What is Hypoglycemia Awareness?

Recognize the Signs and Symptoms of Low Blood Sugar

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Hypoglycemia (low blood sugar) awareness refers to the ability of people with diabetes to sense the physical symptoms of low blood sugar.

What is Hypoglycemia and Who is at Risk?

Hypoglycemia his is defined as any time when blood glucose levels fall below 72 mg/dL.

It's most often an issue for people who take supplemental insulin (often people with type 1 diabetes).

What Situations Increase the Risk of Hypoglycemia?

Many situations can increase the risk of hypoglycemia.

These include:

  • Hot weather: your blood vessels dilate in hot weather and insulin can be absorbed more quickly 
  • Exercise (during or after): During and after exercise (up to 2 days after), your muscles need to replenish the energy stores they lost and they do this by taking in glucose from the blood. This can cause your blood glucose levels to drop.
  • Alcohol (during or after): Drinking alcohol can impair your liver's ability to release glucose into the bloodstream. Monitor your blood sugars regularly during and after drinking alcohol.
  • Delayed meal after insulin injection: If you've taken a dose of insulin in preparation for a meal, but that meal is delayed, you can experience hypoglycemia
  • Problems calculating insulin: Either overcorrecting for high blood sugars or continuously overestimating insulin needs can increase hypoglycemia risk
  • Going to bed with low blood sugar: If your blood sugar at bedtime is less than 99 mg/dL, then you may experience hypoglycemia while you sleep. To prevent this, make sure your blood sugar level is above 117 mg/dL at bedtime.

    What Are the Symptoms of Hypoglycemia?

    Everyone experiences different symptoms of hypoglycemia. Symptoms can be physical, emotional or night-time symptoms. They are related to the release of adrenaline that accompanies low blood sugar levels.

    • Subtle physical symptoms include:
    • Dilated pupils
    • Pale complexion
    • Sweating
    • Talking during sleep
    • Lack of coordination (e.g. dropping things)

    More noticeable physical symptoms include:

    • Headache
    • Nausea
    • Abnormal hunger
    • Blurred vision
    • Tiredness
    • Shaky
    • Sweaty or clammy skin

    Emotional symptoms include:

    • Anxiety or panic
    • Irritability or aggression
    • Restlessness
    • Giddiness or silliness
    • Unable to concentrate

    Night-time symptoms include:

    • Nightmares
    • Insomnia with anxiety
    • Jerking movements
    • Sweating
    • Shouting during sleep

    Severe symptoms occur when blood sugar levels get dangerously low and may include:

    • Confusion
    • Slurred speech
    • Difficulty walking or standing
    • Seizure
    • Unconsciousness

    Low blood sugar, also called an insulin reaction, typically occurs because your insulin, food, and exercise are out of balance. For example, if you take extra insulin in anticipation of a big meal in 10 minutes but then that meal is delayed, you could experience hypoglycemia.

    Situations That Make it Harder to Spot Hypoglycemia

    Some situations can make it tricky to spot hypoglycemia. These include:

    • Being sick: If you're sick, you might have some of the symptoms of hypoglycemia (headache, nausea)...or it may be hypoglycemia.
    • Being tired: if you didn't sleep well the night before, that might account for your fatigue
    • Being stressed: Stress can give you many of the same feelings as hypoglycemia
    • Confusing high and low blood sugars: Some of the symptoms can overlap
    • Alcohol: Alcohol can make it harder to spot hypoglycemia. Things like lack of coordination could be mistakenly attributed to alcohol
    • Exercise: Sweating and tiredness could be from exercise...or not

    Find Out How to Prevent, Confirm and Treat Low Blood Sugar

    What is Hypoglycemia Unawareness?

    Hypoglycemia unawareness occurs when a person with diabetes is unable to sense those same symptoms. As a result, their blood sugar could become dangerously low, progressing to severe hypoglycemia, which can result in unconsciousness, or if prolonged, a coma or even death.

    What Causes Hypoglycemia Unawareness?

    The most common cause of hypoglycemia unawareness is when your blood sugar levels are elevated for a prolonged period of time. Prolonged levels of high sugar in the blood cause your brain to be less able to sense the symptoms of low blood sugar. This frequently happens, for example, when a person has a persistent spike in their blood sugar at night during sleep.

    The good news is that hypoglycemia awareness can usually return if good blood sugar control is consistently practiced for 1-3 weeks.