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Can I "feel" my high and low blood sugars reliably?

Although many people with diabetes confidently state that they can reliably detect both their high and low blood sugars without actual measurement, studies have shown that these beliefs are not usually accurate. It is generally easier to be aware of hypoglycemia ("low sugars") than high blood sugars. This is because the margin of safety between blood sugars in the lower part of the normal range and dangerously low blood sugars is quite narrow — only about 25 mg/dl — and the body has a vigorous and rapid response system, designed to ensure that a source of energy is rapidly found and consumed. Nevertheless, especially after longstanding diabetes or a period of very tight glucose control, symptoms of low blood sugar are often not detected by patients. If they are detected, they are perceived with insufficient time to take preventive action. Typical early symptoms of hypoglycemia are shakiness, sweatiness, hunger, abdominal discomfort, palpitations (i.e., a fluttering sensation in the chest), and headache. When blood sugar is very low, confusion and disorientation often occur together with sometimes bizarre behavior, but these features are generally noted by others rather than the affected person him- or herself. In the case of hyperglycemia, people with diabetes are usually quite unaware of the presence or severity of high sugars until secondary symptoms such as frequent urination and thirst occur. For the great majority of people, the only sure way to detect high blood sugar is to perform regular glucose monitoring.

My doctor says I have hypoglycemia. Isn't that the opposite of diabetes?

Yes, hypoglycemia (low blood sugar) is the opposite of the hyperglycemia (high blood sugar) that characterizes diabetes. Certain treatments for diabetes and several conditions unrelated to diabetes can cause hypoglycemia. The most common form of hypoglycemia occurs in otherwise healthy young individuals, more commonly in women than men, and is quite benign, although it can be associated with distressing symptoms. Fortunately, it is usually treatable by adjustment of the composition and timing of meals. Sometimes, hypoglycemia can be caused by serious conditions and your doctor will be able to determine whether you are one of the small percentage of people who needs further investigation and specialist referral.

It is important to note that hypoglycemia can be an early feature of diabetes. This type of hypoglycemia occurs in people with prediabetes (see Question 9) who are resistant to the action of insulin and yet are still capable of mounting a vigorous insulin release from the pancreas to overcome it. In the later stages of absorption of calories from a meal, the insulin levels may remain high as the blood glucose level is falling quite rapidly. This may lead to a temporary but sometimes distressing period of low blood sugar that usually occurs about 3 to 5 hours after a meal. It tends to resolve if the prediabetes progresses to frank diabetes, but in some people, it may persist for some years. It is also often treatable by dietary adjustment or other means.

Could I have had diabetes for a long time and not known it?

Yes, indeed, you could have had diabetes for a considerable period of time, months or even years, and been unaware of it. However, it is unlikely that you could have had severe diabetes with very high blood sugars for a long time without having to seek medical attention, as you would have experienced complications. However, milder degrees of diabetes are often without obvious symptoms, although in retrospect patients will realize that all was not well when they start to feel the benefits of treatment. Studies have shown that, on average, type 2 diabetes has been present for several years by the time it is diagnosed. It is important that asymptomatic diabetes is detected and treated, because it can lead to serious health consequences, which may be irreversible when detected. About one of every three people has detectable neuropathy (nerve damage) at the time of diagnosis, indicating that longstanding diabetes has been present. Less commonly, eye damage (retinopathy) and/or kidney damage (nephropathy) are discovered at the time of diagnosis. These are serious consequences of diabetes and are the leading causes of blindness and kidney failure in working age adults in the United States, as well as much of the industrialized world. As serious, or even more serious than this, is the potential for undetected and untreated diabetes to lead to heart attacks, strokes, heart failure, or amputations. Indeed, almost 4 of every 10 patients admitted to hospital with a sudden serious cardiac event will be found to have previously unsuspected and undiagnosed diabetes or prediabetes. It is now clear that prediabetes is almost as serious a risk factor for such cardiac events and death from them as full-blown diabetes.

It is important that asymptomatic diabetes is detected and treated, because it can lead to serious health consequences, which may be irreversible when detected.

 
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