Hypoglycemia Unawareness

Repeated hypoglycemic episodes can shift the body’s response threshold downward. The sympathetic nervous system releases fewer warning signals at a glucose level that previously caused sweating or tremor. At the same time, the brain becomes accustomed to functioning at lower glucose levels until its glucose supply falls far enough to impair thinking. This creates a harmful cycle: 1. Recurrent lows blunt the autonomic warning response. 2. Blunted symptoms delay treatment. 3. Delayed treatment increases the risk of severe hypoglycemia. 4. Further severe or recurrent lows worsen awareness. Sleep adds another layer of risk. A person cannot reliably perceive symptoms while asleep, and a low may be discovered only by a continuous glucose monitor (CGM) alarm, a caregiver, or morning hyperglycemia after counterregulatory hormone release. Renal impairment also changes the risk picture. Reduced renal clearance can prolong insulin action, so a previously appropriate insulin dose may become excessive. An unexplained increase in lows in a person with declining kidney function should prompt medication review rather than repeated treatment with carbohydrates alone. For REx-PN (Canada), items rarely announce the topic in the...