Do you have any information on severe hypoglycemia unawareness? I have had type 1 for 26 years and everything is good, but I get severe hypoglycemia unawareness, I mean, in the 20s mg/dl [1.1 to 1.6 mmol/L] kind of unawareness. Could this be a side affect from Humalog or just signs of diabetes and length of disease?

This is a serious problem as it can cause you to have changes in your mental status very rapidly and interfere with the ability to drive a car or operate machinery or even supervise children. When this occurs, the treatment is frequent monitoring of blood sugars, adjustment of target blood sugars to a higher level so as to prevent the lows, and frequent contact with your provider. Previous research has shown that strict avoidance of hypoglycemia will allow for you to have a return of symptoms of hypoglycemia. They may not be as prominent as they once were, but they would be a help to you in avoiding serious reactions. We have even had patients receive pancreas transplantation for severe hypoglycemia unawareness. Obviously, medical management should be tried before consideration of transplantation. In some states, you can lose your license for a hypoglycemic episode with loss of consciousness. Your physician has to be in on this and provide you direction. Frequent monitoring with strict adherence of glucose goals is mandatory. This may be associated with a rise in the hemoglobin A1c if your usual value is low. However, with poor control and frequent lows, the avoidance of lows may help improve the A1c by preventing the rebound hyperglycemia.

JTL