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Hypoglycemic unawareness prevention tips

Hypoglycemic unawareness prevention tips

Conclusions Hypoglycemia nuawareness a common complication in diabetic patients receiving oral or insulin therapy. Received : 14 January Women are more prone to this problem because they have reduced counter-regulatory responses and reduced symptoms.

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Hypoglycemic unawareness prevention tips -

It is not clear if this is only because of the hypoglycemia, or if these are just very frail people. Health care professionals should keep this in mind and pay close attention to other risk factors for cardiovascular disease in these patients, such as hypertension and high cholesterol.

Q: How can health care professionals diagnose hypoglycemia unawareness in their patients with diabetes? A: Health care professionals should talk to their patients about hypoglycemia at every visit, and they should ask their patients how low their blood sugar has to go before they have symptoms.

This should prompt the health care professional to think about why the patient is experiencing episodes of hypoglycemia. Is the patient using too much insulin? Is the patient skipping meals? Has the patient changed their physical activity level?

This also reminds us that these patients should carry glucagon with them, and someone—a family member, coworker, or teacher—should know how to access and administer it. Q: How can health care professionals help patients manage hypoglycemia unawareness?

A: Continuous glucose monitors are very good tools for patients that are at risk of hypoglycemia unawareness, because the CGM will alert them if their blood glucose level gets too low. Patients also will know what their blood glucose level is before they drive, and have insights into how food and exercise affect their glycemia.

Health care professionals should also make sure that patients understand that they need to be aware of some circumstances that may put them at risk.

The same is true for alcohol—if patients drink alcohol, it increases the risk of hypoglycemia, so they should be reminded to eat food if they are going to drink. Some studies have shown that if patients avoid hypoglycemia for some time, they can begin to feel the symptoms of hypoglycemia again.

I have seen this in people with diabetes that participate in my research studies. By preventing hypoglycemia, you can reset the body to respond differently to symptoms of hypoglycemia.

Some health care professionals may prefer to use newer basal insulins in patients at risk of hypoglycemia because these insulins seem to have less risk of hypoglycemia than the older ones, but they can still cause hypoglycemia, and we need to be aware of that.

I think that for many people, it is easier to administer mealtime insulin when they have an insulin pump. It is also important to remember that some patients may be afraid to report episodes of hypoglycemia to their doctors because of legal implications.

For example, some states may require people with diabetes to not have a hypoglycemia episode for 6 to 12 months before they can drive a vehicle. Health care professionals should emphasize to patients that they should know what their blood glucose level is before they drive a car, and that they should have food on hand, so if their glucose level drops, they can manage it.

Q: What research is being conducted on hypoglycemia unawareness? A: Researchers are interested in different aspects of hypoglycemia unawareness such as the cause, complications, and treatments.

Some groups are studying why recurrent hypoglycemia leads to impaired awareness. Is it a problem with brain adaptation to hypoglycemia, or is it only a problem with people who have severe glucagon deficiency?

Other groups are doing research on the long-term effects of recurrent hypoglycemia on the function of other organs. I just finished a study where we gave people naloxone during an episode of exercise to determine if they recognize their hypoglycemia the next day, but the study was just completed, so we do not have results yet.

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Q: What is hypoglycemia? Q: What is hypoglycemia unawareness, and how common is it? What is your experience managing hypoglycemia unawareness?

Tell us in the comments below. Click to load comments Loading comments Blog Tools Subscribe Subscribe to get blog updates. Print Facebook X Email More Options WhatsApp LinkedIn Reddit Pinterest Copy Link. Patient Communication Research Advancements Complications of Diabetes Medication and Monitoring Practice Transformation Diabetes Prevention Patient Self-Management Obesity and Weight Management Social Determinants of Health New Technologies According to Cryer, 1 the average person with type 1 diabetes suffers two episodes of hypoglycemia per week and one episode of severe hypoglycemia per year.

Severe hypoglycemia is less common in those with type 2 diabetes. However, in the U. Prospective Diabetes Study UKPDS , 0. Among patients with type 2 diabetes, the greatest frequency of hypoglycemia is found in those on insulin.

The body's normal response to hypoglycemia is significantly altered in diabetes, as well as by the use of exogenous insulin or insulin secretagogues. Thus, the physiological symptoms and negative consequences of hypoglycemia may result in significant fear of hypoglycemia and anxiety associated with possible hypoglycemia for individuals with diabetes.

Yet, pivotal studies such as the UKPDS and the Diabetes Control and Complications Trial leave no doubt that improved glycemic control prevents or delays microvascular complications and may also reduce macrovascular events.

The risk of hypoglycemia should not be used as an excuse for less-than-optimal glucose control. The American Diabetes Association ADA Workgroup on Hypoglycemia did not define hypoglycemia as it traditionally has been presented in most educational materials i.

This would include any level of unconsciousness. These levels were also established to aid in improving consistency of reporting for research studies. This unawareness occurs as impairment in epinephrine release and other normal physiological responses to hypoglycemia and limits individuals' ability to respond appropriately to impending low blood glucose.

The usual warning symptoms such as shakiness, sweating, and irritability are absent. Without these adrenergic responses, such individuals only develop neurological symptoms such as confusion, at which time they are unable to take action to treat their low blood glucose and therefore develop severe hypoglycemia.

Hypoglycemia unawareness was once associated with longstanding diabetes but is now known to occur as a result of increasing frequency of hypoglycemia and not just longer duration of the disease.

Avoidance of hypoglycemia for several weeks may lead to improved hypoglycemia awareness. Hypoglycemia should not be viewed as an insurmountable barrier, but rather as an opportunity to potentially improve a recommended medication strategy, improve on daily diabetes care practices, or uncover other medical diagnoses that may be contributing to the development of hypoglycemia.

How can HCPs assist individuals with diabetes in identifying potential risk factors for the development of hypoglycemia or identifying the causes of hypoglycemia events?

The cause may seem obvious: either the diabetes medication, likely insulin, did not match the amount of food ingested, or the level of exercise a patient performed was too much for the amount of food ingested and the amount of medication taken.

But often, teasing out the exact triggers can be a challenge. Table 1 provides a checklist of potential causes of hypoglycemia. HCPs may need to think like a crime scene investigator to uncover the causes and contributing factors that have led to a hypoglycemic event.

Allowing individuals with diabetes and their family to tell their story about a hypoglycemic event may allow HCPs to uncover a need not only for medication changes, but also for changes in patients' behavioral responses to hypoglycemia. Empowering individuals to have more control over such situations will also help reduce the anxiety and fear often associated with hypoglycemia.

Probing patients with pertinent questions will help create an accurate understanding of the context of reported hypoglycemia. This can also reduce misunderstandings between patients and providers and provide education opportunities about skills or concepts that may seem basic to providers but can be challenging for patients.

When patients report that they have been experiencing low blood glucose, it is important to define hypoglycemia together. What do patients consider to be a low blood glucose level?

Is this based solely on feelings or have they been able to actually check their blood glucose at the moment of symptoms? If self-monitoring of blood glucose SMBG records are available, at what point or level of blood glucose do individuals start to experience symptoms of hypoglycemia?

People with consistently high blood glucose levels will feel hypoglycemic at blood glucose levels higher than the normal range, whereas those with tight glycemic control may feel hypoglycemic at lower levels.

Discussing these concepts with patients provides practical motivation and support for the role of SMBG in medication adjustment and safety. Another area worthy of inquiry is patients' actions leading up to hypoglycemic events.

It may seem obvious that changes in food choices, physical activity, or medication can produce hypoglycemia, but letting patients verbalize their patterns or changes in patterns can allow them to discover this for themselves. Eating a smaller meal or one containing less carbohydrate than normal may result in a low postprandial blood glucose level.

If changes in food choices lead to hypoglycemic events, patients likely did not do this on purpose. Have they been less hungry lately, or are they trying to lose weight?

Has there been a change in their oral health? Many individuals do not understand the complexity of factors affecting postprandial glucose levels or are not able to consistently identify a low-carbohydrate or high-carbohydrate meal or to accurately estimate the number of calories in their meals.

For patients who are doing basic carbohydrate counting, explore the potential impact of the presence or absence of protein and fat in meals. These individuals may not recognize or may easily forget the role of protein and fat because they are concentrating more closely on carbohydrates.

For patients who are counting calories or using some overall means of portion control, explore the impact of significant changes in carbohydrate content and assess their ability to identify foods that are rich in carbohydrates.

These individuals may not understand the importance of carbohydrate budgeting. In these discussions, providers may find patients to be at a point of readiness to be referred to a registered dietitian or certified diabetes educator for more nutrition education.

Changes in physical activity that can lead to hypoglycemia can include more than just intentional exercise. Particularly for people who are usually sedentary, an increase in overall energy and stamina that leads to doing more errands, gardening, or housework than normal may result in hypoglycemia.

In contrast, athletes with diabetes who have temporary periods of two-a-day practices might need help learning how to adjust their medication to deal with the increase in insulin sensitivity and glucose uptake that results from increased exercise.

Asking open-ended questions about the timing and dosing of medication or asking patients to demonstrate or describe their injection technique also may reveal potential causes of hypoglycemia. Finally, it is important to ask exactly how patients treat low blood glucose.

This question often reveals a tendency to consume more than the recommended 15—20 g of carbohydrate or may uncover a misunderstanding of what types of foods and substances will most quickly raise the blood glucose level. Table 2 reviews the recommended treatment guidelines for hypoglycemia.

Discussing patients' knowledge of food choices, physical activity, and medication can help prevent future hypoglycemia and allow providers to best determine any necessary changes in medication and identify education needs.

Lipohypertrophy is a buildup of fat at the injection site. Injecting insulin into lipohypertrophy usually causes impaired absorption of insulin. However, injecting into sites of lipohypertrophy can result in erratic and unexplained fluctuations in blood glucose.

When advising patients to rotate to new injection sites, HCPs should note the need for caution. Because insulin injected into a fresh site likely will be absorbed more efficiently, doses may need to be decreased. Regular rotation of insulin injection sites may prevent lipohypertrophy from occurring.

Keep in mind that some patients, especially children, may be hesitant to inject in areas other than one with lipohypertrophy because they report that area is less sensitive to injections.

Many alcohol-containing drinks contain carbohydrate and can cause initial hyperglycemia. However, alcohol also inhibits gluconeogenesis, which becomes the main source of endogenous glucose about 8 hours after a meal.

Therefore, there is increased risk of hypoglycemia the morning after significant alcohol intake if there has not been food intake. Alcohol consumption can also interfere with the ability to feel hypoglycemia symptoms. For patients whose blood glucose is well controlled, the ADA guidelines for alcohol intake suggest a maximum of one to two drinks per day, consumed with food.

Close monitoring of blood glucose for the next 10—20 hours may be beneficial. Insulin and sulfonylurea clearance is decreased with impaired hepatic or renal function. Decreasing the dosages of some anti-hyperglycemic medications and avoiding others may be necessary.

Of the oral agents, sulfonylureas are more likely to cause hypoglycemia. Glimepiride may be a safer choice than glyburide or glipizide in elderly patients and those with renal insufficiency because it is completely metabolized by the liver; cytochrome P reduces it to essentially inactive metabolites that are eliminated renally and fecally.

As kidney function declines, exogenous insulin has a longer duration and is more unpredictable in its action, and the contribution of glucose from the kidney through gluconeogensis is reduced. Patients who have had diabetes for many years or who have had poor control are at risk for autonomic neuropathy, including gastroparesis, or slow gastric emptying.

It is thought that delayed food absorption increases the risk of hypoglycemia, although evidence is lacking.

Intercurrent gastrointestinal problems such as gastroenteritis or celiac disease can also be causes of altered food absorption. Medications such as metoclopramide or erythromycin are used to increase gastric emptying time.

Giving mealtime insulin after meals or using an extended bolus on an insulin pump may also help to prevent potential hypoglycemia related to delayed gastric emptying. Hypothyroidism slows the absorption of glucose through the gastrointestinal tract, reduces peripheral tissue glucose uptake, and decreases gluconeogenesis.

For people with diabetes, this can cause increased episodes of hypoglycemia. Measuring the level of thyroid-stimulating hormone is the most accurate method of evaluating primary hypothyroidism. As hypothyroidism is treated, an increase in insulin dose will likely be needed to meet the increased metabolic need.

The risk of severe hypoglycemia increases with age. Slowed counter-regulatory hormones, erratic food intake, and slowed intestinal absorption place older adults at higher risk of hypoglycemia.

The incidence of mild and severe hypoglycemia is highest between 8 and 16 weeks' gestation in type 1 diabetes. Severe hypoglycemia in early pregnancy is three times more frequent than during preconception. Providing preconception counseling, including information about a potential increase in hypoglycemia early in pregnancy, may help reduce the incidence of hypoglycemia for women planning to become pregnant.

Intentional insulin overdose is thought to be relatively rare, but the actual prevalence is difficult to measure. A common method used to estimate the number of deliberate insulin overdoses is to analyze data from regional poison control centers.

In the annual report of the American Association of Poison Control Centers, only 3, of the 2,, inquiries 0. Although rare, most cases of insulin overdose reported to poison control centers have occurred during suicide attempts.

HCPs who are unable to identify other reasons for persistent hypoglycemia may not be able to rule out intentional induction of hypoglycemia. Patients who are suspected of intentionally inducing hypoglycemia should be referred to a behaviorist for evaluation and treatment.

Individuals with diabetes and, ideally, their care partners who have received diabetes self-management education should have a better understanding of how their medication, meal plan, and physical activity interact to achieve optimal glucose control while limiting hypoglycemia.

They also will be better equipped to prevent and treat hypoglycemia should it occur. HCPs should help individuals who have not had an opportunity to work with a diabetes educator or dietitian to identify educational resources in their area. Table 3 provides a list of resources for locating local diabetes educators and dietitians.

Hypoglycemic unawareness prevention tips Disclosures. Please read the Hyplglycemic at the end Hypoglycemic unawareness prevention tips this page. Hypoglycemia unaaareness the medical term for low blood Calcium and digestion blood sugar. People with type 1 diabetes Hypoglycemmic take insulin to manage their blood glucose levels are at risk for getting hypoglycemia. The frequency of hypoglycemia among people with longstanding type 2 diabetes increases over time, as the body eventually stops making enough insulin. The symptoms of low blood glucose vary from person to person and can change over time. During the early stages of low blood glucose, you may:.

Hypoglycemic unawareness prevention tips -

People do not wake up during most nighttime lows. On waking in the morning, all were given insulin to lower their blood sugar to see when they would recognize the symptoms of low blood sugar.

Veneman found that after sleeping through hypoglycemia at night, people had far more trouble recognizing a low blood sugar the following day.

Their warning symptoms became less obvious because counter-regulatory hormones, like epinephrine, norepinephrine, and glucagon are released more slowly and in smaller concentrations if they have had a low in the previous 24 hours.

A recent low blood sugar depletes the stress hormones needed to warn them they are low again. The second low becomes harder to recognize. Since this unawareness occurred in people without diabetes, it is even more likely that a recent low would cause hypoglycemia unawareness in someone who has diabetes.

Research has shown that people who have hypoglycemia unawareness can become aware again of low blood sugars by avoiding frequent lows.

Preventing all lows for two weeks resulted in increased symptoms of low blood sugar and a return to nearly normal symptoms after 3 months. A study in Rome by Dr. Carmine Fanelli and other researchers reduced the frequency of hypoglycemia in people who had had diabetes for seven years or less but who suffered from hypoglycemia unawareness.

As the higher premeal blood sugar target led to less hypoglycemia, people once again regained their low blood sugar symptoms. The counter-regulatory hormone response that alerts people to the presence of a low blood sugar returned to nearly normal after a few weeks of less frequent lows.

Avoidance of lows enables people with diabetes to regain their symptoms when they become low. To reverse hypoglycemia unawareness, set your blood sugar targets higher, carefully adjust insulin doses to closely match your diet and exercise, and stay more alert to physical warnings for 48 hours following a first low blood sugar.

Use your records to predict when lows are likely to occur. You might also consider using prescription medication like Precose acarbose or Glyset miglitol , which delay the absorption of carbohydrates.

This has been shown to reduce the risk of low blood sugars. Use of Precose or Glyset can be combined with a modest reduction in carb boluses to lessen insulin activity over the length of time in which carbs are digested.

Be quick to recognize problems that arise from stress, depression, or other self-care causes. For people with a physically active lifestyle, less insulin is needed during and for several hours after increased activity. An occasional 2 a. blood test can do wonders in preventing unrecognized nighttime lows.

Using a continuous monitor or Sleep Sentry can alert you and your health care team to occurrences of unrecognized hypoglycemia. Once these devices warn of nighttime lows, insulin doses can be changed rapidly to stop the lows.

As continuous monitoring devices become available, they should prevent most episodes of hypoglycemia entirely. Even short-term use of one of these devices may be able to break the cycle of lows through more appropriate insulin doses.

Educating patients with diabetes about the prevention, early identification, and appropriate treatment of hypoglycemia is a critically important component of individualized diabetes care.

Hypoglycemia prevention involves an understanding of the impact of diet, exercise, and medications on hypoglycemia risk.

Treatment of hypoglycemia includes administration of oral carbohydrates for the patient who is conscious and administration of glucagon in the setting of severe hypoglycemia.

Advances in glucose monitoring and the availability of newer glucagon formulations provide additional intervention options for the management of hypoglycemia. Despite many recent therapeutic and technological advances, hypoglycemia remains a significant barrier to treatment intensification and the achievement of individualized glycemic goals in diabetes patients.

The ADA recommends that, at each clinical encounter, patients with diabetes be asked about the occurrence of both symptomatic and asymptomatic hypoglycemia.

The signs and symptoms of hypoglycemia vary depending on the severity of the event and can also differ between patients. Symptoms may be generally categorized as autonomic or neuroglycopenic. Examples of adrenergic symptoms include tremor, palpitations, tachycardia, and anxiety; some cholinergic symptoms are sweating, hunger, and paresthesias.

Importantly, the blood-glucose threshold at which an individual patient will experience hypoglycemic symptoms depends on the degree of diabetes management.

That is, the threshold for hypoglycemia will be higher in patients with consistently elevated blood-glucose levels; conversely the threshold tends to be lower in those who experience frequent hypoglycemia.

Neuroglycopenic symptoms result from a lack of glucose in the central nervous system and may include dizziness, weakness, drowsiness, delirium, confusion, seizure, and potentially coma.

For diabetes patients who meet one or more of these criteria, individualized treatment plans should consider risks of treatment intensification versus potential benefits. Educating patients about strategies for hypoglycemia prevention is an important aspect of diabetes care. The following sections discuss considerations for hypoglycemia prevention, including medication, diet and physical activity, use of glucose monitoring, and screening and management of hypoglycemia unawareness.

TABLE 1 summarizes the associated hypoglycemia risk of common glucose-lowering medications. If a patient is struggling with severe or recurrent hypoglycemia, it is important for the clinician to critically evaluate the appropriateness of the continued use of high-risk medications.

Although physical activity has many health benefits and should be encouraged in patients with diabetes, it can contribute to hypoglycemia in at-risk individuals; therefore, caution is warranted and individualized strategies for hypoglycemia prevention should be developed.

The effect of exercise on glucose levels will vary depending on the timing of physical activity relative to meals and medication administration as well as the duration and intensity of physical activity. Monitoring via finger-stick glucose readings and a glucose meter or a continuous glucose monitor CGM is essential for the detection and avoidance of hypoglycemia.

Patients at risk for hypoglycemia should be counseled to check their blood glucose before engaging in potentially dangerous activities e. As noted previously, the threshold for experiencing hypoglycemia is often lower in patients who have frequent hypoglycemic events.

The ADA also recommends that insulin-treated patients with hypoglycemia unawareness be advised to raise their glycemic target to strictly avoid hypoglycemia for at least several weeks in order to partially reverse hypoglycemia unawareness and reduce the risk of future episodes.

While implementation of strategies to prevent hypoglycemia is critical, diabetes patients at risk for hypoglycemia e. Hypoglycemia treatment involves two main strategies: 1 administration of oral carbohydrates and 2 administration of glucagon in the setting of severe hypoglycemia.

The preferred treatment for hypoglycemia in conscious patients is glucose, but any readily available form of carbohydrate that contains glucose may be used. The Rule of 15 both facilitates the appropriate resolution of hypoglycemia and prevents overtreatment of the hypoglycemic event in order to minimize rebound hyperglycemia.

Carbohydrate sources high in protein should be avoided, as protein will delay carbohydrate absorption and resolution of hypoglycemia. It may be helpful to provide patients with examples of carbohydrate sources that contain approximately 15 grams of carbohydrate, such as glucose tablets or gel carbohydrate content may vary , five or six Life Savers candies, 4 oz of juice or soda regular, not diet , and 8 oz of skim milk.

In situations where the patient is unconscious or otherwise unable to ingest oral carbohydrates, the administration of exogenous glucagon is indicated. Lyophilized glucagon has been available commercially for several decades. Newer Glucagon Formulations: The limitations of traditional lyophilized glucagon kits have led to the development of two new glucagon formulations that address barriers to use and appropriate administration.

The following paragraphs give a brief overview of the Baqsimi and Gvoke glucagon products see also TABLE 3. However, it's important to talk to your health care provider and not just intentionally keep your blood glucose high because of this.

High blood glucose levels can lead to serious long-term complications. See "Patient education: Preventing complications from diabetes Beyond the Basics ". The treatment of low blood glucose depends on whether you have symptoms and how severe the symptoms are.

No symptoms — Your health care provider will talk to you about what to do if you check your blood glucose and it is low, but you have no noticeable symptoms. They might recommend checking your levels again after a short time, avoiding activities like driving, or eating something with carbohydrates.

Early symptoms — If you have early symptoms of low blood glucose, you should check your level as soon as possible.

However, if your monitoring equipment is not readily available, you can go ahead and give yourself treatment. It's important to treat low blood glucose as soon as possible. To treat low blood glucose, eat 15 grams of fast-acting carbohydrate.

This amount of food is usually enough to raise your blood glucose into a safe range without causing it to get too high.

Avoid foods that contain fat like candy bars or protein such as cheese initially, since they slow down your body's ability to absorb glucose. Check your blood glucose again after 15 minutes and repeat treatment if your level is still low. Monitor your blood glucose levels more frequently for the next few hours to ensure your blood glucose levels are not low.

Severe symptoms — If your blood glucose is very low, you may pass out or become too disoriented to eat. A close friend or relative should be trained to recognize severe low blood glucose and treat it quickly.

Dealing with a loved one who is pale, sweaty, acting bizarrely, or passed out and convulsing can be scary. A dose of glucagon stops these symptoms quickly if they are caused by hypoglycemia. Glucagon is a hormone that raises blood glucose levels. Glucagon is available in emergency kits as an injection or a nasal spray , which can be bought with a prescription in a pharmacy.

Directions are included in each kit; a roommate, partner, parent, or friend should learn how to give glucagon before an emergency occurs. It is important that your glucagon kit is easy to locate, is not expired, and that the friend or relative is able to stay calm.

You should refill the kit when the expiration date approaches, although using an expired kit is unlikely to cause harm. This releases the powder into the person's nostril without requiring them to inhale or do anything else. If you have to give another person glucagon, turn them onto their side afterwards.

This prevents choking if they vomit, which sometimes happens. Low blood glucose symptoms should resolve within 10 to 15 minutes after a dose of glucagon, although nausea and vomiting may follow 60 to 90 minutes later.

As soon as the person is awake and able to swallow, offer a fast-acting carbohydrate such as glucose tablets or juice. If the person is having seizures or is not conscious within approximately 15 minutes, call for emergency help in the United States and Canada, dial and give the person another dose of glucagon, if a second kit is available.

FOLLOW-UP CARE. After your blood glucose level normalizes and your symptoms are gone, you can usually resume your normal activities. If you required glucagon, you should call your health care provider right away.

They can help you to determine how and why you developed severely low blood glucose and can suggest adjustments to prevent future reactions.

In the first 48 to 72 hours after a low blood glucose episode, you may have difficulty recognizing the symptoms of low blood glucose.

In addition, your body's ability to counteract low blood glucose levels is decreased. Check your blood glucose level before you eat, exercise, or drive to avoid another low blood glucose episode.

WHEN TO SEEK HELP. A family member or friend should take you to the hospital or call for emergency assistance immediately if you:. Once in a hospital or ambulance, you will be given treatment intravenously by IV to raise your blood glucose level immediately.

If you require emergency care, you may be observed in the emergency department for a few hours before being released. In this situation, you will need someone else to drive you home. Your health care provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our website www. Related topics for patients, as well as selected articles written for health care professionals, are also available.

Some of the most relevant are listed below.

Hypoglycemic unawareness prevention tips Sustainable weight loss supplements occurs inawareness someone with Tipx doesn't have enough sugar glucose in Hypoglycemic unawareness prevention tips or her blood. Glucose is the main source of Hypoglcemic for the body and brain, so you can't function well if you don't have enough. But your numbers might be different. Ask your health care provider about the appropriate range to keep your blood sugar target range. Pay attention to the early warning signs of hypoglycemia and treat low blood sugar promptly. Hypoglycemic unawareness prevention tips

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