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hypoglycemia unawareness
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hypoglycemia unawareness

My boyfriend, who is 23, has been a type 1 diabetic for 14 years. He moniters his BG very carefully, testing ~7 times a day, but sometimes he injects too much insulin. Over the past two years i have witnessed extreme lows in which he has needed assistance. Most of these have occured over night and it's when he wakes up that he realizes he is very low. However, these lows occur during the day as well and, just recently his hypoglycemic symptoms have diminished and it has come to a point where he is completely unaware of his low BG.  Obviously, this is very frightening, for if he cannot tell what range he is in, there is no warning for an insulin reaction. my question is, for a young man who is in good health, excersizes regularly, is this normal for his age? is he regulating too stringently? is it a result of neuropathic damage, or even tolerance to counterregulating glucose hormones? And finally, is it possible to reverse the situation and build a tolerance to insulin again?
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Recent studies have proved that this problem is reversable. It has nothing to do with neuropathy damage or tolerance to counterregulating glucose hormones, but everything to do wtih tight control and a snowball effect that can happen after a few severe lows. A study published a few years ago in England had several helpful findings.

The problem happens when a person has one or more severe lows that are not treated quickly. The body's defense mechanism causes it to release emergency sugars stored in the liver when this happens to try to protect itself. After these sugars are released, another severe low will cause the brain to THINK that the body HAS glucose available, and it then does not send out the warning signs. If yet another low happens that is  not quickly repaired, the problem just gets worse until there are no warnings at all.  The following steps were suggested by the people who did the study to repair this essential warning system:

1. In the study, people had their warnings return if they could manage to avoid ALL lows for a period of 2 weeks. I have since read of similar studies with simiilar results and some studies suggest different time frames where the person needs to avoid lows. But 2 weeks seems to work for me. This does not necessarily mean running high for 2 weeks, but means testing even more often for those two weeks in order to catch drops in glucose befoer they get below the low end of the normal 70-126 range.

2. If a low DOES happen, it is imperative to get the quickest possible fix into the body. This is different from what most of us do if the low is not severe. Most of us will nibble a snack if the low is a moderate one rather than drinking juice,but apparently the important thing is to bring the glucose levels back up BEFORE the body has a chance to send for the emergency stores of sugars in the liver. So if he is low before a mealtime, he should sip a half cup of juice to get something quickly digesting before he eats his meal.

I had this same problem for years, but after reading about this study, i followed the suggestions and am happy to report that my warning symptoms are back now. What he needs to be aware of is that this fix is something he may have to do every now and then, for a few goofs and lows that catch him off guard can start the process of losing warning symptoms all over again. So he needs to stay on top of it. And especially go for the Gatorade or juice instead of the crackers if he does get low, for any foods containing fats are going to be slowly digested and may not bring his sugar levels up before his body sends for emergency sugar stores.

I hope this helps. Many doctors still are not aware of these studies and I feel that every tightly controlled diabetic needs to be aware of this in order to protect himself or herself.
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