Ask the Diabetes Educator Archive

6/7/04

Q:
Would you please advise concerning the most current strategies available to combat hypoglycemic unawareness? I am presently thirty-seven years old and was diagnosed with IDDM at the age of four years. About half the time I am experiencing an insulin reaction (for the past few years), I do not exhibit the usual signs and symptoms that formerly always alerted me to the presence of this condition (i.e., extreme hunger, shakiness, etc.). Quite often, my only symptom during these virtually asymptomatic insulin reactions is a lack of clarity of thought, but not typically accompanied by any grossly abnormal speech to necessarily alert anyone else that my blood sugar level is probably too low. Additionally, several months ago, my blood glucose level had plummeted to 56, and my only symptom was a rapid heartbeat (I do not suffer from cardiac disease, so I knew there was something amiss when I experienced persistent palpitations). Thank you for your time and attention to my inquiry.

A:
Unfortunately, there is no neat alarm watch or other devise you can reliably hook up to alert you. The first thing I would suggest is that you revisit your daily food intake, with attention to carb counting and an insulin/carb ratio that may become somewhat obvious to you and your physician. This can be challenging, particularly since you have long-standing diabetes. Frequent testing, although not enticing, is another avenue. If you are taking Humalog with your meals, you are perhaps already doing this. If your highs and lows are frequent, then your menu needs tweaking. This still may not level off your blood sugars, even with Lantus for a basal insulin. You may consider an insulin pump. I wish there was a more "fix it" answer for you.



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