July 4, 2002
Hypoglycemia
Question from Australia:
I no longer have the sensitivity to detect hypos in their early stages. I do not develop symptoms until my blood sugar level drops below about 1.8 mmol/L [32 mg/dl]. My endocrinologist believes that this is the result of my body losing sensitivity to low blood sugar levels as a result of “well controlled” diabetes since my diagnosis nearly 20 years ago. The outcome of this is I am “fine” and appear okay, then suddenly slip into being confused/incoherent, etc. By this time, of course I am no longer able to help myself.
Do you have any suggestions of how to avoid this situation? I monitor my blood sugar at least four times a day and aim to maintain levels of 4-8 mmol/L [72-144 mg/dl]. Lately, I have been accepting of higher blood sugar levels with the aim of trying to increase my body’s sensitivity to low blood sugar. Do you think this may work? How long would it take to regain sensitivity etc.? I was thinking that a GlucoWatch may be useful, but it is not available in Australia.
Answer:
My recommendation to you is to go about aggressively avoiding low sugars. This is the inverse of trying to get good blood sugars. There is literature to suggest that avoidance of lows over time, including asymptomatic lows during the night, will allow you to regain some of your ability to distinguish hypoglycemia.
Monitoring needs to be done six to eight times per day, and you need to set higher target ranges. Finally, you need to do this in concert with your physician.
JTL
[Editor’s comment: This situation is called by the rather interesting name of hypoglycemia unawareness.
WWQ]
