Most people with diabetes know when their blood sugar level is low, but others have difficulty detecting it or are completely unaware of it. This is known as hypoglycaemia unawareness, or impaired hypoglycaemia awareness.
Hypoglycaemia can be caused by excess insulin, missing a meal without reducing medication, overexercising on a hot day, or infection. Hypoglycaemia unawareness occurs when one doesn’t perceive the symptoms, which typically occurs when blood sugar falls below 3.0 mmol/L.
Cecilia (not her real name), a diabetic, remembers her first experience with hypoglycaemia. It was a cold and rainy night in November. She recalls feeling dizzy and sweating. She hardly ever sweats when sleeping and it certainly wasn’t the weather, so she figured something else had to be wrong.
She checked her blood sugar and was shocked to see it was at 1.9 mmol/L. Although she felt panicky, she told herself to take charge and that everything would be fine. She took a glucose tablet and 15 minutes later, her blood sugar only went up to 2.2 mmol/L.
She then drank a glass of apple juice and, after 15 minutes, the reading went up to 5.0 mmol/L.
Knowing the signs
People with hypoglycemia unawareness are at a higher risk of experiencing symptoms because they are less likely to recognise red flags such as shakiness, hunger or sweating. Other signs include neuroglycopenic symptoms, which alter brain function and behaviour due to low blood sugar.
Cecilia is sharing her doctor’s advice on the steps to reduce the frequency of one’s blood sugar levels falling below 3.0 mmol/L. Measuring blood sugar several times daily, especially upon waking up (fasting) and before and after meals, lets people with impaired awareness monitor potential hypoglycaemia and reduce the risk of developing low levels without warning.
Monitoring the trend of your own glucose levels on a regular daily basis reduces your risk of having large fluctuations.
Clinical trials show that seeing your glucose levels in real-time can help prevent hypoglycaemia. While the traditional finger-prick system provides a one-time snapshot, continuous glucose monitoring provides a reading every time you scan a sensor placed on your arm.
It also tracks information and has optional alarm functions, alerting users of lows when they start or even before they happen.
One way to combat hypoglycaemia unawareness is to have an emergency kit handy with items you will need in case it happens, such as glucose tablets. Make sure your friends and family know what to do in case of an hypoglycaemic event, and that they know where the emergency kit is kept.
While impaired awareness of hypoglycaemia can be a serious issue for some diabetics, the risk can be significantly reduced and managed with the right tools, resources, and awareness.
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