You have asked some good questions. The first episode of hypoglycemia with increased alcohol intake is likely related to the drug effect that alcohol has on the production of glucose by the liver. Normally, the liver is always putting out glucose between meals and overnight so that the brain has a constant source of glucose to use. However, the drug effect of alcohol causes the liver to shut down its glucose production and puts patients at risk for insulin-induced hypoglycemia at a serious risk for a bad hypoglycemic reaction.
There has also been a lot of work done to determine why it is that patients develop an unawareness to low blood sugars. It is thought that the development of this condition requires frequent lows prior to developing unawareness. So, low sugars beget more low sugars. Why this occurs is not totally worked out, but there seems to be some resetting of the body’s set point for turning around lows. What is important is that you do something about this. Hypoglycemia unawareness will continue unless you work hard to avoid lows. Even a period as short as two to three weeks of avoiding lows may allow your early symptoms of low blood sugars to return and give you a cue to eat something to prevent a serious reaction. This means working with your physician to avoid asymptomatic low blood sugars and not putting off the treatment of lows that you do recognize. Some people refer to this as a form of neuropathy. The thing to realize is that you can do something about it. If you don’t, you are faced with severe reactions that do not get any better. So, the choice is pretty clear to act now and prevent lows.
JTL
