Hypoglycemia unawareness: When low blood sugar gives no warning

Have you ever had a low that seemed to come out of the blue? Maybe there were no symptoms at all, and your first indication of low blood sugar was the confusion -- and maybe the shot of fear -- that came when you saw a startlingly low number on your glucose meter? Some with diabetes live with that fear all the time. It's called hypoglycemia unawareness, and it can be a deadly complication of living with diabetes.

What is hypoglycemia unawareness?

Hypoglycemia unawareness is a condition in which you might not recognize the signs of low blood sugar. It is caused by having many episodes of hypoglycemia over a long period of time. Eventually, your body adjusts to these episodes; as a result, the early symptoms become mild enough that you can actually miss them.

This means that your first signs of low blood sugar don't show up until the situation is already dangerous. You could lapse into the deep confusion, disorientation, seizures or unconsciousness that accompanies extremely low blood sugar. Hypoglycemia unawareness is most commonly seen in those with type 1 diabetes, who have lived with the disease for much of their life, or those with a long history of type 2 diabetes.

How to deal with hypoglycemic unawareness

Fortunately, the condition can be reversed. "Prevent hypoglycemia for a period of time and the awareness should begin to return," said Elizabeth DeRobertis, MS, RD, CDN, CDE of the Scarsdale Medical Group. This might mean letting your glucose numbers run high for a few days or weeks. Do this only under the supervision of your doctor, and keep tight watch over what those numbers are.

1. Check your blood glucose frequently.
2. Try to identify the patterns that are leading to hypoglycemia, so it can be more easily prevented.
3. Wearing a continuous glucose monitor can also be extremely helpful. A low alarm can be set to alert you before you reach a designated "low" threshold.
4. Be vigilant about testing blood sugar in the hours after exercise.
5. Keep a fast-acting sugar source handy. Keep juice boxes in the car or next to the bed, and carry glucose tablets or gels with you at all times.

If your hypoglycemia unawareness is very severe, the Mayo Clinic recommends carrying glucagon, an emergency treatment for extremely low blood sugar. Speak with your doctor about ways to remedy hypoglycemia unawareness, and the proper steps to take while you wait for your body to readjust.