Glucagon, a hormone which increases glucose in the bloodstream, prevents people who do not have diabetes from having hypoglycemia. In people with diabetes, the secretion of hormones responsible for controlling blood glucose (insulin, glucagon and adrenaline) are compromised. In type 1 diabetes patients, injected insulin stimulates the continued removal of glucose from the blood and inhibits the release of glucagon. At the same time, adrenaline is also reduced or is delayed which leads to attenuation, or lessening, of the normal autonomic response of feeling shaky, fast heartbeat, sweating, chills, or pallor, which compromises the characteristic symptoms associated with low glucose levels. As a result, hypoglycemia may often go unnoticed, which is called Hypoglycemia Unawareness.

Recurrent episodes of hypoglycemia are among the main reasons for the reduction of sympathoadrenal (adrenaline release) which causes symptomatic and cognitive responses to hypoglycemia. This lack of response is very dangerous for the brain, which needs a constant supply of glucose to function properly. An important study called DCCT (Diabetes Control and Complications Trial) has shown an increased incidence of hypoglycemia in individuals with intensive diabetes treatment. This does not mean that good control should be given up, rather, educational, technological, and pharmacological resources should be used to amplify the symptoms to detect and correct hypoglycemia early, so that it is possible to get out of the vicious cycle that favors the occurrence and worsening of Hypoglycemia Unawareness.

Recommendations to reduce the risk of Hypoglycemia Unawareness:

• Reduce the total daily insulin dose and use higher glycemic targets for a few weeks (at least 2-3 weeks).
• Monitor blood glucose more frequently with BGM and CGM
• Consume the correct food before blood glucose reaches low levels (below 90 mg/dl).
• Do not consume alcoholic beverages.
• Keep in contact with the healthcare team to manage exercise type, meal and medication timing
• Have glucagon injections available at home or in the workplace for the severe episodes.

Advanced type 2 diabetes can also cause deteriorating pancreas and kidney function, increasing the risk of hypoglycemia. This can happen in type 2 patients mainly in those who use multiple insulin treatments or /and who have other complications such as kidney failure. A study published in the journal Diabetes Research and Clinical Practice estimated that nearly 10 percent of people with type 2 diabetes taking insulin experience Hypoglycemia Unawareness .

The advancement of medical technology and knowledge at GluCare allows us to make use of different strategies, with emphasis on individualized therapy and continuing education, to improve diabetes management and quality of life.