Hypo awareness?

[LittleGreyCat]

T2 not currently on any medications which carries a high risk of hypos.
Although Dapagliflozin can carry some risk.

I have never (as far as I am aware) had a hypo.
Although my Libre 2+ has shown readings around and below 4 which I have not checked by finger prick.

So how do you know if you are hypo aware?
Are hypos inevitable on certain medications?

I am just pondering this for the future if I progress to some drug which over stimulates my pancreas, or onto insulin.
I would need to notify DVLA and state that I am hypo aware.
Which presumably means that I would have to experience a hypo and be aware of that.
Not something I have thought about much until recently.

Has everyone on hypo risk medications experienced at least one hypo?

What are the implications of being hypo unaware?
Do you just pass out, and with luck there is someone near who can supply sugar?

 

[Pipp]

Hello @LittleGreyCat . Have you been prescribed different or new medication? Or still just on Metformin, which shouldn’t put you at risk of hypo.

The following link has some info that could be useful.

Hypo unawareness is used to describe a situation where people with diabetes, usually type 1 diabetes, are frequently unable to notice when they have low blood sugar, hypoglycemia.

Hypo unawareness is used to describe a situation where people with diabetes, usually type 1 diabetes, are frequently unable to notice when they have low blood sugar, hypoglycemia.

www.diabetes.co.uk

 

[Melgar]

For one reason or another I get low blood sugars. I’ve had them when not taking drugs that may cause hypoglycaemia as well as my current drug Bupropion which stimulates insulin secretion and is a known risk for causing hypoglycaemia. Looking at my CGM Libre 3 records I have had 5 recorded low blood sugar events in the last 7 days. My lowest recorded event was 3 mmol/ls . I don’t drink alcohol.

Usually I am aware when my blood sugars are going low, I feel nauseated, shaky, agitated and sweaty. I can get a thumping headache as well. If you are prone to low sugars events you get to recognize these low blood sugar symptoms and check your blood sugars. If they happen at night, and you are hypo sensitive then you will wake up. You check your blood sugars. Looking at my recorded Low glucose events , I was not aware of any of these ‘ low sugars episodes. So either my blood sugars were higher than what was recorded by my CGM or I’m not as sensitive to these events.

If you have healthy blood sugars, or If you are diabetic, but not on drugs that can cause hypoglycaemia then dropping into the mid 3’s is considered just fine. If you are fasting for more than 8 hours, according to my lab parameters for spontaneous blood sugars tests, 3.3 is the lower limit.

Risks are greater when you are on drugs than can cause low blood sugars, or if you are on insulin. Being hypo aware, means if you went low at night you would wake up, if you are not hypo aware, then the risk is you don’t wake up and your blood sugars keep falling. So CGM low blood sugar alarms are definitely a good thing.

Edited to correct autocorrected spelling errors

 

[EllieM]

I think hypos depend on the medication. Eg when my dad was on gliclazide ( pre going low carb) he never had a hypo.

As a T1 on insulin who makes none of her own I believe mild hypos are inevitable with current tech, but since going on a pump I no longer fear that I might have a hospital inducing one.

There is quite a big period between feeling hypo at maybe 3.5 to 4 mmol/L and becoming confused at 3 and unconscious at about 2 or even lower.... Non diabetics can happily run bgs in the mid 3s.

I find cgms great at preventing hypos but once I am actually hypo then a glucometer works better.

I have in the past had periods of hypo unawareness, usually associated (for me) with too many hypos. I cured it by keeping my bg higher for several weeks/months.

 

[grantg]

Although my Libre 2+ has shown readings around and below 4 which I have not checked by finger prick.

I am just pondering this for the future if I progress to some drug which over stimulates my pancreas, or onto insulin.
I would need to notify DVLA

if taking any drugs which come with increased hypo chances require to notify dvla. usually issued medical license which can varying lengths of time between 1 and 5 years (mines 3 years).

vision is another thing which can be effected which hasn't been mentioned above.

your comment on libre2+ shown readings below 4, i would be checking against fingerprick. abbots clearly state on their product manuals to check both highs/lows or indeed if you don't feel as per the sensor states before medical decisions. another consideration each person is different, libre2plus reads generally a little lower for me, others have found it can read a little higher. alongside what your doing, for me if im laying down it can read a little bit lower, if i lean directly against the cgm for a little while it can read much lower. despite some quirks absolutely love the libre

 

[Lamont D]

Because I had so many hypos one after another before diagnosis. My hypo awareness was non existent. And I never knew at that time, what was happening. I never knew the reasons for the symptoms or the effects of the hypos. For example falling asleep and extreme sweating etc.
it wasn't until I was diagnosed and discovered why. It was clear to me, that the first few symptoms I discovered that the first was blurred vision, then a dull headache behind my eyes, followed by shaking, sweating, palpitations, by then, I knew I had to take action to arrest the downward trend to hypoglycaemia.
like a lot of diabetics, individual symptoms that give warnings of both rapid highs and lows. Can become hypo awareness, when getting better control of your BG levels.
The more, the control, the better awareness should be.
The lower towards normal levels as possible, the better control.
Best wishes.

 

[LittleGreyCat]

Thanks for all the responses so far.
The only drug that I am on which carries some hypo risk is Dapagliflozin, but I am told that the risk isn't high.

I have turned off my low glucose alarm (have done for a long time) because as @grantg says if you lean on the sensor when asleep you get false lows, and the alarm then wakes you up, and then you grumble about not getting back to sleep.

The question I didn't directly ask was "Do you remember your first hypo, and how long did it take to work out what was happening?".

I don't have an immediate concern because my BG is behaving itself at the moment.
Just looking forward to when I might have to increase my medication, and wondering.

I really should update my profile!!

 

[Gemma2]

62 years T1. I have no hypo awareness. I use Libre sensor and reader. But I have to keep checking it when out shopping.

 

[EllieM]

like a lot of diabetics, individual symptoms that give warnings of both rapid highs and lows. Can become hypo awareness, when getting better control of your BG levels.
The more, the control, the better awareness should be.
The lower towards normal levels as possible, the better control.

While this may well be the case for you, it wasn't for me as an insulin user. In the days before cgms I lost hypo awareness when my control was too good, with an hba1c under 50mmol/mol . This was because when I kept my levels in mostly normal range I just had too many hypos , and so lost awareness. (My two pregnancies were a nightmare, though worth going through because I ended up with two beautiful children as a result.)

62 years T1. I have no hypo awareness. I use Libre sensor and reader. But I have to keep checking it when out shopping.

55 years T1. Even though I do have hypo awareness now, it's not nearly as good as it was forty or even twenty years ago. I agree that cgms are wonderful.

 

[grantg]

I have turned off my low glucose alarm (have done for a long time) because as @grantg says if you lean on the sensor when asleep you get false lows, and the alarm then wakes you up, and then you grumble about not getting back to sleep.

rather than disable alarm entirely, I decided changing the alarm settings was perhaps the safer option. instead of the default 3.9 and to account for some differences within pressure lows, just turned changed it to alert at lower level and when up and about set back to normal. lowest settings the official libreapp appears to be is 3.3mmol/L that helped a fair bit with the pressure lows stopped getting woken up so many times.

some third party apps have the ability of setting a lower customised level for the alarm alongside can have a 'calibration' option, not done enough proper research on how accurate those said calibrations are.. what appears to be pretty consistant is that calibration (especially if rapid moving glucose levels at the time choose to calibrate) may actually cause further inaccuracies.

Perhaps in the the future abbots maybe able to add something which detects 'pressure' and adjust the reading alternatively give the ability to set different alarms and indeed range depending on the time of day. good example was given originally range 4-10. changed after few months different target range for waking hours, with before bed being given a higher target range (to prevent lows)