Hypoglycemia unawareness is a condition in which people no longer experience the usual warning signs of hypoglycemia. The symptoms of hypoglycemia may be different, less pronounced or even absent.

CAUSES:

• Long duration of diabetes.
• Diabetic neuropathy. Neuropathy (nerve damage) can be present after having diabetes for many years. Neuropathy may stabilize or get better if blood glucose control is improved.
• Use of medications such as beta-blockers.
• Intensified diabetes control. Patients whose blood glucose control is greatly improved (e.g. by intensified insulin therapy) may experience a change in, or loss of, their usual warning symptoms of hypoglycemia.

TREATMENT:

Since frequent low blood sugars (less than 60 mg/dL [3.3 mmol/L] or so) cause the brain to quit giving the usual warning signs even in people without diabetes, treatment is aimed at eliminination of episodes of hypoglycemia. It is important that you do get some symptoms. Pay close attention to these, even if they are atypical or subtle, and be sure to treat at the first sign of them even if you cannot test to verify the low.

By testing frequently you can see what symptoms you have, if any, when your sugars are in the around 60 mg/dL [3.3 mmol/L] and use these, even if atypical, to help you know when you are low. If you can avoid these with frequent testing and appropriate adjustment of your treatment plan, the "usual" warning signs may return. Let your levels run a little higher for a while until your symptoms reappear and then gradually lower your targets again.

CAUTION:

If you experience hypoglycemia unawareness, it may be unwise for you to drive or engage in other activities requiring complete mental focus. You should discuss this with your doctor or diabetes nurse specialist.