I have really ever shifting insulin sensitivity.I can be at 150 and eat bolus what Im supposed to and be at 40 in no time.Ive never been blamed for my unawareness but as I work in a job that has emergencies meal times are not set. Everything you said made absolute sense and I can understand your frustration. You sound like you do a great job on managing your diabetes. I also think if your working and busy combined w/ rapidly dropping you cant see or feel any signs at least thats how it is w/ me.
It was the textbook regime of "2x a day R+NPH" - kinda the standard of T1 diabetes dosing from the 70's through the 2000's - that was less than optimal.
I went to a MDI regime of R and NPH, 4 little shots of NPH each 6 hours apart, and bolus with R, in the mid-80's and stayed with it until circa 2006/2007. It was way way way better than "2x a day R+NPH". I was pretty dang good at it (lots of A1C's in the 5's.)
But... I do feel that modern analog insulins are an improvement over that, even, especially when it comes to reducing the frequency of hypos. And in my experience, reduce the frequency of hypos, and a good chunk of hypo awareness comes back.
Hypo awareness isn't the full-on adrenaline shakes I had when I was a kid, but I do mostly have the awareness.
so why does one become hypo unaware?- Good control? or is a complication? Or is it not related to diabetes? Could someone who has high blood sugars often become hypo (or hyper) unaware?
I'm not sure if anyone truly knows why someone becomes hypo unaware, but I'm fairly certain that in some cases that it can't be prevented. It simply happens to some people through no fault of their own.
Now, obviously in some cases I suspect that you can become hypo unaware by getting used to being at a certain BG level and that we would be able to identify it more by a larger swing in our BG levels. For example if you usually run at 7.0 and drop below 4.0, I suspect you would feel it more than if you were to always run around 4.5 and drop below 4.0 as its a much smaller change.
But to be truthful, that's just my two cents and should be taken as a grain of salt. I am in no way an expert on this subject matter. :P
If you get too many lows your body adjusts. I have it from time to time and it sucks.
Karen, this brought back many memories, all the way back to 1975 when my son was diagnosed, and 1988 when I was diagnosed. Yes we have certainly come a long way haven't we? And even so, diabetes is still such a great challenge for us every minute of every day for the rest of our lives. And you are so very right, none of us deserved this, and we don't deserve to be blamed for things that happen to us that are out of our control. We just do the best that we can with the tools that we have and hope for the best.
When I first was diagnosed I was on pork insulin. when I got lows form the pork I was able to tell and eat something and be just fine.. Later when humanlin (human insulin) came on the market and I got switched to it, I became unaware of my lows and after recovering from a low I was wiped out for the day until I had a nap or went to sleep. I still had that problem today....
Great blog, brought back a lot of memories
Funny I developed Hypo Unawareness by um being in 'poor control". Oh I gave up with R and NPH insulins as I could never get good control, always felt I was being blamed or doing something wrong for not beign able to have good control that I just literally gave up and said screw it, might as well enjoy life and lets the BG do whatever the heck it wants to do cause Im getting NO help from the Dr's and the medication just blows.
Up until last year I was STILL messing around with 70/30 a R and NPH mixture. Finally did some research into Lantus, and it sounded promosing, I mean hey it can't be worse than what I was already on right? Managed to find a good endo who quickly got my A1c back down to 6.6 I belive was my last result...(it was def in the 6's). Starting off my A1c was in the 12's. im very fortunate to have not suffered long term complications from my rebellious, stubborn, non-compliant self lol. But yes my hypo unawareness did not come about by trying to maintain "perfect" a1c levels. Honestly i have no idea what caused it, as I used to feel my hypos very strongly. Get really bad shakes etc. I did suffer a LOT of hypoglycemia while pregnant, but even so, for several years after that when I'd have the occasional low...I'd still feel it.
I too am aware I am unaware, and I have taken every step possible to keep it in check, but no this is NOT something we did to ourselves. No more so than me catching the flu that caused my body to launch an immune attack upon itself. It is what it is, and you learn to live with it and deal with it.
Oh btw I too started on pork insulins...gave me a couple of WICKED lows, one of which nearly killed me. Talk about some horrific insulins. I was so happy to come off of that combo.
I have been Type 1 for 16 years..
Until recently my control has been average at best, I wasn't having hypos my HbA1c was okay for many years..
Have to admit since my control has tightened up, I am having more lows, many more in fact and as a consequence my warning signs have suffered over the last two years.. I dip down into the 40s most days, but drinking some juice or eating some jelly beans and is no real bother..
My main worries are the impact of low blood sugars on brain function, my mother was type 1, she used to have crazy, crazy lows almost daily, the ambulance crew knew her on a first name basis and I must have given hundreds upon hundreds of glugacons to bring her out of unconsciousness in my teens. I started giving them to her at the age of 5 and was still doing it 20 years later... There was a stubborn women who was celiec, incredibly insulin sensitive and who wouldn't eat, not an easy thing to manage.
I saw first hand how constant low blood sugars effected her, she had severe memory loss, couldn't concentrate and her personality completely changed, she was only 47 when she died following a hypo (left with zero brain activity and in a vegativitve state from an overnight hypo), but it was like she had an early form of dementia..
I found this article interesting specifically the comments from long term diabetics at the bottom..
I pretty much have to get to 35 before I feel really bad, I don't shake or sweat anymore, unless it is a night time low and I have been in it for a while. I think we just need to be careful, the DCCT is a great, and no one can argue that a lower HbA1c doesn't decrease your chance of complications, but lows are very real, very dangerous and a massive pain in the behind..
I think I would sacrifice 0.5-1% on my HbA1c if meant less hypos and hypo awareness...
I also think that hypo unawareness may just be down to having the D for years and years, your body gets used to the lows, so it doesn't panic anymore and the adrenalin cycle isn't initiated.
Wow, that's an astonishing story. I'm very sorry for your loss what sounds like a generally brutal experience.
I'm at least moderately concerned about the cognitive side of things. I have Alzheimer's on both sides of my family which is an added thing. Plus, perhaps foolishly, I did *a lot* of wild and crazy things when I was younger. That being said, I'm 44 now and decently sharp. Sometimes I'm a bit oblivious but I still feel like I'm making a choice to say "oh well, whatever..." about various things, maybe a bit more laid-back than I used to be or something?
I think too about the hypos if you are going up and down a lot it is more risky to push one's BG readings down, in an effort to beat an A1C goal. Doctors and medical societies and well, probably a lot of us, talk about getting numbers "down" but what we really should talk about is getting numbers stable. If you are realatively stable, I think that it's reasonable to raise one's numbers which I think can help "restore" some of the hypo symptoms? I don't have any scientific evidence of this but I feel like that's what's happened to me.
Yeah it was brutal, but it was just life at the time..
But looking back I do feel incredibly guilty and frustrated that she wasn't given more help and support. I remember being so gutted when I was diagnosed at 12 as I thought that going unconscious a couple of times a week was the normal life for Type 1.. Now through experience I realize how unnecessary it all was, she was on far too much insulin and she would bolus at meal times and then not eat etc! Infuriating for my sister and I. But in the end just really very sad and it could have been avoided :(
I was also pretty bonkers and partied quite hard from about 17 until 24, but have calmed down alot now ha. I am getting there and am feeling much more stable, I may shell out for a CGM and see what benefits it brings..
I think this is the most valuable thing I've learned here - the importance of getting numbers stable and eliminating as much of the fluctuating as possible. It's amazing to see on a cgm the flatter lines vs the crazy swings and it's totally achievable using the good advice here.