Some people with diabetes, particularly after having the condition for many years, lose the ability to detect hypoglycemia—low blood sugar—just by the way they feel. This “hypoglycemia unawareness” is obviously more dangerous than being able to detect and treat hypoglycemia early on. Blood sugar levels may continue to fall and reach a life-threatening degree. Hypoglycemia unawareness can be caused by impairment of the nervous system (autonomic neuropathy) or by beta blocker drugs prescribed for high blood pressure or heart disease. People with hypoglycemia unawareness need to check blood sugars more frequently, particularly if driving a car or operating dangerous machinery.
How Is Hypoglycemia Treated?
Folks who can indeed perceive signs or symptoms of hypoglycemia usually won’t notice them until their blood sugar is under 65 mg/dl (36 mmol/l).
If you have diabetes, your personal physician and other healthcare team members should teach you how to recognize and manage hypoglycemia. Immediate early stage treatment involves ingestion of glucose as the preferred treatment—15 to 20 grams. You can get glucose tablets or paste at your local pharmacy without a prescription. Other carbohydrates will also work: six fl oz (180 ml) sweetened fruit juice, 12 fl oz (360 ml) milk, four tsp (20 ml) table sugar mixed in water, four fl oz (120 ml) soda pop, candy, etc. Fifteen to 30 grams of glucose or other carbohydrate should do the trick. Hypoglycemic symptoms respond within 20 minutes.
If level of consciousness is diminished such that the person cannot safely swallow, he’ll need a glucagon injection. Non-medical people can be trained to give the injection under the skin or into a muscle. Ask your doctor if you’re at risk for severe hypoglycemia. If so, ask him for a prescription so you can get an emergency glucagon kit from a pharmacy.
Front cover of book
Diabetic Mediterranean Diet 
I regained my hypoglycemic awareness on a low-carb diet … ketones substitute for blood sugar so your brain can keep working
That’s great news, Jonathan.
Having had T1D for 50 years and eaten LCHF for 11 years, I’ve found that I can function minimally well at blood sugars less than 50 mg/dl and even below 40. Not that I would ever advise someone to allow that to happen. But I believe that the ketones in my brain keep it minimally functional at those low numbers.
Taking 15 to 20 grams of glucose is a common and even ‘official’ recommended remedy for hypoglycemia. However, from Dr Bernstein’s book, I found out that each gram of glucose raises my blood sugar about 4 mg/dl. Thus, if I had a reading of 65 mg/dl and took that much glucose, I would end up with a high blood sugar of 125 to 145 mg/dl. This of course assumes that whatever caused my low reading would not continue to lower my glucose level even more. But still, with good education and careful monitoring, smaller glucose doses can be used effectively.
Doc could you post something on gastroparesis, which I think is as important as hypoglycemia unawareness?
That’s very helpful information, Nate.
Here’s a little on gastroparesis:
https://diabeticmediterraneandiet.com/2010/06/23/difficulty-controlling-blood-sugar-consider-diabetic-gastroparesis/
If you’ve read Bernstein’s book, I probably don’t have anything to add. Drug therapies include metoclopramide (Reglan) and intravenous erythromycin. Some places are using gastric “pacemakers,” an electrical device that stimulates contraction of stomach muscles.