Can Hypo Unawareness be regained?

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Type1Babs

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Type 1
Hi all

I have had Type 1 for 43 years and have been using the pump for some years now. I have managed to achieve a good HBA1c and generally am steady throughout the day with my sugar levels. About 5 years ago I noticed that my hypo awareness had diminished and, due to losing my teenage daughter in her sleep from a severe hypo, I suffered from anxiety and PTSD. When I finally decided I needed to live and look after myself, I applied for an alert dog who successfully alerts me day and night when my levels are dropping (well in time for me to do something about them and well before my meter says I am dropping.) I wear the Libre in my arm too and test constantly. I follow all of the rules for driving and don't get in my car under 5. However, I have had my licence revoked recently and I am devastated to say the least. I won't go into all that about what this has done to me emotionally and socially, but what I am looking for is an online programme that I could follow that shows me how to regain my hypo awareness. I have read lots about it but can't actually find it. There is one called HAATT (Hypoglycaemia Anticipation, Awareness and Treatment Training) which sounds ideal. Can't find it online. I would just like to look at what sort of levels to run at and how to avoid going below 4.5 mmols/L whilst I am trying to regain my awareness, if at all. Thanks.
 
Sorry to hear part of your story Babs - but we don't need a 'course' when we lose our hypo awareness.

It's actually simple - we just have to run our BG higher for couple of months, until hypo symptoms have returned and become embedded again. Then after remaining stable at a higher level, take a couple of months weaning your BG back down a bit again. Because of the time it all takes it's advisable to talk to your pump clinic before you start and for advice and confirmation you're doing OK along the way.

Having a pump is an advantage here because you can just change your correction dose and bolus dose parameters to always bring you back to a slightly higher number. In my case that was 7.5, instead of 6.5 which was annoying but there you go - it's far better to be stable at a higher level than all over the place when trying to be lower!
 
Hi Jenny and thanks for your very informative reply. Yes, I just looked at my pump settings for my BG is 5.5 - 6.5 so I am going to change that to 6.5 - 7.5. Not sure why mine has a range of from and to. Oh yes, I am all over the place at the moment and my healthy eating and exercise has also gone out of the window as I have tried not to do anything that will bring on a low while I am trying to avoid it. Before I worried about regaining my hypo awareness, I was doing well on my low carb diet and plenty of walking and my levels were pretty steady around 6.5 to 7.0. Today I have been 4.5, 19.0, 16.5 and so on. I have not felt very well - sort of like I have been ill and just getting over it kind of feeling. Tomorrow I will go back to my usual eating plan and walking but by changing my rates, I should avoid a hypo occuring. Thanks again.
 
Hello and welcome @Type1Babs 🙂

I'm so sorry to read what you've been through.

In relation to trying to regain hypo awareness from my experience it doesn't always reappear. I've not had awareness for approx 18 years now despite trying everything to regain any early warning signals

How are your diabetes team helping you with trying to regain awareness? As TW says run higher for a perod of time - stable higher - I found this a hard challenge when I was told to just run my bg between 8-10 for a few months, it assumes you always have good control over the base level which for any number of reasons isn't always the case. I went through that and also did some intensive work with my DSN to try and pick up on any tiny physical indications that I was hypo. For a while I could see the laser burns in my vision from my retinas when I was hypo but these also disappeared over time. I was referred for consideration for a pancreas/islet cell transplant but decided I couldn't go down that route so live with cgm and my pump which has helped me so much with insulin suspension especially overnight. Have your clinic discussed applying for funding for cgm with alarms etc to predict and minimse hypos?

The only references I could find to HAATT were from the American Diabetes Assocn with trials in the USA and Bulgaria. There was a UK course recently that combined BGAT - blood glucose awareness training- with a new method, it required attendance but recruitment has closed for it https://www.harpdoc.org/

Sometimes I find I make things worse when I try too hard to intensively control my bg and end up plummeting and then sky rocketing, I try and take a step back and think I'm a lot safer at 7/8/9 than zig-zagging from 2 - 20 .

I wish you well and hope your hypo awareness starts to reappear 🙂
 
Hi Flower

Thanks for your reply and helpful information. Since last night I have been reading absolutely loads and looking at Dr Bernstein's reasons for losing hypo awareness. It does seem that it is the nocturnal hypos I have been having that could have caused me to lose my awareness (and the number of years with Type 1) so I am going to persevere and try my best not to get into the hypo range for a while. Yesterday I was all over the place but since TW's advice to adjust my pump, I have not dropped below 6.5 today so far. My DSN has not got back to me for a few days but I am hoping she does so that I can explain what I am doing and get the support I need. I think you're right to be in the range of 7/8/9 as I was hypo/hyper all day and off my food because of it.

I am also looking at DAFNE's site today.

Thanks again.

xx
 
It can be possible to regain awareness, and for the level at which the hypo-response happens to change for some people - but as @Flower says it may not work perfectly for everyone.

I’ve had slight IAH (impaired awareness) for years and have got quite a lot of my awareness back by really concentrating on avoiding lows as much as I can (I’m usually 1% or less below 3.9 according to my sensors), but even that means a few still sneak through.

The brain adapts and physically changes when repeatedly exposed to below-normal BG levels (and can trigger hypo-like symptoms in the normal range if a person runs consistently high for months/years.

In your shoes I would treat any reading of 4.x or below as needing some extra carbs, and try to make sure that there is a very slight upward-trend in BGs overnight to protect against overnight lows.

As Flower says there are specific training courses to tackle this and the HarpDoc trial hopes to add another to the mix. DAFNE has a good reputation for significantly reducing hypos. BERTIE is a similar course that can be undertaken online.
 
Hi @everydayupsanddowns

Yes, I am hopeful that I will regain my awareness by avoiding lows. I am going to look up hypoglycaemia complacency as I woke up this morning and wondered if there was such a thing. For me, perhaps I have been complacent, especially when I am stuck into my bank reconciliations at work and don't want to be disturbed. I am guilty of asking my alert dog to 'shhh' while I am deep into something. Putting off getting some glucose for a few minutes is very naughty of me, I know.

My overnight lows occur around 2 - 3 am, so I imagine I should adjust my basal at around 1 am. Alcohol has been a factor in this too which is why I haven't had any whilst doing this trial.
 
I don’t have consistent hypo awareness, but my saviour is the Libre. If I get a reading of 4.0 with a downward arrow, I do something about it. If it’s a straight across arrow, there’s no rush.

The Libre 2 appearing next year has optional alarms, so that should help.
 
With a pump - start the change in basal dosage approx. TWO hours before you want it to kick in, whether it's up or down.
 
mikeyB said:
I don’t have consistent hypo awareness, but my saviour is the Libre. If I get a reading of 4.0 with a downward arrow, I do something about it. If it’s a straight across arrow, there’s no rush.

The Libre 2 appearing next year has optional alarms, so that should help.
Click to expand...

Hi @mikeyB

I like the Libre for that, and I didn't know there was a new one coming out, so that's exciting.

Babs
 
Type1Babs said:
I like the Libre for that, and I didn't know there was a new one coming out, so that's exciting.
Click to expand...

Yes, it's on the boxes of newer Readers, and we know the new sensors will be the same price, so presumably it'll just replace the old ones. What we don't know is when it'll happen in the UK. I think it's been released in some other EU countries. Next year seems likely.
 
mikeyB said:
I don’t have consistent hypo awareness, but my saviour is the Libre. If I get a reading of 4.0 with a downward arrow, I do something about it. If it’s a straight across arrow, there’s no rush.
Click to expand...

Absolutely agree that the direction and speed
of travel are incredibly useful extra bits of information. Though I’d not be quite so relaxed at 4.0 personally - Libre would be showing the situation 5-10 minutes ago and a straight arrow means a potential change of up to 0.06mmol/L per minute. Which sounds tiny, but is still up to 0.9mmol/L in 15 minutes. And if that’s all downwards then there’s not much room for manoeuvre!
 
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