Most of us come to expect certain things... like feeling your lows and fitting into your pants! So why do those things sometimes change? That's what we're covering in this week's diabetes advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois.

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

 

Kayla from Nebraska, type 1, writes: I recently noticed that I am not experiencing noticeable signs of hypoglycemia. Before, when my sugar hit a low level, usually under 70, I would shake, get a warm feeling throughout my body, start sweating, and suffer light-headedness. However, now I don't feel anything. Will the warning signs ever come back? Or will I have this unawareness from now on?

Wil@Ask D'Mine answers: Humpty Dumpty sat on a wall. Humpty Dumpty had a great fall. Of course, he didn't frickin' feel it because he had hypoglycemia unawareness. Who knew Humpty was an Egg With Diabetes (EWD)? So first things first: if you've either developed, or are developing hypo unawareness, you need to test a whole lot more often or get a CGM, because you're at risk of a fall from which all the king's horses and all the king's men won't be able to put you back together again.

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Hypo unawareness is just as you described: you begin to lose your ability to feel low blood sugar. The cause of hypo unawareness is the hypos themselves. The more hypos you have, the more severe they are, and the more frequently you have them; the more likely you are to burn out your ability to feel them. Hypo unawareness generally starts as a creeping lowering of when you feel your lows. People who used to feel them at 80 begin to realize they don't feel anything until they go under 70. Then it's 60. Then 50. Like diabetes itself, hypo unawareness seems to be progressive. I've been in the low 30s with no clue. I have such severe hypo unawareness that my endo insisted I include the fact on my medic alert jewelry. I've had patients who've dipped into the mid-20s with no sensation to warn them.

At some point, as hypo unawareness progresses, you don't feel your lows at all. You can go lights-out with no warning. Or no effective warning, anyway. I know one research endo who insists that there's no such thing as hypo unawareness, but that rather the detection threshold drops to the seizure threshold. In other words, you feel your hypo as you black out.

Okie-dokie. I feel soooooo much better knowing that I'm not really unaware—merely not aware in time.

No one knows why, but hypo unawareness is more common in female PWDs than in men, more common in older people than younger, and more likely among the adult onset (a.k.a. LADA) crowd. And proving once-and-for-all that no good deed goes unpunished, folks who exercise regularly are more likely to develop hypo unawareness than folks who don't exercise regularly. Is it possible that women, older people, LADA folks, and people who exercise are more likely to be control freaks on the blood sugar front, which leads them to more hypos, and thus hypo unawareness; or do these folks have some different biology going on? I don't know. I don't think it's been studied yet.

Also, there's some thought that certain medications might contribute to hypo unawareness, including beta-blockers (for high blood pressure) and the common SSRI anti-depressants.

Will your ability to feel hypos return? Maybe. Possibly. But probably not. The two most common "cures," interestingly, are the two most common cures for hang-overs, too: the hair of the dog that bit you; or a strong cup of joe.

First, to the hair of the dog. Many endos attempt to reverse the hypo unawareness by intentionally running a PWD's blood sugar above target for three-to-six months. The theory is playing the relative hypoglycemia card in reverse. Think of it this way: Let's say your house is 72 degress, but you're feeling kinda cold. You don't want to turn the thermostat up, 'cause the freaking utility bill is killing you. What do you do? Well, if it's colder outside, say 65 degrees, you could walk outside for ten or fifteen minutes. When you come back in, your house will feel warmer. It isn't. It's still 72 degrees. It only feels warmer because you've spent some time somewhere colder. Your body can adjust to "new normals" in the same way when it comes to blood sugar.

Running high for a time might reset your sensitivity. Of course, running too high could also put you into a coma, because you're a type 1. And running high for too long risks lighting the fire of complications. So it might work, but it's not something you want to try on your own. I think this is a good example of something you want to do with medical guidance. (Like those car commercials: professional driver. Do not attempt at home.).

Or you could invest in a Starbucks card instead, as at least one study has shown that caffeine may be one way to bring back your hypo symptoms. You can try this one at home. But don't get your hopes up, I'm very highly caffeinated, and I still don't feel my lows.

Michele from Texas, type 2, asks: I would like to know whether insulin causes you to gain weight. I was told that many diabetes pills cause weight gain, too. Are there any diabetic medications that do not make you gain weight?

Wil@Ask D'Mine answers: You just asked the ultimate chicken or egg question. Half of the smartest diabetes docs on the planet will swear on a stack of Bibles, Korans, and Torahs that insulin absolutely causes weight gain. The other half of the smartest diabetes docs on the planet will swear on that the same stack of holy books that the insulin itself is in no way to blame for the weight gain that's seen in some people following the start of insulin therapy.

Huh?

So here's the problem. Weight gain is seen after insulin is started, a lot of the time. But not always. Some docs think the nature of the hormone causes weight gain. Others look more closely at what was going on before insulin was started. Usually crazy-high blood sugar, that's what. And crazy-high blood sugar means that glucose (and the calories it contains) is being dumped into your urine. You're literally peeing away part of the food you eat when your blood sugar is high. When you fix the blood sugar, the extra calories go into fat storage rather than being flushed down the toilet.

Many diabetes experts think this is where the weight gain comes from. If you're eating more calories than you need, and fix your high blood sugar without cutting back on the Nacho Cheese Doritos, you'll gain weight. If you are eating what your body needs, you won't gain weight. Of course if you lost a crazy-lot of weight from high blood sugar before you were diagnosed, your doc might want you to put some of it back on until you're back to a healthy weight.

As for the other part of your question, there are diabetes drugs that don't make you gain weight, and even some that help you lose weight. To cover all the bases here's a rundown on the various diabetes meds and their effects on weight:

Diabetes meds that have no effect on weight one way or the other are: the DPP-4 meds Januvia and Onglyza; the colesevelam med Welchol; and the AGI meds Glyset and Precose.

Diabetes meds that are associated with a mild increase in weight are: the sulfonylurea meds Amaryl, DiaBet, Glucotrol, Glynase, and Micronase; and the glinide class meds Prandin and Starlix.

Diabetes meds that are associated with a mild-to-moderate increase in weight are insulins in all their flavors.

Diabetes meds that are associated with a moderate increase in weight are the TZD-class meds Actos and Avandia (now pulled from general market due to heart health risks).

No diabetes med is associated with "severe" weight gain.

On the other side of the coin, diabetes drugs that are associated with a loss of weight are: the metformin class meds Fortamet, Glucophage, Glumetza, and Riomet; the injectable GLP-1 meds Byetta and Victoza; and the pramlintide class med Symlin.

Then we have the issue of polypills, or combo meds that mix two classes of meds together. For instance metformin is sometimes mixed with a sulfonylurea or a TZD. Then what? We've got one med that lowers weight and one that raises weight in the same pill! What happens in the body?

I have no frickin' idea whatsoever, and I'm not sure anyone else does either. On top of that, most PWDs take all kinds of other prescription drugs that can have an effect on weight as well. A few of the types that are well-known to cause weight gain include some anti-depressants, steroids, many anti-psychotics and bi-polar meds, and birth control pills.

If you think about it, you have to pity a depressed, bi-polar, diabetic female on steroids for Lupus, who's on birth control to avoid getting pregnant. She'd really have the cards stacked against her!

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.