Avoiding hypoglycemia unawareness

Hi fellow bloggers,

Last week I shared with you a patient story about "hypoglycemia unawareness" — a condition in which a person with diabetes doesn't experience the usual warning symptoms of hypoglycemia. This week I'd like to share some risk factors and possible treatment strategies for such hypoglycemia unawareness.

Long-standing type 1 diabetes. Reduced awareness of hypoglycemia is common among people who have long-standing insulin-dependent diabetes. Many of those who've had diagnosed diabetes for 15 to 20 years report having lost their ability to perceive low blood glucoses and to often failing to treat and prevent severe hypoglycemia.

Severe hypoglycemia is an episode in which the person with diabetes is unable to treat him or herself and needs the assistance of another person. This includes prompting by a relative or friend to drink juice or eat.

Being an older adult and having type 2 diabetes. There also have been an increasing number of hypoglycemia unawareness episodes in those with type 2 diabetes; adults older than 65 seem to be most at risk.

Strict avoidance of hypoglycemia. Strict avoidance of hypoglycemia for several weeks to months can restore at least partial awareness of warning symptoms. Strategies for avoiding hypoglycemia when you have hypoglycemia unawareness or don't experience the warning symptoms include:

Aim for a higher blood glucose targetTry to more accurately count carbohydratesAvoid overcorrection or stacking of insulin dosesTest your blood glucose and adjust your insulin dose more frequentlyConsider blood glucose awareness training education programs to help you learn to identify new symptoms and improve recognitionConsider a personal continuous glucose monitor (CGM) that sounds an alarm when your glucose gets too lowConsider a service dog that can recognize low blood glucose

Glucagon for emergencies. Glucagon is the treatment of choice if someone with diabetes is unconscious or unable to swallow. The length of time a person is unconscious, is more of a concern than how low the blood glucose number is.

Ask your health care provider for a prescription for Glucagon or GlucaGen and for instructions on how to use it. Instruct your family members or friends on how to use this in an emergency and on how to access the emergency response team, such as calling "911."

Have you lost any awareness of symptoms of low blood glucose? How have you coped?

Regards, and have a good week.

Nancy

blog index

View the original article here

Understanding hypoglycemia unawareness

A patient shared the following story:

She was in a grocery store and felt that something was wrong, so she walked over to the checkout lane and grabbed a couple candy bars off the shelf. She stood there in a daze, clutching the candy bars in her hands but not eating them. She must have looked like she needed help, because a woman walked over to her and asked if she had diabetes. The woman told her to open the candy bar wrapper and eat the candy right away. My patient was in such a confused state that she hadn't thought to do that herself. The woman stayed with her until she felt better and told her that she had a family member with diabetes, who she'd assisted before when he or she was in a similar confused state of low blood glucose (hypoglycemia). My patient was lucky to have received this assistance and avoided the need for an emergency medical response team (911) call for the seizures or unconsciousness that could have occurred with severe hypoglycemia.

Is this scenario familiar to you or a family member or friend with long-standing diabetes? This story is an example of "hypoglycemia unawareness" — a condition in which a person with diabetes doesn't experience the usual warning symptoms of hypoglycemia.

Usually, when a person's blood glucose drops, the body tries to raise it by releasing the hormones glucagon and epinephrine. Glucagon spurs the liver to release stored glucose from the liver into the bloodstream. Epinephrine signals the liver to produce more glucose and also causes the typical early warning signs of hypoglycemia — sweatiness, shakiness and weakness.

If you experience hypoglycemia unawareness, you skip these warning symptoms. Instead, without warning, you can lapse into severe hypoglycemia, becoming confused, disoriented or unconscious. This is because when you've had diabetes a long time, or experienced frequent, extreme swings of high to low blood glucose levels, you can lose the epinephrine response to low blood glucose.

In the next blog, I'll discuss more features of hypoglycemia unawareness, including the predisposing factors and possible treatment strategies for this condition.

Until next time, have a good week.

Nancy

blog index

View the original article here