Hypoglycemia Unawareness

I am a Nurse Practitioner and Certified Diabetes Educator.  I also have type 2 diabetes and today my blood sugar was 59 mg/dL!  I was shocked at my blood sugar reading because I did NOT feel bad at all.  I take Metformin for my diabetes.  Three hours prior to checking my blood sugar today I had eaten banana-walnut pancakes with regular syrup.  I have not had any changes in activity, food intake, or medications, I  have not consumed any alcohol, and I am not stressed or depressed.  In other words, I could not think of any reason why my blood sugar was so low.  I last checked my blood sugar 2 days ago and over the past several weeks my blood sugars have consistently ranged in the 80s to low 100s range.  

Hypoglycemia unawareness is defined as a low blood sugar that occurs without any of the physical warning symptoms of a low blood sugar (i.e., shaking or nervousness, headaches, sweating or clammy wet skin, confusion or anxiety, palpitations, etc.).  It occurs more frequently in patients on insulin therapy (patients with type 1 diabetes and patients with type 2 diabetes that require insulin) but it also occurs in patients with type 2 diabetes such as elderly patients, patients that have had diabetes for several years, patients that consume alcohol, patients with diabetic neuropathy (nerve damage), and patients that take beta-blockers for heart disease and/or blood pressure control.  Hypoglycemia unawareness is potentially life threatening because low blood sugars (especially blood sugars less than 50 mg/dL) can lead to loss of consciousness, confusion and behavior changes, coma, seizures, and death.  Usually when blood sugars are low our body hormones send out physical warning symptoms that we recognize and can act upon to immediately raise our blood sugar.  With hypoglycemia unawareness we lose this response and do not experience those physical warning symptoms.  

Today was an anxiety-provoking experience for me because prior to checking my blood sugar I was preparing to travel in my car.  Had I not checked my blood sugar I could have potentially had a fatal accident and killed or injured myself, my daughter and other people.  This is why I advocate people with diabetes to check their blood sugars, including patients with type 2 diabetes that are not on insulin.  Talk to your health care providers about how often you should check your blood sugar and what blood sugar ranges are safe for you.   

Click on the following links to learn more about hypoglycemia and hypoglycemia unawareness:

http://visionsofcontrol.com/AcuteComplications.aspx

http://www.diabetesnet.com/diabetes_control_tips/hypoglycemia_unawareness.php#axzz1As2yTKLx
http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html