What is Hypoglycemia Unawareness?

Most people with diabetes know that they have hypoglycemia – low blood sugar – when they start to feel shaky, dizzy, moody or anxious. Other symptoms can include hunger, sweating, confusion, sleepiness, and difficulty speaking. They also know that they have to treat this condition quickly in order to avoid seizures, passing out, or worse.

But what if your blood sugar dropped to dangerously low levels without your body experiencing these telltale signs? How scary would this be? It can happen, and it is called Hypoglycemia Unawareness.

hypoglycemiaThis condition is also known as "Impaired Hypoglycemia Awareness," and is common enough among people with diabetes. A recent study indicated that 10% of people with insulin-treated type 2 diabetes and 20% of people with type 1 diabetes experienced this dangerous condition.[i]

By definition, it is a complication of diabetes in which the patient is not aware of a deep drop in blood sugar levels because the body fails to trigger the secretion of epinephrine (or adrenaline), which generates the normal symptoms of hypoglycemia.[ii]

Hypoglycemia Unawareness can be caused by too much insulin, or missing a meal without lowering medication, exercise or alcohol consumption levels. 

Hypoglycemia Unawareness should be taken very seriously. CCS Medical encourages everyone to take advantage of the many great resources available to gain a better understanding of this threatening condition. In particular, we highly recommend a good read, “When You Don’t Know You’re Low – Hypoglycemia Unawareness 101,” one of many great blog topics from diaTribe.   

Here are some risk factors to consider:

  • The longer you have had diabetes, the more you are at risk for Hypoglycemia Unawareness. Symptoms can start to in fade in just five years of having a diabetic condition.[iii]
  • Age is an important factor. People above the age of 60 start to experience cognitive symptoms similar to those autonomic symptoms of hypoglycemia that make it difficult to recognize the onset of a hypoglycemic condition.
  • Exercise. This is a tricky one because we encourage all diabetics to exercise regularly because of its positive impact on regulating blood pressure and blood sugar levels; and yet, the odds of a hypoglycemic incident are increased during and after exercise because the body’s tissues are more sensitive to insulin.[iv]
  • Drinking alcoholic beverages can impact your liver's ability to release glucose when your blood sugar level is low. Alcohol consumption can also impact your ability to recognize symptoms for hypoglycemia.
  • Prescription medications for high blood pressure and depression can also reduce your ability to identify hypoglycemic symptoms.

The simple answer for how to prevent hypoglycemia unawareness is to take the necessary measures to minimize the number of times that your blood glucose levels fall below 60 mg/dL. Impaired awareness occurs primarily over time when your body has become accustomed to the increased drops in blood sugar. 

diabetic insulin careWhile the answer is simple, the steps required for increasing awareness are very much a part of the daily/regular routine of managing diabetes. Here are a few of the many key tips offered by diaTribe:

  1. Conduct more blood glucose measurements using finger sticks daily. This will help people with impaired awareness recognize any potential threats for hypoglycemia.
  2. CGMs (Continuous Glucose Monitors) give you a glucose value every five minutes so that you have real-time levels. CGMs also offer trend information and optional alarms so that you can be aware of blood sugar lows even before they occur.
  3. Work with your physician and care management team to continuously improve your insulin regimen. This part of their blog is a must-read as diaTribe has excellent specifics and product recommendations for this step!

The diaTribe blog also offers great tips with regard to structured training and automated insulin delivery (AID), as well as a link to another blog on great strategies for access to care.

We encourage you to inform your loved ones if you find that you are concerned about hypoglycemia unawareness. Having an advocate that can coach you through the steps and provide additional support can help to prevent hypoglycemia before it is too late. 

For those who have recently been diagnosed with diabetes, our Living Healthy portal has a dedicated section on how to check your blood sugar levels from home. This section also includes best practices for those who have lived with diabetes for quite some time but have had difficulty committing to consistent testing schedules.

Finally, we recommend participating in diabetes support groups – especially diaTribe – so that you can learn from and share ideas with other people with diabetes regarding hypoglycemia unawareness. With diaTribe you can also benefit from their extensive network of experts who provide helpful articles and research on this topic, as well as other relevant issues that speak to living a healthier life with diabetes.

 Join the diaTribe!


[i] https://diatribe.org/hypoglycemia-unawareness-101?utm_source=diaTribe&utm_campaign=e2c36c0cd7-EMAIL_CAMPAIGN_2018_03_14_Mailer_154&utm_medium=email&utm_term=0_22467a8528-e2c36c0cd7-149961225%23what%20is%20%20%20%20%20%20  
[ii] https://www.medicinenet.com/script/main/art.asp?articlekey=22381
[iii] https://www.webmd.com/diabetes/features/diabetes-hypoglycemia-unawareness#1
[iv] https://diatribe.org/hypoglycemia-unawareness-101?utm_source=diaTribe&utm_campaign=e2c36c0cd7-EMAIL_CAMPAIGN_2018_03_14_Mailer_154&utm_medium=email&utm_term=0_22467a8528-e2c36c0cd7-149961225%23what%20is%20%20%20%20 

Sean Browne

Sean Browne

Chief Revenue Officer, CCS Medical

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