Hypo unawareness

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JellyBaby21

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Type 1
Hi everyone. I am about 6 weeks into T1d diagnoses now and I already appear to be losing my hypo awareness. I'm scared to say anything as I don't want to lose my driving licence (although I know I will have to for safety). Why is this happening to me so soon. I am on fluoxetine and have read this can cause hypo unawareness - is this true? I am having 3-4 mild hypos a week. Is this why? Is this permanent? It's quite frightening to see my BG at 2.8 mmmol/L and not really feel much. Any advice please.
 
Sorry to hear your hypo warning signs have taken a bit of a bashing :(

As I understand it, every time you have a hypo, your brain physically changes to try to “do better” if the same situation re-occurs. The warning signs are quite resource intensive (adrenaline and other hormones), so they begin to fire at lower and lower levels.

Often warning signs can recover if you avoid spending any time below 4.0 if you can help it. Even if that means treating impending low BGs in the mid-high 4s

I haven’t heard of fluoxetine interacting with hypo warning signs.

Hope you can recover them. They are precious!
 
everydayupsanddowns said:
Sorry to hear your hypo warning signs have taken a bit of a bashing :(

As I understand it, every time you have a hypo, your brain physically changes to try to “do better” if the same situation re-occurs. The warning signs are quite resource intensive (adrenaline and other hormones), so they begin to fire at lower and lower levels.

Often warning signs can recover if you avoid spending any time below 4.0 if you can help it. Even if that means treating impending low BGs in the mid-high 4s

I haven’t heard of fluoxetine interacting with hypo warning signs.

Hope you can recover them. They are precious!
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Thank you so much for answering! Your explanation makes sense. I will try to not let myself run so low - I am often in the mid to low 4s. I hope so much I can regain my awareness - like you say, they really are precious!
 
Are these readings Libre readings or finger prick readings? My Libre will often (almost always) say I am 1 mmol below actual BG so a 2.8 on my Libre will be a 3.8 when I do a finger prick. Usually I will start to feel hypos at low 4s but sometimes it is high 3s when I feel it and that is perfectly acceptable.
Just wondering if these low readings are perhaps not anywhere near as bad if you are using Libre rather than verifying with a finger prick.
I average just over 1 hypo a day according to Libre and the vast majority are not even hypos at all when I can be bothered to double check them. I do however eat some carbs after I have double checked unless I am above 4.5 when I finger prick and I am about to get out of bed which I know will naturally bump my levels.
 
rebrascora said:
Are these readings Libre readings or finger prick readings? My Libre will often (almost always) say I am 1 mmol below actual BG so a 2.8 on my Libre will be a 3.8 when I do a finger prick. Usually I will start to feel hypos at low 4s but sometimes it is high 3s when I feel it and that is perfectly acceptable.
Just wondering if these low readings are perhaps not anywhere near as bad if you are using Libre rather than verifying with a finger prick.
I average just over 1 hypo a day according to Libre and the vast majority are not even hypos at all when I can be bothered to double check them. I do however eat some carbs after I have double checked unless I am above 4.5 when I finger prick and I am about to get out of bed which I know will naturally bump my levels.
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I've always double checked with a finger prick and even when they are confirmed hypos of 3.5 or less I am feeling them less and less. Got a confirmed finger prick of 2.8 today and wasn't feeling much. It was straight after an hour of intense exercise. I guess I need to start trying to run a bit higher for a few weeks and treat at maybe 4.5 rather than the 3.8 I have been going for do you think?
 
JellyBaby21 said:
I guess I need to start trying to run a bit higher for a few weeks and treat at maybe 4.5 rather than the 3.8 I have been going for do you think?
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I have my sensor alarm set at 5.2 (because of the sensor lag). Helps enormously!

Start with a few weeks, but it may need months, depending on how your symptoms respond 🙂
 
JellyBaby21 said:
I need to start trying to run a bit higher for a few weeks and treat at maybe 4.5 rather than the 3.8 I have been going for do you think?
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Yes, absolutely do this! Remember it takes ~15 minutes or so for whatever you eat to have much of an effect, so it's definitely better to act a bit sooner. And now we have CGMs we can do that, and almost never actually go hypo.
 
JellyBaby21 said:
Do you think if I do this there is a good chance I'll get my awareness back?
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It’s certainly a possibility. There are specific education courses, and other interventions to help

pubmed.ncbi.nlm.nih.gov

Interventions That Restore Awareness of Hypoglycemia in Adults With Type 1 Diabetes: A Systematic Review and Meta-analysis - PubMed

This review provides evidence for the effectiveness of a stepped-care approach in the management of patients with IAH, initially with structured diabetes education in flexible insulin therapy, which may incorporate psychotherapeutic and behavioral therapies, progressing to diabetes technology...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
 
JellyBaby21 said:
I've always double checked with a finger prick and even when they are confirmed hypos of 3.5 or less I am feeling them less and less. Got a confirmed finger prick of 2.8 today and wasn't feeling much. It was straight after an hour of intense exercise. I guess I need to start trying to run a bit higher for a few weeks and treat at maybe 4.5 rather than the 3.8 I have been going for do you think?
Click to expand...

I now treat anything below 5 with a small top-up of glucose/carbs. I’ve had Type 1 almost 30 years and doing this has greatly sharpened up my hypo awareness. Even though it was pretty good to start with, it does gradually get blunted. Running a bit higher and treating at a higher level can work wonders if you do it for a sustained period of time.

Also, try to work out what your hypo signs are. One of mine is tingling lips. It’s quite subtle. Try to spot your signs earlier and don’t wait for the big ones like being drenched in sweat.

I’d also make sure your blood sugars are running at a slightly higher range eg if you’re running between 3.5 and 9, push that up a little for a while to, for example, 5 - 11. If we try to run too low, we can mess up our hypo awareness pretty quickly. It’s all a balance.
 
JellyBaby21 said:
Hi everyone. I am about 6 weeks into T1d diagnoses now and I already appear to be losing my hypo awareness. I'm scared to say anything as I don't want to lose my driving licence (although I know I will have to for safety). Why is this happening to me so soon. I am on fluoxetine and have read this can cause hypo unawareness - is this true? I am having 3-4 mild hypos a week. Is this why? Is this permanent? It's quite frightening to see my BG at 2.8 mmmol/L and not really feel much. Any advice please.
Click to expand...
6 weeks into injecting insulin. Have you informed the DVLA and got your licence updated already?
 
Inka said:
I now treat anything below 5 with a small top-up of glucose/carbs. I’ve had Type 1 almost 30 years and doing this has greatly sharpened up my hypo awareness. Even though it was pretty good to start with, it does gradually get blunted. Running a bit higher and treating at a higher level can work wonders if you do it for a sustained period of time.

Also, try to work out what your hypo signs are. One of mine is tingling lips. It’s quite subtle. Try to spot your signs earlier and don’t wait for the big ones like being drenched in sweat.

I’d also make sure your blood sugars are running at a slightly higher range eg if you’re running between 3.5 and 9, push that up a little for a while to, for example, 5 - 11. If we try to run too low, we can mess up our hypo awareness pretty quickly. It’s all a balance.
Click to expand...
Thank you that's really helpful. I will follow your advice. I think I have been trying to run too low.
 
Agree with what's been said, run levels wee bit higher for a while & try to avoid hypos, that is key to regaining hypo awareness.

Like Mike have libre 2 alarm set higher to alert me of bg dropping, it's set at 4.8 but you can set it higher if you choose, since using libre 2 hypos are very few & far between now so device is worth its weight in gold.
 
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