Hypoglycemia unawareness is the term used when a person experiences hypoglycemia, or low blood sugar, but does not feel or display the usual associated symptoms. A person can lose consciousness or worse due to hypoglycemia occurring without warning signs or symptoms.
The early symptoms of hypoglycemia are caused by the release of epinephrine and other stress hormones in response to lowering blood sugar levels. The body stops releasing these hormones when levels becomes too low or when there have been recent frequent repeated episodes of hypoglycemia.
The risk for hypoglycemia unawareness is higher with nerve damage (neuropathy), tight blood sugar control, and with certain medications.
This condition is more common in people with type 1 diabetes but can occur in people with type 2 diabetes who take insulin or medications that increase the risk for hypoglycemia. Incidence becomes more frequent the longer a person has had type 2 diabetes. People with type 2 diabetes who experience hypoglycemia unawareness have a 17-fold higher risk of severe hypoglycemia.
As type 2 diabetes progresses, it becomes harder to maintain normal blood sugar levels with oral medications that do not carry a hypoglycemia risk. Eventually, it may become necessary to introduce medications that do increase the risk of low blood sugar, such as insulin. Hypoglycemia can complicate treatment and control. However, there are ways to reduce the risk.
How to Reduce Risk
- Perform frequent blood sugar testing. Let your doctor know if you find your blood sugar levels are low and you do not feel any symptoms.
- Obtain diabetes self-management education.
- Work with your doctor for individualized blood sugar level goals.
- Ask about flexible treatment regimens.
- If you have a history of hypoglycemia unawareness, ask your doctor about hypoglycemia avoidance for a 2-3 week period to increase sensitivity. Hypoglycemia avoidance means easing off therapy for a short time and allowing blood sugar levels to run a little higher in an effort to increase your sensitivity to symptoms.
Sources:
Cryer, Philip E. "The Barrier of Hypoglycemia in Diabetes." Diabetes December 2008 57(12):3169-3176
Schopman, Josefine E; Geddes, Jacqueline; Frier, Brian M. "Prevalence of Impaired Awareness of Hypoglycaemia and Frequency of Hypoglycaemia in Insuliin-Treated Type 2 Diabetes." Diabetes Research and Clinical Practice January 2010 87(1):64-68
