Managing hypoglycemic unawareness -
We also see other risk factors such as having diabetes for 20 or 30 years, trying too hard to reach low glucose levels, or having trouble managing their diabetes. Q: What are the complications of hypoglycemia unawareness? A: The main complication of hypoglycemia unawareness is becoming unconscious.
Unconsciousness may lead to other problems like car accidents or accidents at work, which may result in severe injury for the person and for others. Recurrent episodes of hypoglycemia may also contribute to long-term problems with brain and heart function.
For example, people who have an episode of severe hypoglycemia are at a greater risk of having a heart attack or a stroke in the next year. It is not clear if this is only because of the hypoglycemia, or if these are just very frail people. Health care professionals should keep this in mind and pay close attention to other risk factors for cardiovascular disease in these patients, such as hypertension and high cholesterol.
Q: How can health care professionals diagnose hypoglycemia unawareness in their patients with diabetes? A: Health care professionals should talk to their patients about hypoglycemia at every visit, and they should ask their patients how low their blood sugar has to go before they have symptoms.
This should prompt the health care professional to think about why the patient is experiencing episodes of hypoglycemia. Is the patient using too much insulin? Is the patient skipping meals? Has the patient changed their physical activity level?
This also reminds us that these patients should carry glucagon with them, and someone—a family member, coworker, or teacher—should know how to access and administer it.
Q: How can health care professionals help patients manage hypoglycemia unawareness? A: Continuous glucose monitors are very good tools for patients that are at risk of hypoglycemia unawareness, because the CGM will alert them if their blood glucose level gets too low. Patients also will know what their blood glucose level is before they drive, and have insights into how food and exercise affect their glycemia.
Health care professionals should also make sure that patients understand that they need to be aware of some circumstances that may put them at risk.
The same is true for alcohol—if patients drink alcohol, it increases the risk of hypoglycemia, so they should be reminded to eat food if they are going to drink.
Some studies have shown that if patients avoid hypoglycemia for some time, they can begin to feel the symptoms of hypoglycemia again. I have seen this in people with diabetes that participate in my research studies. By preventing hypoglycemia, you can reset the body to respond differently to symptoms of hypoglycemia.
Some health care professionals may prefer to use newer basal insulins in patients at risk of hypoglycemia because these insulins seem to have less risk of hypoglycemia than the older ones, but they can still cause hypoglycemia, and we need to be aware of that.
I think that for many people, it is easier to administer mealtime insulin when they have an insulin pump. It is also important to remember that some patients may be afraid to report episodes of hypoglycemia to their doctors because of legal implications. For example, some states may require people with diabetes to not have a hypoglycemia episode for 6 to 12 months before they can drive a vehicle.
Health care professionals should emphasize to patients that they should know what their blood glucose level is before they drive a car, and that they should have food on hand, so if their glucose level drops, they can manage it. Q: What research is being conducted on hypoglycemia unawareness?
A: Researchers are interested in different aspects of hypoglycemia unawareness such as the cause, complications, and treatments. Some groups are studying why recurrent hypoglycemia leads to impaired awareness. Is it a problem with brain adaptation to hypoglycemia, or is it only a problem with people who have severe glucagon deficiency?
Modulating GABA signaling as a means to restore counterregulation and hypoglycemia awareness is supported by pre-clinical models Chan et al. Clinically, antecedent GABA-A activation with the benzodiazepine, alprazolam, has been shown to blunt the neuroendocrine and autonomic nervous system responses to subsequent hypoglycemia in healthy humans Hedrington et al.
Consistent with these findings, antagonism of GABA with dehydroepiandrosterone DHEA can prevent the development of HAAF under experimental conditions in healthy humans Mikeladze et al.
Thus, with successful proof of concept studies in healthy humans, more recent studies in people with long-standing diabetes have shown that GABA administration significantly augmented the hormonal counterregulatory response to hypoglycemia Espes et al.
Pre-treatment with opioid receptor agonists can impair the counterregulatory response to hypoglycemia Carey et al. Conversely, pre-treatment with the opioid receptor antagonist naltrexone can prevent the development of an impaired counterregulatory response to hypoglycemia Leu et al.
Based on animal studies that indicate a possible role for selective serotonin reuptake inhibitors SSRIs to augment the counterregulatory response to glucoprivation Baudrie and Chaouloff, , clinical studies have demonstrated that 6-week treatment with SSRIs augmented counterregulatory, but not symptom responses, to hypoglycemia in nondiabetic people Briscoe et al.
It remains to be determined if these beneficial effects of SSRIs are mediated by the inhibition of neuronal serotonin uptake or via inhibition of norepinephrine transport in the CNS Chaouloff et al. It also remains to be determined why hypoglycemia awareness was not improved with SSRI therapy.
IAH continues to be a complication in people with both T1D and T2D who seek optimal glycemic control with insulin therapy. Providers who care for patients with diabetes should inquire about hypoglycemia and IAH with a view towards considering treatment options. This review shows that there are several advances in technology and educational approaches that can improve hypoglycemia awareness.
With regards to pharmacological treatments, basic science research in animal models is continuing to elucidate the mechanism s responsible and these novel treatments for IAH are being advanced into clinical trials.
Future studies should focus on these possible mechanisms to develop more targeted therapies for patients who suffer from IAH.
EM: Writing—original draft. MD: Writing—original draft. YL: Writing—review and editing. MM: Writing—review and editing. MW: Writing—review and editing. CM: Writing—review and editing. AW: Writing—review and editing.
AM: Writing—review and editing. ZB: Writing—review and editing. BP: Writing—review and editing. LS: Writing—review and editing. AI: Writing—review and editing. SF: Writing—original draft. NIH support DK, DK to SF, DK to YL, TL1TR to MD, as well as support from the University of Kentucky Barnstable Brown Diabetes Center and the Diabetes and Obesity Research Priority Area.
The authors would like to thank and acknowledge NIH support DK, DK to SF, DK to YL, TL1TR to MD, as well as support from the University of Kentucky Barnstable Brown Diabetes Center and the Diabetes and Obesity Research Priority Area.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers.
Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Bmj , Hedrington, M. Low blood glucose is common for people with type 1 diabetes and can occur in people with type 2 diabetes taking insulin or certain medications. If you add in lows without symptoms and the ones that happen overnight, the number would likely be higher.
Too much insulin is a definite cause of low blood glucose. Insulin pumps may also reduce the risk for low blood glucose.
Accidentally injecting the wrong insulin type, too much insulin, or injecting directly into the muscle instead of just under the skin , can cause low blood glucose. Exercise has many benefits. The tricky thing for people with type 1 diabetes is that it can lower blood glucose in both the short and long-term.
Nearly half of children in a type 1 diabetes study who exercised an hour during the day experienced a low blood glucose reaction overnight. The intensity, duration, and timing of exercise can all affect the risk for going low.
Many people with diabetes, particularly those who use insulin, should have a medical ID with them at all times. In the event of a severe hypoglycemic episode, a car accident or other emergency, the medical ID can provide critical information about the person's health status, such as the fact that they have diabetes, whether or not they use insulin, whether they have any allergies, etc.
Emergency medical personnel are trained to look for a medical ID when they are caring for someone who can't speak for themselves. Medical IDs are usually worn as a bracelet or a necklace.
Traditional IDs are etched with basic, key health information about the person, and some IDs now include compact USB drives that can carry a person's full medical record for use in an emergency. As unpleasant as they may be, the symptoms of low blood glucose are useful.
These symptoms tell you that you your blood glucose is low and you need to take action to bring it back into a safe range. But, many people have blood glucose readings below this level and feel no symptoms. This is called hypoglycemia unawareness.
Hypoglycemia unawareness puts the person at increased risk for severe low blood glucose reactions when they need someone to help them recover. People with hypoglycemia unawareness are also less likely to be awakened from sleep when hypoglycemia occurs at night.
People with hypoglycemia unawareness need to take extra care to check blood glucose frequently. This is especially important prior to and during critical tasks such as driving. A continuous glucose monitor CGM can sound an alarm when blood glucose levels are low or start to fall.
This can be a big help for people with hypoglycemia unawareness. If you think you have hypoglycemia unawareness, speak with your health care provider. This helps your body re-learn how to react to low blood glucose levels. This may mean increasing your target blood glucose level a new target that needs to be worked out with your diabetes care team.
It may even result in a higher A1C level, but regaining the ability to feel symptoms of lows is worth the temporary rise in blood glucose levels. This can happen when your blood glucose levels are very high and start to go down quickly. If this is happening, discuss treatment with your diabetes care team.
Your best bet is to practice good diabetes management and learn to detect hypoglycemia so you can treat it early—before it gets worse. Monitoring blood glucose, with either a meter or a CGM, is the tried and true method for preventing hypoglycemia.
Studies consistently show that the more a person checks blood glucose, the lower his or her risk of hypoglycemia.
Bypoglycemic the day, depending on multiple factors, Cooking oils and fats glucose unawarejess called blood sugar levels will vary—up or down. This is normal. But if Reducing fine lines goes below hypoglycemoc Cooking oils and fats range and is not treated, it can get dangerous. Low blood glucose is when your blood glucose levels have fallen low enough that you need to take action to bring them back to your target range. However, talk to your diabetes care team about your own blood glucose targets, and what level is too low for you. Unwwareness R. Hypogylcemic The Contribution hypoglycejic Medications to Hypoglycemia Weight management support. Diabetes Spectr 1 April ; 20 2 Unawarenees 77— Hypoglycemia unawareness is defined as the onset of neuroglycopenia before the appearance of autonomic warning symptoms. However,much is known regarding risk factors, biochemical causes, and populations at greatest risk for the development of hypoglycemia unawareness. Less is known regarding the impact of medications on the development or recognition of this condition in patients with diabetes.
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