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The Question
Tue Jul 10 11:03:46 EDT 2012

I have been a juvenile diabetic for the last 34 years. I can't tell anymore when my blood sugars are dropping until I black out. What can I do? dadams
Asked By: golfergrl6  
Category: Type 1

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Expert Answers (1)
2012-07-16 20:08:56.0

You are describing a condition called "hypoglycemia unawareness" that seems to occur more frequently in people who have taken insulin for a long time and or have been keeping blood sugars under tight control.

One strategy used to fix this is to reduce the insulin dose and let blood sugars run a little higher for a week or two. This kind of resets the body's "hypoglycemic thermostat" and helps the body become aware of lows again. It is the only treatment that I am aware of that helps.

A person with hypoglycemic unawareness should take certain precautions to stay safe. These include:

  • Make sure your health care provider knows that you are having low blood sugars without symptoms
  • Check your blood sugar more often
  • Always test before driving or increasing your phyical activity
  • Look for patterns where you might identify reasons that led to a low blood sugar
  • Always wear or carry a form of diabetes identification
  • Identify people you are around everyday and teach them how to identify and treat low blood sugar including use of glucagon
  • If you are not using an insulin pump or continuous monitoring system, consider using both.

    You asked a very good question. Good luck

  • Answered By: Donna Yuscavage
    Accreditations: RN, BSN, CDE
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    Community Answers (3)
    2015-08-08 17:57:52.0

    I have had Type 1 for 50 years (since I was four years old in 1965). This happened to me as well. I set myself on a schedule and checked my glucose level seven times per day, then, of course considered what /when I'd last eaten, what my activity levels are/would be. And I ALWAYS before I drove even if I was in a hurry or didn't want to do it. This really helped. The thing that made me start the frequent checking was that I found when I was low, I'd start arguing with myself: Am I low? No, I can't be. Maybe I should check? No, I don't need to, etc, etc. This "argument became a cue for me to check. My biggest problem was making myself take the time to check (especially before driving) if I was doing something else, in a hurry, or just didn't want to. Best wishes to you!
    Answered By: t1since1965

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    2012-07-20 23:09:50.0

    All the answers and advice are good, but the fact of the matter is, managing diabetes is not an exact science, and so few T1 diabetics survive 50 years, there's just not enough data available to figure out some of these problems. Obviously I've been pretty successful in controlling this disease since next month will mark my 62nd anniversary of starting insulin, but in the past 2 years I've had some unexplained problems, including two severe reactions that required my wife to call 911. The biggest problem is the unpredictability of insulin. It's no longer as rapid acting as in the past, sometimes taking over 3 hours to kick in, so instead of being able to wait until I know what I'm going to eat, I've got to make a guess and dose at least an hour before hand, hoping I'm right. Then, several times a quarter, I'll run high for no apparent reason, dose for it, and three hours later, it barely drops and I dose again, even overdose and still, several hours later, still high. After several high doses, I know it will eventually drop precipitously and dare not drive until I'm sure it's under control. Then there's the problem with meters. I wear a Continuous Glucose Monitor (CGM), and sometimes, in the middle of the night, it will alert me to a low BS (65), but I'll feel fine (not always accurate) and get up and test with a finger prick that shows I'm in the upper normal range. Then other times, I'll feel low, but my CGM shows me close to 100, so I'll do a finger test and discover I'm really in the low 40s. Now I love my CGM and understand it tests differently than blood monitors, lagging behind, but it's usually fairly accurate, but there are times you need to double check, and fortunately for me, I still find the old reliable "felt better" method is usually pretty accurate! It's just not quantitative enough to guage insulin needs. We still need a cure!
    Answered By: wah0205

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    2012-07-20 17:59:21.0

    1. Know your patterns. Basal test, basal test, basal test. The most important thing a T1 should know are their basal patterns. Only then can you refine your meal boluses for consistency. 2. Test! Know your hot spots: late afternoon, before driving, before lunch, before bed; whatever is unique to you. 3. Pay attention to your symptoms. Even we unaware people have some symptoms. One is tiredness. Whenever I yawn, I test. Any hint of eye or speech wonkiness triggers a test. Learn to observe yourself. 4. Tell a friend, coworker, or family member when doing anything remotely risky. 5. Test to a schedule and never trust your feelings. Test; don't guess! I now run sub 6 A1C with almost no hypos, and I catch the ones I do get. I've been 911'd nine times over my 36.5 years.
    Answered By: powerpumper

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