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Hypo unawareness

Not being able to recognise the warnings of a hypo affects many people with diabetes.

What is hypo unawareness?

A hypo is when your blood glucose levels (also called blood sugar) are too low (below 4mmol/l). Hypo unawareness is when you can’t spot the signs you're going hypo.

You're more likely to be unaware of hypos if you:

  • have Type 1 diabetes
  • have had diabetes for a long time and have always tended to have lots of hypos.

If you're unaware of hypos, you can't treat the hypo quickly and get back into your normal blood sugar range. This increases the risk of a severe hypo. Your quality of life is affected and it can be hard to keep your blood sugar levels in a safe range. In some cases you may have to stop activities such as driving. And it isn’t good for your work, social life and home life.

25% of people with Type 1 diabetes are unaware of hypos

If you can’t tell when your blood sugar is low, you will only know by checking your level.

Causes of hypo unawareness

We know that if you have lots of hypos, you’re more likely to stop noticing when you have new hypos.

We don’t yet fully understand why people are unaware of hypos but our researchers are trying to finding out. They’re looking at how to bring back awareness.

Treatment for hypo unawareness

If you think you’re losing your hypo awareness, speak to your diabetes team. There are a number of ways to help you get your awareness back.

Getting your hypo awareness back

If you can avoid hypos, your awareness may well return, but avoiding them isn’t always easy. So you need the help of your diabetes team.

They may talk to you about checking your blood sugar levels more often. And they may suggest relaxing your blood sugar targets for a while.

Some people find they start to be aware of hypos again if they run their blood sugar levels a bit higher for a while. But don't do this without speaking to your team. They can advise you on what sort of sugar level you should aim for and for how long.

Continuous glucose monitor (CGM)

If you've completely lost your hypo warning signs, your diabetes team may talk to you about using a CGM. This kind of monitor is particularly helpful for hypo unawareness. You can set an alarm on it which sounds if your sugar levels go above or below a certain level. For some people this is life changing and you don’t have to finger-prick so often.

Your diabetes team may be able to lend you a CGM to help work out when you’re going low. Then they can advise you on how you can avoid and manage your hypos.

Flash glucose monitor

If you've recently lost some hypo awareness, a flash glucose monitor might help you. You can use it to keep an eye on your blood sugar levels until you're more aware of them. But if you're complete unaware of hypos, you'll need a CGM with an alarm.

Islet transplants

Some people with Type 1 who have severe hypos and poor hypo awareness can be referred for islet transplants. This is not yet a standard treatment. It's when the insulin-producing cells you don't have are transplanted into your pancreas. Bruce had an islet transplant in 2014. Read Bruce's story to find out more. 

Our research on hypo awareness

We need to find better ways to help people with diabetes bring back their hypo awareness. And our scientists are on the case. 

Can exercise bring back hypo awareness?

Our research fellow Dr Catriona Farrell is seeing if exercise can override how the brain adapts to hypos, and restore awareness.

“If we find out high intensity exercise works, this could be a really useful and accessible treatment option. It doesn’t involve taking medication, it doesn’t cost anything and it’s got added health benefits." Dr Catriona Farrell

The brain and hypo unawareness

People with hypo unawareness show changes in the signals in their brains meaning they experience fewer signs — like stress, anxiety and hunger — to let them know they’re low.

  • Dr Patrik Choudhary is using advanced brain imaging techniques to figure out how and why this happens. He’s looking at the brain patterns in people who are hypo unaware, and whether these responses can be reversed if they bring back their awareness. These insights could help scientists find better ways to treat the problem.
  • Dr Craig Beall is looking at specialised cells in the brain that appear to sense hypos to understand how they go wrong. So far, he’s discovered that these cells become stressed when they’re exposed to repeated episodes of low blood sugars, and stop detecting important cellular danger signals. This could help to develop new drugs that focus on restoring this sensitivity to danger signals to treat hypo unawareness.
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