Hypoglycemia unawareness is when a person cannot recognize that they are experiencing an episode of low blood sugar. This can result in them losing consciousness or contribute to long-term health problems.

Hypoglycemia is when a person’s blood sugar levels fall below the normal range. Sugar is the main source of energy for the body, and maintaining blood sugars within a suitable range is essential for good health.

When a person experiences a hypoglycemic episode, they typically have symptoms warning them that their blood sugars are low. These can include sweating, confusion, and shaking.

After identifying low blood sugar levels, a person can consume fast-acting carbohydrates to raise their blood sugars.

However, if a person is unable to recognize the symptoms and correct their blood sugars, they are at risk of hypoglycemic complications. These can include loss of consciousness, brain or organ damage, and even death.

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Hypoglycemia unawareness is when a person is unable to perceive the early symptoms of low blood sugar levels.

In most cases, a person will experience hypoglycemia symptoms when their blood sugars fall below 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter. These symptoms can include feeling weak, nauseous, or irritable. Although unpleasant, they are warning signs from the body that blood sugars are low.

However, some people can have low blood sugar levels and not feel any symptoms. This is known as hypoglycemia unawareness.

When a person frequently experiences low blood sugar levels, it alters how the body responds, and the threshold to trigger symptoms becomes lower. For example, a person may typically experience symptoms when their blood sugars are around 60 mg/dL. However, after recurrent episodes, this threshold may drop to 55 mg/dL.

Although a person’s threshold for warning symptoms may drop, the threshold that triggers unconsciousness and other serious health problems does not. Therefore, if they are unable to recognize and treat hypoglycemia, they are at a higher risk of severe hypoglycemia.

The main complication of hypoglycemia unawareness is not correcting blood sugars and becoming unconscious. This can increase the risk of other problems, such as car accidents, which can result in severe injury.

If their blood sugars fall too low, an individual may experience severe hypoglycemia, which is also known as level 3 hypoglycemia. This describes when a person is unable to function and requires assistance from another person to recover. Without prompt treatment, severe hypoglycemia can lead to brain or organ damage or even death.

If a person frequently experiences episodes of hypoglycemia, it can have a negative long-term effect on their health. This can include long-term problems with brain and heart function.

For some people, it may be possible to get their early warning symptoms back by maintaining their blood sugars within a suitable range for several weeks. Doing so can help the body relearn how to react to hypoglycemia. However, as this may involve increasing target blood glucose, or raising A1C levels, it is advisable for a person to work with their diabetes care team.

Continuous glucose monitors (CGMs) can also be beneficial for those at risk of hypoglycemia unawareness. A CGM is a wearable medical device that monitors blood glucose. It allows a person to quickly and easily check their blood sugars. They will also receive an alert if their blood sugar levels become too low.

Additionally, healthcare professionals can help individuals manage their blood sugar levels by educating them on circumstances that may increase their risk. For example, on days when a person is active, they will typically require less insulin overnight. Also, because alcohol can increase the risk of hypoglycemia, it is advisable to eat if they are going to drink.

Furthermore, it is important for a person to work closely with their diabetes care team and have a support network that can recognize the symptoms of hypoglycemia and help them if necessary. This can help reduce diabetes distress, which are feelings of frustration and worry that can occur when living with diabetes and which may negatively affect well-being and management behaviors.

A person can experience hypoglycemia for many reasons. These can include:

  • an excess of diabetes medications, such as insulin or sulfonylureas
  • a lack of carbohydrates in the diet
  • how much protein, fat, and fiber is in the diet
  • the timing of diabetes medications
  • the amount and timing of exercise
  • alcohol consumption
  • hot weather
  • menstruation
  • time at high altitudes
  • puberty
  • changes to regular schedules

Other factors that may contribute to hypoglycemia unawareness can include:

  • living with type 1 diabetes, or type 2 diabetes that requires insulin or other similar medications
  • having diabetes for more than 10 years
  • often having low blood sugars or trying too hard to reach low levels
  • having difficulty managing diabetes
  • living with other conditions that can limit the ability to manage blood sugars, such as dementia
  • taking certain medications, such as beta-blockers for high blood pressure

If a person’s blood sugar levels fall below 70 mg/dL, they should take action to increase their blood glucose.

To do so, it is advisable to follow the rule of 15. Also known as the 15-15 rule, this refers to a method of quickly and safely raising blood sugar levels. It involves consuming 15 grams of fast-acting carbohydrates and then rechecking blood sugars 15 minutes later.

Examples of fast-acting carbohydrates include glucose tablets or gel, gummy candies, and regular soda.

If a person’s blood sugars are still low after 15 minutes, they should consume another serving of carbohydrates. They can repeat this process until they are within a suitable range.

If a person has hypoglycemia unawareness, they may experience severe hypoglycemia and become unconscious. In such situations, they may be unable to eat or drink, and they will instead require an emergency dose of glucagon. This is a natural hormone that can help quickly raise blood sugar levels. It is typically available as either a nasal spray or an injection.

Usually, a person will regain consciousness 15 minutes after receiving glucagon. If they do not, it is advisable to administer another dose.

Hypoglycemia unawareness is when a person is unable to discern the symptoms of low blood sugar levels. Common symptoms of hypoglycemia include sweating, confusion, and weakness.

Hypoglycemia unawareness occurs when a person frequently experiences low blood sugars, altering how their body responds and lowering the threshold to trigger warning symptoms. This means that they may not notice that their blood sugars are low. This increases the risk of them becoming unconscious or experiencing a severe hypoglycemic episode.

To help prevent hypoglycemia unawareness, a person can work with their diabetes care team to keep their blood sugars within the target range and allow their body to relearn how to respond. A person can also use a CGM to help track their blood sugar levels.