak is the best way I could describe it. Maybe a little hungry, or a little uncoordinated, or finding it difficult to contcentrate, but all extremely subtle even to me, much less to anyone watching me. If I’m at all districted I can easily miss them. The Dexcom has greatly increased my ability to detect lows, and I thought it had improved my hypo awareness. But then I went for a week without a sensor recently when I ran out, and I found myself testing at 2.6 mmol/L (46 mg/dl) with no symptoms whatoseoever. I didn’t believe it until I tested again and got similarly low numbers. And that happened more than once. Overnight, I rarely wake up unless I’ve dropped to 2.3 mmol/L (41 mg/dl) or lower, unless I happen to wake up for another reason (I used to always test any time I woke up).

I do not have super, ultra tight control, and so my blood sugar average is not super low, and I spent a fair chunk of time high. I think that maybe avoiding lows completely for six weeks might help, but avoiding lows is exceedingly difficult to do when you don’t feel them until you’re already there. And my hypo unawareness, while not super severe, has just been something I’ve always seemed to have, so I’m not entirely sure what causes it.

1 Like
20

Thanks for adding your experience. My endo told me I have autonomic neuropathy starting based on hypo unawareness…and I asked if that makes sense with tight A1C’s in upper 5’s for first eight years…the upper 6’s and low 7’s post-kiddo. He shrugged.