Type 2 Diabetes: Hypoglycemia Unawareness (Low Blood Sugar Condition)

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Hypoglycemia and type 2 diabetes

What is hypoglycemia unawareness?

Hypoglycemia unawareness occurs when someone has low blood sugar without any symptoms, or he is unable to recognize the symptoms. In such cases, a patient could lose consciousness from low blood sugar without ever recognizing the early warning signs.

This acute complication of type 2 diabetes is more common in people who've had the condition for years and in older adults. That's because about five years after a diabetes diagnosis, the symptoms of low blood sugar tend to fade.

After 20 years with type 2 diabetes, symptoms can sometimes be too subtle to detect or may occur only after a patient's glucose level has been too low for too long, rendering him incapable of treating the condition himself.

This situation is also more likely to occur if the person in your care has neuropathy (nerve damage) or if he takes certain heart or high blood pressure medications.

How can I tell if hypoglycemia unawareness is happening?

  • Often there are no symptoms of low blood sugar -- hence the name.
  • Sometimes while the physical and behavioral signs of low blood sugar aren't apparent, the patient (or his caregiver) may still detect mental red flags for hypoglycemia, such as difficulty concentrating, slowed speech, slowed thinking, or lack of coordination.

Dealing with hypoglycemia when someone has diabetes

He's unconscious. What should I do?

  • Call 911 if the person is unconscious.
  • Give a glucagon injection if he's unconscious or unable to swallow -- if the person has a glucagon emergency kit and you (or another caregiver) know how to use it. While you're giving the shot, someone else should call 911.

He's conscious. How should I proceed?

  • Call his main diabetes doctor and treat for low blood sugar if he's conscious and able to swallow.

Typically, hypoglycemia can be addressed by consuming a quick-fix, sugar-rich food. Each of the following contains about 15 grams of carbohydrates:

  • 3 to 4 glucose tablets
  • 1 serving of glucose gel
  • 1/2 cup (4 ounces) of fruit juice
  • 1 cup (8 ounces) of milk
  • 1 to 2 teaspoons of sugar or honey
  • 5 to 6 hard candies

Have the person in your care consume one of the above, then follow the 15-15 rule: After 15 minutes, check his blood sugar level again to make sure it's at 70 or above. If not, have him eat or drink another 15 grams of carbohydrates.

Even if his numbers bounce back, if it's an hour or more before his next meal, give him a carbohydrate- and protein-rich snack, such as peanut butter on toast or half a turkey sandwich.

How to prevent hypoglycemia unawareness

  • Keep on the lookout for mental indications of low blood sugar, and point them out to him so he can stay on top of his condition.
  • Make sure he checks his blood glucose on a routine basis.

Sarah Henry

Sarah Henry has covered health stories for most of her more than two decades as a writer, from her ten-year stint at the award-winning Center for Investigative Reporting to her staff writer position with Hippocrates magazine to her most recent Web work for online sites, including WebMD, Babycenter. See full bio

over 6 years, said...

This article is misleading in that most Type 2's will NEVER have this problem, unless their condition worsens to the point that they have to start injecting insulin. Even then, they'll most likely be given a long-acitng insulin such as Lantus, to supplement the oral medications they're on (which have the effect of re-sensitizing the body's cells to that insulin) and a low dose at that, not the rapid-acting insulin that Type 1's have to use for correcting and for mealtime boluses. The interaction between the meds and the additional insulin is the most likely culprit in bringing on a hypoglycemic 'attack'. But Type 2 diabetics, again, aren't the group that faces the biggest risk of developing hypoglycemic unawareness in the first place. That dubious distinction rests with us Type 1 diabetics, those who are forced to inject insulin multiple times a day (a lousy way of replicating the function of a major organ) because no one in the medical community has yet to come up with a better way of keeping us alive. Yes, kids - type 1 diabetics WILL DIE if they don't inject insulin, because our bodies are incapable of making the hormone anymore, thanks to our &^#$@!(*&$% immune systems mistaking out beta cells for a viral invader and killing them off. We are dependent for life on an expensive, injectable drug that has a few unfortunate and dangerous side effects. One of those 'fun' side effects is hypoglycemic unawareness. A hypo for a Type 2 makes that diabetic tired, shaky, exhausted and so on. A hypo for a Type 1 can mean seizuring and becoming unconcious. In some cases, a type 1 diabetic will have a low BG episode while sleeping and die as a result. I've had BG readings of 14. You heard me right - a BG (blood glucose) reading of 14. At least that's the reading that the paramedics got from me when I passed out at the park. Another example - before going out to help my husband in the yard this morning, I had to test my BG levels - it came back at 150. When I came back in twenty minutes later, I tested again and it was down to 59 AND I DIDN'T FEEL ANY DIFFERENT. No warning signs, no shaking, no faintness. The condition arises after years of exposure to the adrenaline that the body releases during a hypo. After a while, the diabetic no longer feels the effects of that hormone because their body has become used to the deluge of adrenaline. And when you're on insulin, it's incredibly hard to try to figure, from minute to minute, how much insulin you'll need for a particular activity. Miscalculate and you could be dead as a result. Get a bad test strip reading (this also happened to me), misdose as a result and you could have a hypo that kills you. I know so many adult type 1 diabetics with some varying degree of hypoglycemic unawareness, because we spend the majority of our lives injecting a potentially dangerous drug in dosages that, try as we might, can't really mimic the function of a properly working pancreas, and when we inevitably miscalculate a dose, we end up with a catastrophic hypo. Because intensive insulin therapy (the supposed 'gold standard' of Type 1 treatment, which is shorthand for many injections and blood tests over the course of every single day of our lives without a break and without any relief in sight) puts one at greater risk for catastrophic hypos, WE are the ones that are more likely to end up becoming desensitized to the warning signals our bodies try to send to our brains to head off the problem. It only gets worse as a Type 1 gets older - It's only when it starts heading below 30 that that I know something is wrong and by then, the window of opportunity to fix things is very small, because the first thing to go is higher thinking and reasoning, which a Type 1 diabetic needs to head off the hypo. By the time one loses one's motor skills, it's too late. And the sick part about all of this is that if we're harmed by this condition and the side effects of our REQUIRED medication, WE take the blame because 'we're not managing our diabetes right'. In the public's view, we deserve to get hurt because 'diabetes is manageable'. Intensive insulin therapy is a crapshoot and for every Type 1 diabetic who has to deal with the potential for a catastropic hypo due to hypoglycemic unawareness, it's just more salt rubbed into an already open and bloody wound. Hypoglycemic unawareness is the reason I can no longer get behind the wheel of a car without testing on two different meters (to keep from getting a bad test strip reading) and why I must pull over every 20 minutes and test my BG again to make sure it's still above 100 (I will not drive if it reads below 100, because I have no idea if my BG is heading south or not, and for those who think I should get a CGM monitor, take it up with my insurance company, which refuses to help pay for the device). This has limited my employement opportunities. Hypoglyceimc unawareness is the reason I have to test my blood sugar at least 10 times a day, to make sure it's not going too low to work out in the yard or go to the store or even take a short bike ride or walk. As the test strips are expensive, it's a huge drain on me financially. Talk to ANY type 1 over the age of 18 and you will more than likely find out that they've had to deal with hypoglycemic unawareness at times throughout their life sentence with this disorder. And yet, here is an article that makes it sound as if this horrible side effect of the medications require to 'manage' one's diabetes is limited to the Type 2 segment. NOTHING could be further from the truth. I am so SICK of these articles relating the resulting complications to Type 2 diabetics, with NO mention at all of the segment that is far more likely to encounter hypoglycemic unawareness due to mandatory insulin treatment. Yet again, the Type 1's are ignored and dismissed. It's as if we just don't exist and articles like this don't help the situation. The author's homework on this subject is severely lacking.

almost 7 years, said...

I don't agree. I get hypoglycemia and I am not taking any meds for it. I have had hypoglycemia almost all my life and my kids have it too. I just got diabetes a few months ago. SO it is something u can have without having diabetes, or if u have it and u take no meds u can still have it.

almost 7 years, said...

It tells u what to do if ur level is 2 low. or if a person passes out.

about 7 years, said...

Hi Gaf, Wow, that sounds pretty scary, and uncomfortable! Unfortunately, we are unable to diagnose medical problems for our site members. We suggest that you contact your doctor right away regarding your medical issue. We hope our informational site will be of help for you in the future. I hope you feel better soon! -- Emily

about 7 years, said...

I have been treated for epilepsy but my new doctor thinks I may have a wrong diagnose. I stopped taking my medication for about a month. I actually fell better without the medication, but this morning I got sick. I thought I was having a seizure again but I'm not sure what it was. I slept on and off for about 3 hours. I was dizzy, had headache and pain in my left arm and lower back. My legs were shaking. After a while I got a little better. I went to the supermarket and got really tired for walking. I wasn't hungry. I was feeling tired and decided to lie down. In about 20 minutes I got sick again but this time I was sweating a lot, had very low energy, almost couldn't talk. I asked my daughter to bring me something to eat. I checked the blood sugar level which was 54. I thought I was going to pass out. I was shaking really bad. My husband said my forehead was red. I ate a lot of sugar and eventually I got better again but I still feel tired and confused. I'm not taking any medication at all. My blood sugar level is usually close to 100( I check it sometimes). I just had my period. I'm 43, 175 lbs. What could it be? I had this a couple times before (1 year period).

over 7 years, said...

I think that what is addressed in this article is misleading. Hypoglycemia in a diabetic is caused by the diabetes medication, not by diabetes itself. Diabetes is a a failure of the pancreas to produce insulin to keep the blood sugar from being high. In diabetes, the blood sugar is not low until after the diabetes medication is given and only if the person does not eat something that can be broken down into sugar. Hypoglycemia is the result of the treatment for diabetes, it is a not a complication of diabetes.