When did the term ‘hypoglycemic unawareness’ originate and who coined it? I ask this question because I never once heard the term when I was diagnosed with type 1 diabetes (21 years ago). In my opinion, the advent of this term coincided with the widespread availability of synthetic insulin in the marketplace. While the majority of medical professionals attribute hypoglycemic unawareness to longstanding diabetes of ten or more years, I am very skeptical of this position. Indeed, when I was first diagnosed with diabetes, I was told that in ten to twenty years from now I might develop retinopathy, neuropathy, and nephropathy. However, I was never once told that I would acquire this extremely frightening and at times debilitating condition called hypoglycemic unawareness that I developed after I transferred from animal to synthetic insulin. Could you please comment?

It is much more likely that hypoglycemia unawareness is a secondary phenomenon related to either neuropathy (autonomic neuropathy) and also general tighter control than was possible a decade or two ago. Since that time, the DCCT results have become known.

You are correct that this is also about the time of use of human insulins, but tight control is more likely the correct culprit. You can decrease hypoglycemia unawareness by adjusting blood glucose targets, meticulous attention to food and insulin interactions, exercise effects, avoiding alcohol and lots of blood glucose monitoring. You should discuss these approaches with your diabetes team to see which ones make the most sense for your individual situation. Multidose insulin algorithms using analog insulin (smaller tail effect and therefore also less hypoglycemia, especially nocturnally) and/or insulin pump treatment also can help to decrease the hypo episodes.

SB