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Re: [IPk] hypo unawareness

>Searching for something completely unrelated, I found a reference to a
>PhD thesis by A.M. Robinson in 1995 about diabetes control and the
>pathophysiology of hypo unawareness.
>John N, this may have been where you heard it but he also makes the claim
>about reduced physiological and symptomatic response to hypos when you're
>lying down as opposed to standing up (unconnected to whether you're asleep
>or not).

I think it was Gianfranco who told me :-)

>He claims therefore that people with good control may be losing
>their awareness because they're having lots of hypos in their sleep which
>they are unaware of. He also claims thatin normal people it takes between 6
>days and  4  weeks for the counterregulatory response to return to  normal
>if no further episodes of hypoglycaemia occur.

Diabetes Clinical Management by Tatersall and Gale quotes an astonishing
figure that on any given night, 20% of all people with diabetes will go
hypo. Not the same people evey night. And usually they will sleep straight
through it. That's the beauty of the pump - you can tweak your overnight
insulin to give you exactly the insulin you need, with more predictable

I know we all seem to have different experiences - I have never had classic
hypo unawareness in the day-time - where your first symptom is falling over
- but I have also never had the shakey-sweaty group of symptoms. I seem to
have a long run-in to a hypo, where I just feel odd and get irritable and
sullen, but retain enough mental ability to realise this and take some
glucose tablets. These symptoms usually cut in at around 3.8.

The exception to this is the dreaded night-time hypo which was the scourge
of my life before I went on the pump. On Human Insulatard they were
frequent and unpredictable - violent spasms and sweating - which left me
wiped out the following morning. The only way to prevent one was to get my
bg ridiculously high before going to bed, which meant I still slept badly
and woke feeling shitty!!!

>So I guess the answer is for all us to sleep standing up if we want good
>control without hypo unawareness :-)

I was very interested to note that Prof Stephanie Amiel, when questioned at
the JDF conference after her talk on hypo unawareness, had not heard of the
lying down theory: that being in a lying position (eg in bed) can switch
off a set of hypo symptoms. Given that the brain's glucose sensor is
located near its balance control centre, there is possibly more room for


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