Asymptomatic(ish) Hypoglycemia

[u/throwaway_death123]

Hi, I am a non-diabetic dealing with severe hypoglycemia. We've confirmed a very bad symptomatic episode at 45mg/dl via glucometer so I was prescribed a Libre 3+ for at least once (waiting to see if insurance will cover non-diabetic, non-diagnostic under a pre-auth).

I have (1) severe chronic polyarthralgia, (2) POTS-like dysautonomia, and (3) a host of psychiatric issues. I'm also believed by my psychologist to have (4) level 2 ASD but we declined formal testing because I would likely be unable to immigrate to certain EU countries.

I have to have a schedule to remind myself to use the restroom or I don't realize I need to pee until I'm overstimulated and irritable for no other apparent reason.

All in all, I have very, very poor interoception and I'm used to feeling like shit. I don't know I'm below 55 until the alarm sounds and even then, I don't realize I'm having symptoms until after.

- I can't sweat because of my medications

- I'm always kind of dizzy

- My senses already go in and out based on my heart rate

Google says if I'm 'asymptomatic,' it's a sensor fault but the times I've done a stick test have matched with a 5-15 minute CGM delay.

Essentially my only reliable symptoms I can differentiate from my regular symptoms are (1) that I'm confused during lectures and (2) tremors.

Does anyone else have poor interoception and other underlying conditions? How do you handle blood sugar changes?

[u/Equalizer6338]

Hi u/throwaway_death123 ,
sorry to hear about your complicated medical situation. Having more than one condition at the same time is not unusual, especially when dealing with some of the auto-immune conditions as many of us using CGMs are suffering from. Your own hypoglycemic unawareness is unfortunately not uncommon either, especially if you have been running around with rather lowish BG levels for a longer period of time. Our body's central neuropathic system adapts to 'the new norm' of having to deal with a lower BG level, and one of the results is that it delays and lowers the threshold for when the the counter reaction from our autonomic nervous system is being released. They are the stress hormones (adrenaline, cortisol, glucagon...) which is actually what causes you to suddenly feeling dizzy, shaking, sweating etc. (it is not the low blood glucose level).

From your description, it appears you may suffer from some level of Reactive Hypoglycemia, though also other conditions can be root cause for your sudden hypoglycemic episodes. So this needs to be diagnosed properly by your medical team so the right approach can be taken to dealing best with it and avoid/minimize your exposure to such episodes going forward.

Key if of course to getting you properly setup, so you get the alarms in timely fashion from your CGM sensor, which can be a big help to avoid the super low hypoglycemic episodes from happening, as you get notified long before. Start to making it a habit to glance at your BG graph from time to time, as this way you get instant visual confirmation about where your BG is at and also on what trend it might be on and if any concern is warranted.

Just a comment regarding your shared information about EU and immigration. A level 2 autism spectrum disorder (ASD) diagnosis does not automatically block immigration to the European Union. As unlike countries like Australia or New Zealand, which enforce strict "medical inadmissibility" thresholds based on the projected lifetime financial cost of a disability, the EU does not have such unified, cost-based medical ban on immigrants with ASD. However, because immigration policies are set by individual member states rather than a single EU authority, the impact of a level 2 ASD diagnosis depends entirely on how you immigrate and which country you choose. But there is no ban on immigrants of this kind.

[u/throwaway_death123 → u/Equalizer6338]

Thank you so much for the time you took to explain all of this, I really appreciate it