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Amit Gupta : Hypoglycemia Unawareness and ManagementHypoglycemic unawareness support groups -
People with diabetes who tightly control their blood sugar levels are more likely to have episodes of low blood sugar. Frequent and severe low blood sugar episodes are likely to evolve into hypoglycemia unawareness.
The longer a person has had diabetes, the more likely it is that they will develop hypoglycemic unawareness. After a person has had one hypoglycemia unawareness episode, more are likely to occur.
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It looks like your browser does not have JavaScript enabled. A: Health care professionals should talk to their patients about hypoglycemia at every visit, and they should ask their patients how low their blood sugar has to go before they have symptoms. This should prompt the health care professional to think about why the patient is experiencing episodes of hypoglycemia.
Is the patient using too much insulin? Is the patient skipping meals? Has the patient changed their physical activity level? This also reminds us that these patients should carry glucagon with them, and someone—a family member, coworker, or teacher—should know how to access and administer it.
Q: How can health care professionals help patients manage hypoglycemia unawareness? A: Continuous glucose monitors are very good tools for patients that are at risk of hypoglycemia unawareness, because the CGM will alert them if their blood glucose level gets too low. Patients also will know what their blood glucose level is before they drive, and have insights into how food and exercise affect their glycemia.
Health care professionals should also make sure that patients understand that they need to be aware of some circumstances that may put them at risk. The same is true for alcohol—if patients drink alcohol, it increases the risk of hypoglycemia, so they should be reminded to eat food if they are going to drink.
Some studies have shown that if patients avoid hypoglycemia for some time, they can begin to feel the symptoms of hypoglycemia again. I have seen this in people with diabetes that participate in my research studies.
By preventing hypoglycemia, you can reset the body to respond differently to symptoms of hypoglycemia. Some health care professionals may prefer to use newer basal insulins in patients at risk of hypoglycemia because these insulins seem to have less risk of hypoglycemia than the older ones, but they can still cause hypoglycemia, and we need to be aware of that.
I think that for many people, it is easier to administer mealtime insulin when they have an insulin pump. It is also important to remember that some patients may be afraid to report episodes of hypoglycemia to their doctors because of legal implications.
For example, some states may require people with diabetes to not have a hypoglycemia episode for 6 to 12 months before they can drive a vehicle. Health care professionals should emphasize to patients that they should know what their blood glucose level is before they drive a car, and that they should have food on hand, so if their glucose level drops, they can manage it.
Q: What research is being conducted on hypoglycemia unawareness? A: Researchers are interested in different aspects of hypoglycemia unawareness such as the cause, complications, and treatments.
Some groups are studying why recurrent hypoglycemia leads to impaired awareness. Is it a problem with brain adaptation to hypoglycemia, or is it only a problem with people who have severe glucagon deficiency?
Other groups are doing research on the long-term effects of recurrent hypoglycemia on the function of other organs.
I just finished a study where we gave people naloxone during an episode of exercise to determine if they recognize their hypoglycemia the next day, but the study was just completed, so we do not have results yet.
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