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!!!
My wife and eye were kind of rolling our eyes at it , 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.
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 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.