Tools & Techniques

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Technique 2: Hypoglycemic unawareness precautions

Hypoglycemic unawareness is when your blood glucose drops below normal but you do not sense it. You may have symptoms, but you are not aware of them or they are very subtle. This decrease in symptoms usually happens after many years with diabetes. Studies have shown that insulin pump therapy actually decreases the number of hypoglycemic episodes, but even with an insulin pump, there are safety concerns when you have hypoglycemic unawareness.

First, you should discuss with your health care team what your blood glucose goal range should be. Generally, goals are set somewhat higher for people who have hypoglycemic unawareness. For example, your range may be 85-150, whereas someone who still detects his or her lows might have a goal blood glucose range of 70-140. The same goes for hemoglobin A1c goals. Your goal may be set slightly higher, but still in an acceptable range for decreasing your risk of complications.

Secondly, it is very important for successful insulin pump therapy for you to monitor your blood glucose levels frequently, at least 4 times per day. With hypoglycemic unawareness, you may be asked to increase this frequency depending on your situation. Be sure to check with your healthcare team.

Lastly, it is critical that you know the proper treatment for hypoglycemia and that you have someone close to you trained in the use of Glucagon -- a hormone that raises the level of glucose (sugar) in the blood. The alpha cells of the pancreas, in areas called the islets of Langerhans, make glucagon when the body needs to put more sugar into the blood. An injectable form of glucagon is available as a prescription item, for use to treat severe insulin reactions. The glucagon is injected and raises blood glucose levels within a half-hour. Over-treating hypoglycemia only leads to a vicious cycle of highs and lows. Not treating enough can put you in danger of passing out and/or having a seizure. If your blood glucose drops right before a meal, ideally you should still treat the low and wait until your blood glucose has risen. Do not just subtract insulin from your bolus dose and eat unless you have to.

One recommended treatment for low blood glucose is to consume 15 grams of a fast-acting carbohydrate (something with very little fat content) and waiting 10-15 minutes. If your reading is still low, repeat the treatment. If you find yourself always needing to repeat the treatment, then double the initial treatment to 30 grams. There are lots of pre-packaged treatments such as glucose tabs (i.e. Insta-Glucose or B-D Glucose Tablets) you can buy over-the-counter, or you can read nutrition labels and find items with 15-30 grams of carbohydrate per serving with minimal fat content (fat slows the absorption of the carbohydrate). The best way to learn about treating low blood glucose episodes is to consult with your healthcare team. They are best equipped to offer treatment advice based on your body type, lifestyle and current insulin therapy.

To prevent repeated hypoglycemia, go at least 3 days without any hypoglycemic episodes. It takes that long for your body to fully recover from one episode. Having repeated episodes of hypoglycemia put you at risk for even more lows. Remember, knowledge is the best way to succeed!

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