Article of the Week: Be Aware of Hypoglycemia Unawareness

In his blog entry this week, Andy Stuckey writes about feeling the symptoms of low blood glucose, or hypoglycemia. This article from the archives reviews symptoms and discusses how to prevent and treat hypoglycemia as well as how to deal with hypoglycemia unawareness, or the absence of the usual signs of hypoglycemia.

Click here to read the article.

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And remember that articles on a wide variety of diabetes topics are always available in our magazine archives section!

  • Scott

    The assertion that hypoglycemia unawareness is both preventable and treatable is unsubstantiated by the facts. While it is usually preventable in most patients, Diabetes Self-Management is implying that hypoglycemia unawareness is due to patient error exclusively. Unfortunately, the reality is that its not that simple.

    More correctly, hypoglycemia is the result of the interplay of absolute or relative insulin excess and compromised glucose counterregulation in established (C-peptide-negative) T1DM. As plasma glucose levels decline, insulin levels do not decrease-they are simply a passive reflection of the absorption of exogenous insulin, and glucagon levels do not increase. The mechanism of the latter defect is poorly understood, but it is tightly linked to, and possibly the result of, insulin deficiency. Thus, the first and second defenses against hypoglycemia are lost in established T1DM, leaving patients with only one element of counterregulatory function.

    Further, the epinephrine response is typically attenuated, i.e., the glycemic threshold for the epinephrine response is shifted to lower plasma glucose concentrations. This reduction of the third defense is largely the result of recent antecedent iatrogenic hypoglycemia, thus this one element may be prevented, but clinicians have no ability to address the other counterregulatory impairments.

  • spongeCakeBob

    Robert S. Dinsmoor’s article on hypoglycemic unawareness has a corollary: heart attack unawareness.

    In short, with glucose damaged nerves, some people do not feel an MI. Yet, when the docs do the heart imaging stuff, you can see the scar tissue.

    My father was thus compromised.

    Moreover, the same process damages the autonomic nerves, causing among other things, difficulty in controlling blood preasure and thus MI and stroke.

    What a life!