Is there any chance I have low blood glucose with no symptoms like heart palpitations, cold sweating, and trembling? How serious that can be? What should I do about it? What is hypoglycemia unawareness?

Low blood sugar without classic symptoms is called hypoglycemia unawareness. It may be a serious complication of diabetes depending on when (nighttime or while driving) and how often it happens. Nowadays, in my experience, it isn’t unusual at all, and actually it has become more and more usual as more patients are following multiple insulin regimens aimed at tighter control of blood sugar levels. Moreover, after many years of diabetes, you may lose the glucagon as well as epinephrine counterregulation, and this can further lead to a variety of “neuroglycopenic” symptoms. A short period of “relaxed” blood sugar control generally is able to ameliorate these symptoms.

MS