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Hypoglycemia Unawareness

“I’ve had diabetes for 25 years and I’ve noticed that I don’t feel my lows like I used to.”


This is a textbook example of a dangerous state called hypoglycemia unawareness (HU). HU can happen in people who have had diabetes for a long time and/or have been experiencing frequent hypoglycemic events.


Hypoglycemia is one of the most scary and dangerous challenges we face as PWD. It can be induced by any number of things; exercise, excess insulin, alcohol, stress, a sulfonylurea, and more. Because the human brain depends solely on glucose for fuel, these lows can result in shakiness, dizziness, irritability, sweatiness, and weakness.


To understand the cause of HU, we must understand normal physiology. When there is an inadequate amount of glucose available, such as in a hypoglycemic state, the body reacts! This reaction acts as a physical warning and triggers the stimulation of protective physiologic mechanisms. First, a decrease in insulin secretion. This mechanism is completely impaired in people with type 1 diabetes and becomes impaired over time in people with type 2. The second response is a glucagon release from the liver. This response, though often intact at onset of DM, decreases over time. Lastly, an epinephrine response inhibits glucose to the periphery, allowing the little glucose available to be used by more vital organs.


All these mechanisms are impaired in PWD and even more so in people who experience hypoglycemia frequently. In fact, the lower the PWD’s average BG, the higher the risk of HU. This can be very dangerous, especially overnight! If a person’s body does not show symptoms of hypoglycemia, they may not wake up to treat it.


Don’t worry! People who experience HU can regain some awareness by avoiding lows. Alcohol ingestion can also contribute to HU by decreasing the liver’s ability to release glucose (it is too busy processing alcohol). Alcohol avoidance is important in someone suffering from HU or trying to regain some of that awareness.


Ultimately, if a PWD is suffering from HU, access to a CGM is a must. This way the PWD and their loved ones can be alerted of a low before it becomes serious. I also always recommend that PWD carry glucagon with them…just in case.

Photo credit: Hunsaker Photography

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