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During hypoglycaemia, why does my mother not feel the symptoms?

Q: My mother is 55 years old. She is suffering from diabetes for the last 22 years and has a high diabetic family history where she lost her father and brothers due to kidney failure. She has been on human mixtard for the last 6 years. It has been noticed that nowadays when her sugar levels fall (hypoglycaemia, say till 49), she does not feel much symptoms. There is only slight uneasiness. On checking with a glucometer it is found that her blood sugar is actually low. Why is this so?

A:People with long standing diabetes get this phenomenon, called hypoglycaemia unawareness. It is because over the years the body's ability to respond to low sugars gets decreased. She will need to check her sugars very frequently, and adjust her insulin doses accordingly, to reduce the risk of hypoglycaemias. She should also aim to keep her pre-meal sugars between 100-130 rather than 80-130. In addition, I hope her HbA1c, retina and renal function are tested regularly.

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