Am I Hypo Unaware?

Am I hypo unaware?

This is a question I had to ask myself recently after I realized that walking around at 36 mg/dL was nothing to be proud of. Still, I admit that I took pride in the feeling, as if I was powering through my lows. It gave me this sick feeling of invincibility. As if not feeling them meant I had reached a new level of type 1 diabetes (T1D) management—Bowser level sh*t.

But here's the thing, I haven't reached a castle at 36 mg/dL. I'm at the bottom of a volcano, dangling over lava.

That attitude is wrong because those lows are still happening inside my body, whether I feel them or not. Admitting this doesn't come easy because I have to wonder if it's my fault. Except for a brief period in my teenage years, I've always been a pretty good diabetes self-manager.

But even good self-managers can be at risk of the ramifications of a long life with T1D.

And let me be the first to say, I know that long lives aren't guaranteed, period, much less with chronic illness. I am genuinely grateful for each day I get. When T1D so often blurs my life, there are many more moments where it offers sharp clarity into life's fragility.

Here are some of the causes of hypoglycemia unawareness:

• Frequent hypoglycemia: Repeated episodes of low blood sugar can damage the nerves responsible for detecting hypoglycemia. (NOVI Health)

  
  

• Autonomic neuropathy: Damage to the autonomic nervous system, which regulates blood sugar levels, can impair the body's ability to recognize low blood sugar. (American Diabetes Association)

  
  

• Insulin use: Insulin therapy can suppress the release of counter-regulatory hormones (such as epinephrine and glucagon) that typically raise blood sugar levels, leading to hypoglycemia unawareness. (T1D Strong)

Today, I find myself walking around at 43 mg/dL the same way I walk around my house at 82 mg/dL. I no longer say this happily, thinking my body can withstand it. Instead, I now know there's a secret battle happening in my body and that a sneak attack could be looming. The lack of warning signs is jarring.

I know them logically, but knowing and feeling are very different when you're in a state of severe hypoglycemia.

Is Hypoglycemia Unawareness My Fault?

It wasn't always like this for me. Perhaps that's what makes it hardest to accept.

I can recall many moments as a child having to stop what I was doing to treat lows starting at 65 mg/dL, sometimes even sooner, but if I really reflect on the last several years, I can attest to the fact that my awareness has taken a steep drop.

In my early 20s, it started to get worse. I feared "dead in bed" syndrome more than I ever had before. I didn't have a continuous glucose monitor (CGM) until my mid-20s, when my insurance covered it enough for me to be able to reasonably maintain it financially.

Now, I don't know how I'd live without one. So long as I'm living with T1D, I need a CGM to manage it safely. Maybe one day, a diabetic alert dog will be in my future, too. Using a CGM is the best way for people with diabetes (PWD) like me to get ahead of hypoglycemia unawareness.

I honestly can't tell if it's my fault that I've reached this place of hypoglycemia unawareness. I admit that, not asking for sympathy, but recognizing the accountability I have in how I choose to take care of my body. All I can tell you is that I'm doing my best and I hope it's good enough to avoid some complications of T1D later in life, should I be so fortunate to become elderly one day.

Trusting My Body or My CGM: An Internal Battle

Hypo unawareness is scary, and I hope that from this point forward, I can do a better job of jumping on my lows and trusting my CGM before my levels reach this point of severity. Because I don't feel my lows and have not entirely accepted that my body has reached this state of hypo unawareness, I sometimes wonder if my CGM or my body is lying to me.

The majority of the time, it's my body. I'm torn about that. On the one hand, I'm happy I can rely on my CGM, but on the other hand, I'm very sad my body doesn't feel it anymore.

I rely on my CGM more than any other piece of technology in my life. Maybe more than anything, period. I have put a lot of faith into it. It isn't perfect. Sometimes it's off, but it's "on" enough to be dangerous. Or, in this case, the hero to my dangerous low blood sugar emergencies.

I'd rather hear alarms all day than the silence of unfelt lows.

CGM Alarms: Annoying Angels for T1D Survival

I will always get up in the middle of the night in response to those alarms so that I may wake up more days, happy and healthy. Living with T1D is scary, and I don't mean to fear-monger, but I think it's important to address this side of life with a chronic illness, too.

I hope that by addressing this, more people will be encouraged to explore CGMs to support prolonged life with diabetes. If you are at risk of severe hypoglycemia, I highly encourage looking into one with your doctor and working closely with them to monitor your blood sugar levels.

Stay safe out there. If you are in a similar situation and no longer feel your lows, my heart is with you.