Editing Hypoglycemia (section)

==== Hypoglycemic unawareness ====
Recurrent episodes of hypoglycemia can lead to ''hypoglycemic unawareness'', or the decreased ability to recognize hypoglycemia.<ref name=":18">{{Cite journal |vauthors=Johnson-Rabbett B, Seaquist ER |date=September 2019 |title=Hypoglycemia in diabetes: The dark side of diabetes treatment. A patient-centered review |journal=Journal of Diabetes |volume=11 |issue=9 |pages=711–718 |doi=10.1111/1753-0407.12933 |pmid=30983138 |s2cid=115202581}}</ref><ref name=":19">{{Cite journal |display-authors=6 |vauthors=Ibrahim M, Baker J, Cahn A, Eckel RH, El Sayed NA, Fischl AH, Gaede P, Leslie RD, Pieralice S, Tuccinardi D, Pozzilli P, Richelsen B, Roitman E, Standl E, Toledano Y, Tuomilehto J, Weber SL, Umpierrez GE |date=November 2020 |title=Hypoglycaemia and its management in primary care setting |url=https://findresearcher.sdu.dk/ws/files/170369949/dmrr.3332.pdf |journal=Diabetes/Metabolism Research and Reviews |volume=36 |issue=8 |pages=e3332 |doi=10.1002/dmrr.3332 |pmid=32343474 |s2cid=216594548}}</ref><ref name=":20">{{Cite journal |vauthors=Martín-Timón I, Del Cañizo-Gómez FJ |date=July 2015 |title=Mechanisms of hypoglycemia unawareness and implications in diabetic patients |journal=World Journal of Diabetes |volume=6 |issue=7 |pages=912–926 |doi=10.4239/wjd.v6.i7.912 |pmc=4499525 |pmid=26185599 |doi-access=free}}</ref> As diabetics experience more episodes of hypoglycemia, the blood glucose level which triggers symptoms of hypoglycemia decreases.<ref name=":18" /><ref name=":19" /><ref name=":20" /> In other words, people ''without'' hypoglycemic unawareness experience symptoms of hypoglycemia at a blood glucose of about 55&nbsp;mg/dL (3.0&nbsp;mmol/L).<ref name="Jameson_2018" /><ref name="Cry2009" /> Those ''with'' hypoglycemic unawareness experience the symptoms of hypoglycemia at far lower levels of blood glucose.<ref name=":18" /><ref name=":19" /><ref name=":20" /> This is dangerous for a number of reasons.<ref name=":18" /><ref name=":19" /><ref name=":20" /> The hypoglycemic person not only gains awareness of hypoglycemia at very low blood glucose levels, but they also require high levels of carbohydrates or glucagon to recover their blood glucose to normal levels.<ref name=":18" /><ref name=":19" /><ref name=":20" /> These individuals are also at far greater risk of severe hypoglycemia.<ref name=":18" /><ref name=":19" /><ref name=":20" />

While the exact cause of hypoglycemic unawareness is still under research, it is thought that these individuals progressively begin to develop fewer adrenergic-type symptoms, resulting in the loss of neuroglycopenic-type symptoms.<ref name=":19" /><ref name=":20" /> ''Neuroglycopenic symptoms'' are caused by low glucose in the brain, and can result in tiredness, confusion, difficulty with speech, seizures, and loss of consciousness.<ref name="Jameson_2018" /> ''Adrenergic symptoms'' are caused by the body's reaction to low glucose in the brain, and can result in fast heart rate, sweating, nervousness, and hunger.<ref name="Jameson_2018" /> See section above on ''Signs and Symptoms'' for further explanation of neuroglycopenic symptoms and adrenergic symptoms.

In terms of epidemiology, hypoglycemic unawareness occurs in 20–40% of type 1 diabetics.<ref name=":18" /><ref name=":20" /><ref>{{Cite journal |vauthors=Lucidi P, Porcellati F, Bolli GB, Fanelli CG |date=August 2018 |title=Prevention and Management of Severe Hypoglycemia and Hypoglycemia Unawareness: Incorporating Sensor Technology |journal=Current Diabetes Reports |volume=18 |issue=10 |pages=83 |doi=10.1007/s11892-018-1065-6 |pmid=30121746 |s2cid=52039366}}</ref>