Hypo-unawareness Unawareness

Will you still feed me - When I'm 64?

Every time I see my endocrinologist, he asks questions like “Can you feel it when you’re 70?” “How low does your blood sugar have to get before you know?” You know, the typical questions used to figure out if, and by how much, Hypoglycemic Unawareness has set in.

I’ve been reading a lot about Hypo Unawareness lately. As I understand it, Hypo-Unawareness is when you are unable to tell that your BG is low without testing it. Its magnitude is defined by a threshold – some can’t feel it until they drop below 60 mg/dL, some not until 50, and some not until 40 or lower. Some people can’t tell when they’re hypoglycemic at all. Hence the question, how low before you feel it?

As for me, I don’t know my cutoff. Sometimes I “feel it” when I’m at 85. Other times, I test, and am shocked to see a 58 because I feel fine (but once I know, then I start to feel it, like it’s psychosomatic or something).  Maybe I’m hypo-unaware, I’m not sure.  I’ve got Hypo-Unawareness Unawareness.

But what does it mean to be able to “feel it” anyway?  I always thought it was some form of impairment: confusion, trouble thinking straight, feeling really tired, that kind of stuff. That’s typical, right? If that’s the case, then I’m happy not to feel it when I’m 64. It means I’m not struggling to drive, or to attend to a crying baby, or to do whatever it is that I’m trying to do. So a lower threshold for “feeling it” just means a better tolerance for dealing with lows.

I’m sure that everything I just said in that paragraph is completely wrong. But I just don’t understand what hypo-unawareness is about, or even if I have it. I do feel hypos – usually (but not always) when my BG is dropping quickly, moreso than when it falls below an absolute number.  And if I let it continue to drop, I continue to feel worse.

(Of course, sleeping is an exception. It’s hard to pay attention to this kind of stuff when in a deep slumber.  I have slipped into dangerous lows during sleep — either because I didn’t feel it or was too tired to do anything about it. Fortunately, the last one of those was about ten years ago.)

Can someone with hypo-unawareness please explain it to me? I know it’s something serious and something real, but I can’t get a grip on how it feels or how it really happens. The textbook definitions just don’t make sense to me. If they did, I’d know if I’ve got it.

For now, though, I’m thankful that I know when lows are coming on. I do wear a CGM, and in many cases it warns me of lows ahead of time if I don’t know myself, though that’s not the reason I use it. And I generally can handle them, even If it means sitting quietly until that low blood sugar gets up to normal.

My wife has not had to bring me food or juice since that time ten years ago when I got low in my sleep. She’s offered, but I’ve already been a step ahead at that time and have eaten something. I hope I don’t need to rely on her, someday, to uphold a lyric that were sung when we were younger and shared a piece of wedding cake.

That lyric is in the caption of the picture at the top of this post; the context giving it a slightly different meaning.

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Posted on March 14, 2012, in Personal, Type 1 and tagged . Bookmark the permalink. 4 Comments.

  1. It is hard to describe how it feels because you literally don’t feel anything. One of the signs you mentioned for being low is confusion. I am thinking that it is possible to be confused when you are low even if you are hypo-unaware and just not realize that. I have heard other people say that someone close to them is good at picking up lows and telling them they need to check their BS. I know that I have done some strange things when low that I later know that I did and it should have clued me into something being wrong. A couple weeks ago, I couldn’t figure out how to get my microwave to work. One other time, it was my meter that I couldn’t figure out. Numbers were coming up in the display for the code and that confused me. If you are acting strange, your wife will most likely pick up that something is not right because she knows you really well. If you are home alone, you might not pick up the clue that you are acting strange.

    If you sometimes look at your meter and see a 58 and are surprised, I think you might have some hypo-unawareness. I agree with you that sometimes the feeling low after you know is psychosomatic. I have had a lot of those surprises on my meter and then feel low after I see the number. I once did a random BS test and had a 13 show up on my meter. I didn’t feel anything until after I saw the 13 the panic set in. The bad part is that if you don’t pick up on the low, you can keep going lower and get to the point that you pass out from the low.

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    • The thing is, Kelly, is that it’s inconsistent. (is anything with diabetes consistent?). I know sometimes I am short-tempered when low, both with and without knowing it, so maybe that’s a result of the confusion that I didn’t pick up on. What really boggles me about the whole concept is that there is a set trigger — like not noticing until I fall below 50, or something like that. That whole concept doesn’t work for me; sometimes I notice and sometimes I don’t.

      Then again, with the CGM, usually I don’t have to pick up these signals on my own anymore. Thanks for the feedback.

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  2. Likewise, it’s tough to know. I can usually feel it when I go below 60, except at key times – like in the middle of the night when I might have no symptoms at all that wake me up. Then, my threshold is somewhere in the mid-30s before the hypo symptoms draw me out of the sleeping haze.

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  1. Pingback: Keep your feet on the ground, and keep reaching for the stars | Rolling in the D

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