Hypoglycemia: What Do You Feel In Your Body? What Do You Feel In Your Mind?

This article was originally published in Diabetes Health in June, 2008.

Not much has changed about hypoglycemia or its treatment in the last 14 years. Am I right or wrong? For me, Learning all I can about Lows makes it easier to recognize and manage them (before I go too Low). I've used this article to help understand what I am feeling so I can recognize a Low early on! Please use the Comment feature below to share your experiences of success, or tell us about your worst Low, what happened and what you learned.

Editor-in-Chief, Scott King, after 34 years on insulin, and near his 51st birthday, April 9th 2008. Very happy to be here!

| May 1, 2008

A word of caution about the values used below. This study was conducted using people without diabetes.  Some people with diabetes experience symptoms at higher glucose levels than the study suggests. Other people with diabetes appear to function well with blood sugars in the 30's and 40's (mg/dl). Therefore, the values in the study should only be used as an approximation. This study also used plasma glucose levels. Your values done at home might be 20 percent lower or higher than these lab values. For example, epinephrine release in someone without diabetes would begin at about 63mg/dl with a home blood glucose meter.

More caution: Many people with long-standing type 1 diabetes completely lose some of these responses. The glucose counter-regulation system becomes impaired sometime during the first few years of diabetes. This impairment is unusual in that it seems to be hypoglycemia-specific: the ability of glucagon and epinephrine to respond to other stimuli is basically unchanged, but is reduced or absent when dealing with hypoglycemia. The cause of this is not known, but it is closely linked with the lack of insulin production.

HYPOGLYCEMIA, What Happens As Your Blood Glucose Levels Fall*:

at 69 mg/dl Epinephrine is released into the bloodstream
at 68 mg/dl Glucagon release begins
at 67 mg/dl The brain conserves glucose by reducing glucose uptake
at 66 mg/dl The body releases the growth hormone Somatotropin, which tells the body to reduce its use of glucose and burn fat instead
at 58 mg/dl Cortisol, a steroid that promotes the conversion of glycogen into glucose
at 54 mg/dl Full-on hypoglycemic body symptoms may start including shaking, pounding heart, nervousness, sweating, tingling and hunger
at 49 mg/dl Thinking becomes impaired. The Mind symptoms start: confusion, drowsiness, weakness, feeling too warm, difficulty speaking, impaired coordination and odd behavior

*Many type 1s don't have all these responses.

In this age of tight control, hypoglycemia has become a major concern for people with diabetes. How much do you really know about it? This article details symptoms, causes, and the body's responses to hypoglycemia. The more you know about hypoglycemia, its progression, and its causes, the more likely you will be to control or prevent it.

"I'm drenched in sweat and everything is getting on my nerves. My face feels tight and my lips feel numb. I know I should check my blood sugar, but I can't think well enough to get it together. Finally I get my finger stuck, my blood drop on the strip, wait... Blood sugar reads 40mg/dl. I eat 4 Dex4's and start to feel better in about 10 minutes. My health practitioner calls this hypoglycemia, but I call it pure hell."

I know many type 1's actually get used to this, and learn to feel, test and correct by eating very effectively. Others, like me, get the "Diabetic Werewolf Syndrome" where I have to keep eating everything in site until my blood glucose raises back up, usually about 20 or 30 minutes until we stop shaking. But of course every hypo can be different.  I have friends that can get quit querulous when they are low.  I have seen some skinny type 1's who, when low, may even "fight off" a husband who tries to get them to eat.  Many of us have spent our whole lives AVOIDING Sweets, so their subconscious eschews sweet even when low. Everyone had heard of some Low diabetic doing something REALLY wacky. Like running out to the parking lot at work and urinating while standing on the bosses car.  Can't you just hear him later, "Wow, I did that? Sorry Boss, I must have had a real bad Low!"

At some level, hypoglycemia as the ability to let our unconscious thoughts come out. Kind of like being drunk and doing something embarrassing you don't remember later. Has anyone here ever woke-up with  paramedic surrounding your bed asking you what day it is? Maybe yours was running naked our the front door one night mumbling something about the ice-cream man coming? This can happen to anyone as it is really very easy to et too much insulin.

No one has to tell most people with diabetes that low blood sugar or hypoglycemia is one of the most common and potentially dangerous problems of diabetes. Mild hypoglycemia is annoying and embarrassing; severe episodes can lead to brain damage, seizure, coma, or, even death.

Although the famous 1993 DCCT study showed conclusively that reducing blood glucose levels also reduces long-term diabetes complications, it also found that people who keep their blood sugars close to the normal range have a three times greater chance of hypoglycemia. Some of the 27 centers involved in the DCCT were able to achieve nearly normal average blood sugar readings with very little hypoglycemia. However, a significant risk remains when tight control is attempted.

Hypoglycemia is dangerous because it impacts the brain or nerve center, which derives almost all of its energy from glucose. The brain depends on the bloodstream for a continuous supply of glucose because it can only store a few minutes' worth of energy as glycogen. Any change in blood glucose levels can quickly and seriously affect thinking and coordination.

Hypoglycemia can usually be detected by the brain, but the brain relies heavily on warning signals generated by the central nervous system as the blood sugar drops. Signals like sweating and shaking are produced by the release of stress hormones in a process called glucose counter-regulation. This release starts the slow return of the blood sugar to the normal range. The liver, interestingly, is directly involved as well in sensing and correcting low blood sugars.  Remember that some type 1s lose this response (the body's own ability to raise BG's) altogether over the years.

Non-diabetics can count on the body's backup systems for raising a low blood sugar. In a research paper done by Dr. Philip Cryer at the Washington University School of Medicine, these recovery systems were outlined in non-diabetic volunteers. Physical responses that generate recovery are triggered at different glucose levels.

The first response, which occurs at around 83 mg/dl, is a reduction of insulin production, while the second, the release of epinephrine into the bloodstream, begins at 69 mg/dl, but plays a minor role unless the supply of glucagon becomes deficient. Glucagon release begins at 68 mg/dl, followed at 67 mg/dl by a reduced glucose uptake into the brain. And at 66 mg/dl, the body releases the growth hormone somatotropin, which tells the body to reduce its use of glucose (so this defense mechanism is trying to keep us form going too Low).  Somatotropin also tells the body to increase the use of fats as fuel.

As the blood glucose level reaches 58 mg/dl, cortisol, a steroid that promotes the conversion of glycogen into glucose, is released to assist in raising the body's glucose levels. For these test subjects, when the glucose level fell to 54 mg/dl, the body's hypoglycemic symptoms started. At 49 mg/dl thinking becomes impaired, as now the brain is low on glucose too.

Long term type 1s who lack a good epinephrine and glucagon response, are 25 times more likely to experience severe hypoglycemia than those who respond normally.

Two types of symptoms are associated with hypoglycemia: neurogenic (body) symptoms, which originate in the nervous system, affect the body, and are usually noticed by the person with diabetes himself; and neuroglycopenic (mind) symptoms, which affect the mind. The latter are a direct result of glucose deprivation in the brain, and are frequently noticed by others but not by the person with diabetes.

In the controlled study of non-diabetics, the neurogenic symptoms occur at around 54 mg/dl and include shaking, pounding heart, nervousness, sweating, tingling, and hunger, while the neuroglycopenic symptoms which occur at 49 mg/dl are confusion, drowsiness, weakness, feeling too warm, difficulty speaking, impaired coordination, and odd behavior (and, of course, coma, seizures, and death).

Risk Factors for Hypoglycemia:

1-an excessive insulin in the blood (due to either high injected dosage or missed meals),

2-an increase in the use of insulin (as seen during exercise),

3-a decrease in glucose production (as occurs after drinking alcohol), or

4-an increase in insulin sensitivity (also seen during exercise).

5-a history of severe hypoglycemia,

6-having type 1 diabetes for over 9 to 12 years,

7-any lowering of HbA1c levels, and

8-an increase in your insulin dose.

9-Any hypoglycemia can impair the body's detection of hypoglycemia for up to 3 days. This means glucose levels must go even lower to produce hypoglycemic symptoms and activate glucose counter-response after any hypoglycemia.

Hypoglycemia unawareness, the clinical condition in which people no longer experience the neurogenic symptoms of low blood sugars, affects many people with type I diabetes and a few with type 2. The glucose levels needed to trigger glucose counter-response are lower in people with hypoglycemia unawareness and the first symptoms they usually experience are neuroglycopenic, a sign of blood sugars of 49 mg/dl or less.

Recent studies indicate that avoiding hypoglycemia for a period of time as short as a few weeks may reverse hypoglycemia unawareness. (See the Uncomplicating Column in the March, 1994, issue of Diabetes Health.) People who suffer from hypoglycemia unawareness should monitor their blood sugar levels very closely. Hypoglycemia unawareness itself increases the risk for hypoglycemia by seven times.

Hypoglycemia is dangerous. As a complication of diabetes, it is perhaps the most easily treated, but can also be the most immediately dangerous. Awareness of the signs, symptoms, and risks of hypoglycemia, and diligent monitoring of blood sugars allows hypoglycemia to be controlled and even avoided. This can be vital, because like many things about diabetes, hypoglycemia is a self-perpetuating problem.

This article was refined from a review article called "Hypoglycemia" which appeared in the July, 1994 issue of Diabetes Care.

Please join me below in the Comment section! Share your experiences of hypo success, or tell us about your worst low, what happened and what you learned.

— Scott King, Editor-in-Chief, 34 years on insulin

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Posted by ngallagher on 1 May 2008

Interesting read. I think once people become adapted to a ketogenic diet and the brain switches over to ketone metabolism as its primary fuel source in lieu of sugar, many of the side effects of hypoglycemia are circumvented e.g. cerebral dysfunction/impairment.

Posted by Anonymous on 1 May 2008

Interesting article. I consider readings in the 60s as good, and it is amazing I have any brain cells left. I've had enough 'worst' lows to not be able to pick one and thankfully none have been lately where I've needed outside assistance or a glucagon shot. I can be fully functioning (if not a bit slower) at glucose readings in the 30s. Since I rarely, if ever, have any neurogenic symptoms any more, I've been working really hard to 'retrain' myself to recognize the little glimpses of neuroglycopenic (love that word - new to me), and make myself test immediately. Then I have to make myself eat something immediately even though of course I'm not hungry at that point. It's an interesting having to train myself to respond to lows.

Posted by Anonymous on 2 May 2008

Several comments. It is entirely true that some people can function quite well at measured blood glucose levels in the 30s mg/dl or lower -- I'm one of them sometimes. You don't say anything about the speed at which blood sugar is falling -- in my experience this has a dramatic impact on whether or not symptoms are consciously experienced. Almost all my really bad hypos have occurred when almost totally inactive -- taking a nap, asleep, or sitting quietly in a meeting, an office, or the back of a car. If I'm active, I almost always feel some kind of symptom before I start to lose it -- but if I'm inactive, I tend to be wholly uncooperative with those trying to help me and often belligerently a refusenik. Lastly, there are some neat training programs to get one more aware of symptoms -- characterizing them, and then recording what symptoms are experienced at different glucose levels. I got one from a doctor, basically instructions, lists of typical symptoms, and PDF templates for keeping records: you would do a service if you were to publish one of them.

Last point: hypoglycemia can be dangerous not only to you, but to others -- e.g. if you are driving. Insulin users have a real obligation to work at awareness and knowing what to do.

Posted by merileek on 2 May 2008

Dynamite article. Much needed. Thanks for this valuable information, Scott.

Next, while the counter-regs may stay in the system for 2 - 3 days, I'd like to see an article with the medical info of the, after a hypoglycemic episode, the time (hours after) at which the counter-reg is released.

In my case, I get the hypo, treat it and am fine for a few hours. Some 4 -5 - 6 hours later, BG rises, I'm sure due to these "rebounds."

Thanks, again,


Posted by Anonymous on 2 May 2008

I have had type 1 diabetes for thirty nine years. I have no hypo symptoms. This is a real pain for me and my friends and family.

Posted by Anonymous on 2 May 2008

Great article and review. Hypo symptoms change with the type of insulin treatment used. In my case, T1 for 38+ years, I found that NPH/Actrapid combination is deadly in terms of the speed Hypos take once BG goes under 60 especially at night (4-6 am)or exercising.At least in my case.
Currently I am on Lantus/Humalog and I find that some of the symptoms that I used to recognize as Hypo are no longer there, since it happens at a slower pace once Lantus takes over. Even at night a low of 60 results in awakening, having had a single episode of really low BG requiring Glucagon injection since I started this type of treatment. But I am firmly convinced that Hypo symptoms really are very particular to each individual and Diabetics should take the time to reflect on synptoms once BG is at a safe level in order to recognize the next one that will surely come.

Fernando Faria -Portugal

Posted by Anonymous on 2 May 2008

"Bottoming out" is what I call it and dread it, it feels so miserable! As a new diabetic, I am learning when I can expect it, and I need to stay alert, because if I feel good, I may get busy and forget to watch the signs.
One thing I have learned is to strive for MODERATION. When recovering from low sugar ( say 50) -- the tendency is to overdo, eat too much, anything to get rid of the horrid symptoms. Then I go too high. Yo-yoing is no fun either. And the symptoms of up-sugar and down-sugar become interchangeable and garbled. I think --- what do I know! --- that discomfort is maximum when there is change of ststus, whether it's moving up OR down.
Bottom line is: know yourself!

Posted by Seymour on 2 May 2008

Not wishing anyone bad luck, but I am glad to hear that I am not the only one who cannot tell when the ole sugar is low. I don't recognize any of the standard signals - sometimes I get a cold feeling in the pit of my stomach. That is about it and I can get to the 29-30-31 level and still feel normal.

I also have the most trouble when completely inactive to the point that I get up every 3.5 hours during the night and check my suger. Fortunately my wife has learned most of my external signals and can convince me to drink a soda. She is the only reason I am still on this earth.

Posted by Anonymous on 2 May 2008

When my sugar rises due to excitement ( positive stress --- I teach college level-- and love my job) it goes into the 300's. I used to worry about that -- but within an hour or two as I drive home and "decompress" it comes down some 100 points.
I can also "walk-off" 100 points, much of the time. But not always!
A high reading due to a pig-out (new definition of pigout: a slice of white bread vs. the usual 7-grain) cannot be walked off -- maybe 10-20 points at most.
So, the bottom line FOR ME is that not all highs are equal, just as no carbs are equal.
My doctor says "a carb is a carb is a carb" That is simply not so!

Posted by kchinoy on 2 May 2008

My diabetic son, a 10year old, has had multiple hypos since (2yrs)the time he's been diagnosed. Inspite of a very low BG level(40mg), still retains consiousness to the extent that he is easily able to walk over to me or if in school stays in control till he is home. Ofcourse, due to his tendency of recognizing his hypos, specially during school hours, hangs on to his snickers bar. But many times he comes home with 40mg/dl to 60mg/dl with full conciousness. In my opinon the lows effect greatly on a child's normal ability to grow, i wonder if same applies for highs as well???? Therefore, i feel every child or an adult responds differently to type1 diabetes. So far we as a team are able to deal with pros and cons of my son's diabetes,knowing he is an active, sporty child with no regrets for being diabetic, a very important and positive aspect in him. hope to have a smooth journey in future as well....AMEN

Posted by Anonymous on 4 May 2008

You said you thought things hadn't changed much since the article was written in the early nineties. I think one big change is the advent of very fast acting insulins like Novolog. The relevance of this is that a mistake in insulin (especially the very occasional whopper like accidentally taking fast acting instead of long acting) hits you much, much faster -- sometimes so fast there is almost no time to read the signs even if you're having them. And if you've made the switcheroo mistake, not only does the blood sugar drop fast, it keeps dropping very rapidly until you can counteract it with enough sugar. That means that the classic "four ounces of juice" and wait 20 minutes may be very dangerous. By the time the waiting period is up, the blood sugar may have dropped enough further than you are no longer coherent enough to realize there is a problem, let alone act on it. At that point you have to hope you have a family member who recognizes what is happening and can convince you to down some more sugar, or can administer Glucagon, or can call an ambulance. We've had a few episodes like this (we're VERY careful but a half a moments distraction is enough) and they are completely unlike anything that happened when regular was the only fast acting insulin. And we don't have a problem with hypoglycemic unawareness, it's just that these hit so fast and hard that they're a completely different animal. Don't get me wrong, the newer insulins are a real improvement but they do come with their own downsides.

Our doctor didn't discuss the impact on the speed with which insulin error lows hit when he switched us to Novolog. I think it is an issue that should be raised by docs so that patients are equipped to deal with them.

Posted by Anonymous on 9 May 2008

Ugh! Lows... I have so much trouble with them! I exercise a LOT- I run a couple miles every day and play basketball and soccer after school for a while- and it makes my sugar drop fast. I sometimes don't realize it, and I can be in the 30s and notice anything is wrong.

Posted by Anonymous on 9 May 2008

As a Type 1 diabetic for 45 years and given my very tight glucose control (keeping the A1C at 5.5 or so) it is not surprising that I often experience hypoglycemic unawareness. This had led to a series of 911 calls every 2-3 months that not only were harmful to me but placed an undue burden on colleagues and my better half. There is a clear palliative for these hypoglycemic events: a continuous glucose monitor which yields a glucose reading every 5 minutes. I use the Dexcom Seven system and am elated with its results. I monitor its glucose chart about every 15 minutes noting the glucose trends. And it has an effective warning system for both hyper- and hypoglycemic conditions. I know that it has prevented more than one 911 call. Major health plans will cover it with sufficient cajoling from your medical doctor. Its effect on reducing "hypoglycedmic stress" (fear that it will occur) while traveling or when driving is immeasurable.

Posted by Anonymous on 10 May 2008

Just wanted to commit about mixing up insulins. I know longer have that mistake as I use Lantus that I draw up myself for my long acting. And then fast acting before meals insulin, I ue the Novolog pen. Haven't confused the two since then. Been using the pen for close to 10 years now. PS I have been insulin dependent diabetic since I was 21 years old. Now 56. Everyone that has posted makes alot of sense. So much of what we as diabetics have learned, many have done it on our own. Keep up the good work folks. Too Sweet Sue

Posted by Anonymous on 11 May 2008

Would some body tell me that the vomitting tendency is the symptom of hypo.

Jacob Gomes

Posted by Anonymous on 11 May 2008

Scott--I love you! In the early 90s when your mag came out I read with glee your description of pigging out--"eat till you're back"--when you've been low. Isn't that the best "snack" ever? Chomp down on the whole fridge!
I'm very interested in these "how YOU feel" articles. I was a counselor at diabetic camp in 1989. Noticed that kids would "turn inward" when low--eyes down, very private when juicing up--except the occasional kooky kid who'd fight or argue "no REALLY--I'm fine!"
As a 42-year Type I (age 52) I have a lot of memories:
1) waking up crawling down the hall, couldn't make my body move right--1984
2) coming to at a hosp., realizing it wasn't a dream as I read signs on the wall--1985
3) living alone--alarm been ringing for an hour--body not moving right--realizing I was gonna die unless I could make my body work to fix up glucagon--1987
4) on a canoe--running out of M&Ms--boyfriend screaming "**it, why can't you just drink sugar water?" (like there's sugar water in the boat). It is with a demonic glee that I report that he's Type II now--there is justice in the world)--mid 1970s
5) another boyfriend's 3 yr. old daughter throwing a fit 'cuz I won't share my candy (he acts like I'm selfish). Another time he visits me in hosp. with DKA and says "you're the sickest girl I've ever known." --late 1970s
6) in a car w/ a new acquaintance and heavy drinking. I wake up and the highway signs are all wrong. I ask "are you sure you know where you're going?" And try to tell her it's a conspiracy. She realizes something's up and buys me a burger, but not a coke. Later she says "I knew sugar's bad for you, so I got the burger."--1986
7) Now with my wonderful-beyond-words husband of 20 years: a. he says "get up and test," then hears "thunk" on the floor. b. he swings my legs around to sit me up and my legs stay rigid. c. my heated mattress pad is shocking me 'cuz I'm so sweaty d. he puts me naked and freezing in a hot bath (that's every time I get that low) e. I wake up and he's screaming at me over and over "drink it." Later I tell him "just don't be so mean." He tells me screaming is the only thing that keeps me conscious. f. I continuously bite the glass of juice. g. with gastroparesis, I drink so much juice, yet stay low, that I open my mouth and juice pours out. h. in the car, eating the molasses candy treats my cows had been licking on at a cattle show--hey, I was glad to have it! i. last week at the diet doctor's ofc--the recpt. is trying to help me--showing the display of foods to buy. "Here, this one tastes good." I check the labels: 4 carbs, 2 carbs, etc. Finally, she shows me the coke machine i. here's a good one--used a jet injector for few years in the 1990s. Spent all night visiting the vending area in a motel. Next day I discover white flakes in my insulin bottle--I'd been concentrating the insulin keeping it connected to the injector, letting air in.
Hey, but I'm still here! Dottie Love

Posted by Anonymous on 16 May 2008

I am a new (one year) diabetic -- but grandfather died of complications at 48 (long ago and far away) and mother at 76 (blind/heart problem).
I fear lows --- mine start around 135 -- and feel miserable. Really bad. So I stoke up at night and try to stay in the 200, which will leave me in a comfortable range in the morning.
I only take Lantus (I am I and II --- and I don't think they really know which and what and if and why) and eat very carefully.
Reading your input heartens me --- we all need to be awake and alert --- nobody else can be responsible.
My "discomfort" symptoms are much the same going UP or DOWN. Please respond to this ---
RID OF IT ---????????????????????

Posted by Anonymous on 19 May 2008

I have had MANY lows over the past 8 years as a type I diabetic (i was diagnosed at 10 yrs old). Mostly at night when I was younger, occassionally ending with the paramedics standing over me asking,"Who's the president of the U.S.?" Since switching to the pump i have had less at night, but many many more throughout the day. Often they occur a few hours after eating, and I usually catch the tingling lips, dizziness, inadequate mental power, and sudden inability to walk straight. I often make very stupid decisions when low, often getting very excited and animated in my voice. I do wild and crazy things that I don't normally do, and I feel bad after I am treated.

Posted by Anonymous on 19 May 2008

My 27 year old son has had two major lows (not to mention several other seizures that weren't as catastrophic just because someone happened to be with him) and both times has come close to dying. The last time was on a running trail, on a 10-mile run. He passed out and it was hours before he was found by a park ranger, after dark. He HAD eaten breakfast, taken a pack with glucose tabs and his tester and was testing. It showed "error" so he didn't know that the reason it said that was because he was so low it couldn't even read it!). He couldn't remember where we lived and who we are (his parents!) and then was so angry, confused and argumentative when we finally got to the hospital they'd taken him to in the middle of the night. Had he not been found, he well could have died. He had no recollection of how he got to the ER or who found him. Of course, we were the ones most scared, because the next morning he couldn't recall one thing the doc said to him -nor could he recall we had even been there. The confusion lasted for days, not to mention the enormous blow his head took when all 6'5" and 250 pounds of him (former college football scholarship athlete) hit the ground. This is a terrible nightmare and I fear one day this will happen and it will be too late. His warning signs just don't happen; he was in the teens (bg) when he went down, the doc said.
So much focus has been placed on keeping those a1c's so low that when he had gone to see the endocrinologist(s) in the past, they basically praised him for being lower than even the average non-diabetic person and sent him out the door with his meds and a substantial bill. It made him come to the conclusion that he was doing "everything right". Of course, this "hypo" problem is every bit as dangerous and being too high.
As his doc in the ER told us, his organs won't be damaged, but if this keeps up he will make an excellent organ donor. When we go for a few days and I don't hear from him I sometimes am on the verge of panic. He was not diagnosed till age 22 and it has been a rough five years. This is a condition that affects everyone, not just the diabetic. I think docs really need to address this more and stress the dangers and importance more with their patients.

Posted by Anonymous on 19 May 2008

The extent of my knowledge for this disease went as far as an injection in the morning and no sweets. (Heard Mary Tyler Moore say that once on TV). So, when my fiance told me he was diabetic when we first dated, I didn't think too much of it. Years went by without incident only that occassionaly his doctor changed his medication and prescribed more insulin a day. Then out of the blue one day as we were on a long stretch of highway (thank God I was driving), he began to behave oddly. Complaining of claustrophobia and trying to tear at his clothes and seatbelt and basically behaving like a child with a tantrum. I pulled into a reststop and began yelling at him and managed to get him inside for a bite to eat so we could both cool down. It was then that I noticed something was not right when he began pointing at the pictures of food on the menu in admiration of the colors. That was my first encouter with hypo and there have been many more since then and scarier. I have noticed that Novolog at 30 units before breakfast doesn't do a thing for him regardless of what he eats. He tests just before lunch (1PM)and his number is high (300+). He then eats and takes 8 units of Lantus and only then does it drop dramatically and rapidly. By 4PM he is low (70). We have since learned to adjust his medication but he still experiences hypo more often now than ever before. This is an illness that never takes "time out".

Posted by cgentry@dirtware.net on 24 May 2008

Have been reading with interest, until things started getting blurry. Hmm checked BG over 400.Took prednisone Th.+ given /c infusion Fri.Also experience lows at night, wake shaking,drenched,usually in the 60s.And I am a type 2 on Lantus & Novolg. Good luck All!

Posted by luveggies on 30 May 2008

There is a free program on the internet for people who are struggling with hypoglycemia unawareness. The program is called blood glucose awareness training.

Posted by cucey859 on 4 June 2008

when i used to live in medford,oregon. i started experiencing symptoms of hypogycemia,but i didn't know it at the time, because i wasn't diagnosed with diabetes yet. i thought that all of my seizures were caused by my epilepsy, and not my diabetes. i also thought that the reason that i wet my pants a lot was because i drank a lot of liquids, but both of these incidents would happen when i would be skipping a meal, and my blood sugar was down. i now try to control my blood sugar, and eat regular meals. i am too afraid of having another seizure, or wetting my pants again.

Posted by Anonymous on 4 June 2008

I just found this site..thank heaven I did!
I have learned alot from your experiences..share many of the same...Thanks!
I agree low blood sugars are hell on earth...I have been type 1 diabetic 30+ years..over half my life and never had an accident driving. I recently had a car accident with a low blood sugar...checked and it was normal when I left work, it was storming out and tornadoes had been spotted in the area...and by the time I got close to home my blood sugar was dropping. I downed the Mt. Dew I had in the car, and thought I could make it the 2 blocks to home where I would be safe from the storm, and could eat supper. Didn't make it...came up to a stop light with 2 cars sitting there...no brake lights showing..the light was green but they hadn't moved yet. I slowly slid into the car in front of me, which slid into the car in front of it....and then my BS really took a dive. I did not get a ticket, but have since gotten notice I have to retake my driver's written and driving test in 2 weeks. Following up I found out it is due to me being diabetic and admitting I was stressed and my BS was dropping.
I hope this doesn't happen to you!
I am not registered, cuz I was reading this, got to this point, and had to comment. My name is Jane....and would so love to hear from you....take care....

Posted by Doreen Taylor on 5 June 2008

Diagnosed at age 10 and having Type 1 for 33 years now,(I'm tied with Scott King) I have had many hypoglycemia episodes. My last A1C was 5.4 and my PCP is having a fit. But my biggest fear is to develop a complication. I like being able to see and not have to go to dialysis 3x a week. People do not understand this. I would much rather have a low blood sugar than develop a complication.I developed hypoglycemia unawareness about 26 years into the disease. There are several episodes that I can recall or remember having been told what I did after the fact. 1)Driving down the road not sure where I was and stopping at a store because I had to use the restroom. I wasn't walking straight and the clerk said to me are you OK? I said I think my sugar is low. 2)playing football with my nephew then going in my parents house, not talking or answering questions, then coming around with an IV in my arm after they called an ambulance 3)sitting in the middle of my bedroom floor yelling"get away from me aliens" and having a Glucagon injection from husband. 4) spitting a soda/glucose gel out at my husband. 5)having to get out of bed to change the sheets then shaking for an hour because I couldn't get warm 6)hitting my husband, pulling away, getting Glucagon needle in my arm 3x because I kept pulling away and he finally had to sit on me 7)going to my sisters house 10 minutes away and not bringing my meter,then driving home I took a left instead of a right and you could see the mailbox I hit, my tracks in the gravel several times, then the tree I hit. Of course I wasn't wearing my seatbelt because of lack of judgement and after I hit the tree I was in the passenger side of the car and I couldn't move because my arm was broken. The paramedic said are you OK? I said I think my blood sugar is low. Those are a few of my experiences. The important lessons from these are 1) wear ID bracelet with alert of diabetes 2) check your blood sugar before you do anything that might involve the lives of other people.It's really ironic that my husband can look at me and tell me my blood sugar is low before I can tell.He has saved my life more times than I want to recall. I have not had a severe low for almost a year now because of the sensor I have with my insulin pump. So 34 years this October, here we go.P.S. I just got diagnosed with celiac disease too!Bring it on.

Posted by Anonymous on 12 June 2008

Wow...it was great to find this site. I am a 30 year old 5'2 100 lb female who was diagnosed with type 2 diabetes about a year ago. At the time of diagnosis my blood sugar was 357. I was immediately put on metformin, given some information packets and a meter and sent on my way. After about 6 months I started experiencing "lows" (in the 60s) complete with shaking, dizziness, studdering, and being disoriented-which is great being a school teacher surrounded by confused 10 year olds). I started seeing a new doctor who took me off metformin, thinking my previous docs made the decision to put me on it hastily. This helped greatly until the last couple weeks. I have had a few more low episodes (61-66)and they scare me half to death. I am so afraid of passing out, and I hate that out-of-control shaky feeling like I'm losing my mind! Not that I wish anyone harm, but it really is good to hear of other people going "crazier" than I do. I don't know if my episodes will progress, I'm just beginning to research "lows", but it is comforting to know people have been a lot worse off than I have and they are still alive!! What a great site! Thank you so much!

Posted by Trekker on 8 July 2008

I just read the Hypo article with great interest as I have been hypo unaware for a very long time. Actually I am also hyper unaware also unless my reading is about 450, which very seldom happens.
I have lived with type 1 for 46 years and my very serious hypos are numerous right from the beginning of my dx date.

To be cont. (want to see if my user name and pw will be accepted as I've had it since this was Diabetes Interview)

Posted by Trekker on 8 July 2008

Cool, it did accept my ID.

If it weren't for my husband, I know that I would have died years ago from hypoglycemia. There have only been three times that he hasn't been able to bring me out of a serious hypo and the first two were early in our marriage, before he became so experienced with my diabetes. Hey, he still loves me even after years of calling him names, shouting he was trying to kill me, biting his fingers, and punching him, all because he was putting sugar or glucose in my mouth. Long, long ago he gave up on juice or soda as I'd dribble or spit it out. Yes, I still try to spit the sugar out, but most stays in dissolving quickly. I lost my glucose counter-regulation system so long ago I cannot even recall those days before. I used to be afraid to get up in front of people, but no longer have that fear as I don't believe that my adrenaline responds as it once did.

FOR ME, I don't believe that what Scott mentioned...."Recent studies indicate that avoiding hypoglycemia for as little as a few weeks may reverse hypoglycemia unawareness." I know I've gone over a month without a serious low and then all of a sudden, WHAM.

The lowest that I've known I've been was right after my daughter was born. My BG was 20, not on a meter, but a lab test, and I was very aware. Once when I was out hiking my meter showed 22, but I felt just fine, I did quickly eat something. My husband and I do a lot of hiking since semi-retirement, keeps us both in shape.

I gave up driving when alone and thankfully never had an accident due to a low.
Years ago I discovered that stress makes my BG drop rather than go high.

Great discussion, thanks for all your input.

Posted by Anonymous on 10 July 2008

For the person who posted "
Anonymous on 12 June 2008

Wow...it was great to find this site. I am a 30 year old 5'2 100 lb female who was diagnosed with type 2 diabetes about a year ago....

I read your response with interest. You may want to talk to your doctor about whether you are a Type II or someone with Adult Onset Type I (sometimes referred to as Type 1.5). Like you, I was in my 30s and slim at diagnosis. I responded to meds initially but not well. I never fit the typical profile of a Type II. I was rediagnosed as a Type 1.5.

Posted by walkercj on 10 July 2008

I am a 19year-old granddaughter to an amazing grandfather,Robert, and after reading this article, I listened to his story. I ask that you please take a few moments to read about his devastating hypoglycemic reaction. Thank you so much.

On June 12th, I had the opportunity to hear a story not many have heard, and even fewer have experienced. I heard the story of a seventy year old male who had been diagnosed with Type One Diabetes since the age of eighteen; this man was my grandfather. Visiting my grandparents on this day, I had read the article discussing Hypoglycemia, in Diabetes Health Magazine, and was taken back by such an unimaginable condition. Intrigued by the article, I sat anxiously in silence on my grandparents chair; then my grandfather began to speak; and this was his story.
It all began in 1955. My grandfather, Robert Hartman, had just begun his professional baseball career; yes, at the age of seventeen. As time passed by, all seemed well until Robert experienced a fifty-pound weight-loss, and began having excessive eating and drinking sensations in the Spring of 1956. These symptoms led to the conclusion that Robert was now a victim to Type One Diabetes.
This was a bump in the road, but it did not stop him from pursuing his dream of playing in the major leagues. Keeping track of his eating habits and insulin shots everyday, Robert made an impeccable season in 1958 by winning 20 games in the AA Southern Association. He was now primed to be a big league left-hand pitcher. Bob’s diabetic specialists were located in Boston; however, seeing as though he lived in Kenosha, WI, he saw a local doctor as well. It was in November of 1959, that his local doctor decided to change his current insulin(NPH), to Protamine Zinc insulin(4-6units). My grandfather stated, “I would test before bed, and in the morning; and the urine test showed I was fine. I also had weekly blood tests at the hospital, showing I was fine.” Feeling great, Bob continued to physically prepare for spring training. Meanwhile, he fell in love with a woman, Audrey. They wed in February of 1959, and are still inseparable to this day. Now nearing the end of February, it was time for Bob to head for spring training; which soon, would be a forgotten memory.
“He was believed to have been in a diabetic shock for six months,” my grandmother said. Then Bob chimed in, “I’ll put it how I remember it. Unknown to my diabetic specialists doctors, my local doctor in my home town decided to switch my insulin to a different type of insulin that had caused me to have low blood sugars throughout many evenings when I was sleeping, and I would wake up in the morning and feel fine. Slight hypoglycemic conditions I was unaware of.” Due to the switching of his insulin, my grandfather experienced subtle hypoglycemic reactions during the night, for nearly six months. “I assumed everything was alright; I was feeling physically fine, and pitching and playing baseball very well. I had earned a spot on the starting pitching rotation for a major league team,” he said. Prepared to begin his season as a starting major-league pitcher, Bob was disappointed that his first game was rained out; little did he know, this would be his last memory of spring training.
“I don’t remember anything really about spring training but what I’ve heard, and what was told to me by Audrey or someone else. It effected my baseball career by having this hypoglycemic condition, it effected my memory and I had no control over it, because of the type of insulin I had been switched to by my hometown doctor without talking to the Boston specialists; they said he never should have done that,” is what he told me. During his stay in Pittsburgh, impatiently awaiting for the rain to stop so he could finally get a chance to play, my grandfather went into an insulin shock, and completely lost his memory. “It was a complete loss of memory; like a state of amnesia,” he claimed. He was then flown to a Milwaukee Hospital, accompanied by the team trainer. Audrey said, “I can remember it like today, the coarse of events of when that plane landed, and having to stand there, and your [Bob‘s] brother was with me and he held my arm and kept saying, you cant go to him, he has to come to you. And I kept thinking, what if he walks right by me? I remember exactly what you said when you came up to me; you hugged me very tight, cried on my shoulder and said, Audrey please don’t leave me, please don’t leave.” Bob expressed that “it took two months of intensive care and rehab with my diabetes to be able to continue pitching or playing pro baseball.” Audrey claimed she had “never seen so many doctors come in and see a patient in my entire life; about ten doctors.” Not only was this an incredible incident, but what was even more amazing, was that Bob did not give up.
Gaining his strength back, he continued to play baseball. It was off to Louisville, winning ten games, and only losing three, in AAA ball. Seemed astonishing to have such a comeback. Bob was always sent to the minor leagues because of his previous condition. Then he was sold to the Cleveland Indians. “They gave up on me quickly, even though I had two successful games against Detroit and Chicago. I was given only a brief opportunity to pitch in the major leagues because of this thing happening to me, that caused ownership and management to be doubtful and skeptical of me and my diabetes. One thing can change a career, and it just happens to be a disease that I can still talk about 52yrs later; but the confidence that was lost in me, and the disease of diabetes by the upper echelons, just turned my career around that no matter how good I did later, it always reverted back to when I had that severe insulin shock, and I was never able to recover in their eyes from that again,” Bob said. He expressed that, “the most frustrating thing is that what happened to me from November to April…it has dictated my whole life.” And as Audrey puts it, “it goes back to what if?”

Posted by Anonymous on 14 July 2008

I don't know if I have Type2 diabetes, however I do experience hypoglycemic symptoms from time to time.

So I can definitely say I know what the phrase 'Hypoglycemic Werewolf Syndrome' means.

There have been times when I have been ravenously hungry and sense that my blood sugar is low and end up raiding the fridge or the cupboard for whatever I can get my hands on (and as much of it as I can get!) It's that sense of 'I MUST HAVE FOOD - NOW!'

There have been times too, when I've felt my blood sugar low and I start to get hungry, I get rather irritable. If I'm waiting in line in a fast-food restaurant or a take-out, I get antsy, because it's like the wait staff can't get my food quickly enough. Seconds seem like minutes in situations like these.

If my blood sugar really gets low, I feel much worse. My brain feels pickled, like I'm on something. Tend to feel a bit out of it, and a little woozy. To say nothing of just plain weird. I can't think clearly, can't concentrate and can't really do much. All too often the low blood sugar triggers huge anxiety which turns into a panic attack and then the feeling I'm going to die is quite prominent.

Not fun. It really, really sucks. And my doctor doesn't think I really have hypoglycemia. According to him, I either have diabetes or I don't. No in-between exists for him.

Fortunately, consuming any sugar or fast-acting carbs with some protein will set me right in about 20 minutes.

I usually take a snack with me wherever I go because I am deathly afraid of experiencing low blood sugar and not being able to get to a source of food quickly.

I know that consuming the snack will buy me at least an hour's time to find a more substantial meal.

One thing I find is really helping me lately is increasing the amount of protein in my diet.

For instance, I'll have half a cup of All-Bran cereal at breakfast with two slices of toasted multigrain bread, a little butter and two hard-boiled eggs with a small piece of ham or two strips of bacon.

A meal like that really stays with me and seems to smooth out the blood sugar levels. If I eat that way I feel much more comfortable - and calmer, too.

Posted by Trekker on 18 July 2008

CJ, I really appreciated your story regarding your grandfather and all he went through because of hypos. He sure had a promising major league career squelched due his lows. What a shame and mainly due to an ignorant doctor.

When I was diagnosed I was placed on PZI (Protamine Zink Insulin) insulin. I became allergic to the protamine, was placed on another insulin and never had the problems I had with it again.

I think it would be great if Diabetes Health would do an interview with your Granddad for the magazine. I know many people would find it very interesting. I noticed that there were two baseball cards done for Bob Hartman. perhaps DH could get one, the one that mentions his diabetes on the flip side of the card and use it in the article.

What do you say Scott.......go for it. A great diabetes human interest story.

Posted by Anonymous on 25 July 2008

I used feel as I am healthy man upto the age of 47. One night, i got itching sensation all over my body. I felt drowsiness, shaking, trembling. It became hard to breath, somepain in heart as it is pulling down and felt unconsious. My wife brought a doctor immediately. After revival, i could not understand why it happened. On the next day, I could able to find by blood test that I got "hypoglycemia"

Posted by Anonymous on 28 August 2008

I have a nine year old son that I have been taking to the doctor for almost five years for what I am finding out, is symptoms of hypoglycemia. He has almost all of the symptoms. I was able to get the doctors to do a fasting test on him one time and he was 84. He is getting worse. What can I try to do with him. We are to the point that I don't know what else to do because I don't understand it, and I can't get his doctors to help us. I have been testing him on my own and he will go from 164 to 94 in 35 minutes. Is that normal?
Please help us. Thank you

Posted by maryellen on 7 September 2008

I am so relieved to find you guys. Type 1 for 43+ years and have had intense lows from the start. Woke up from night lows until after daughter was born; recovery from viruses have consistently produced unexpected and erratic lows. Menopause, and a growing list of allergies and illnesses of unknown origin and etiology have made control of blood sugar and lows very difficult. I have found that a week without lows sometimes allows return of symptoms, altho the symptoms and intensity vary. Am very happy to find out about the continuous monitoring options, and to find others who know what this is like. I am also married to a wonderful person who has saved me more than once, can recognize low symptoms when I don't, even over the phone, and has called 911, and retrieved me from the emergency room. I am very grateful and happy to be alive. Wish balance wasn't so hard/complex.

Posted by maryellen on 7 September 2008

my daughter was/is mildly hypoglycemic (and during her pregnancy was diagnosed with gestational diabetes). She is now considered borderline diabetic. Anyway, when she was young, the nurse practioner we were seeing told us to try 6 small meals a day with minimal sweets and processed foods. complex or long chained carbohydrates such as multi grained (chunky) breads and crackers combined with cheese, nut butters, small amounts of candy if it contained nuts or peanut butter, and lots of vegetables, fruits and nuts, meat. This worked for my daughter. Don't know about the numbers. think this is difficult to diagnose. Might want to try a different doctor...maybe an endocrinologist or pediatrician who works with diabetic children. be calm and don't give up.

Posted by maryellen on 7 September 2008

I am so relieved to find you guys. Type 1 for 43+ years and have had intense lows from the start. Woke up from night lows until after daughter was born; recovery from viruses have consistently produced unexpected and erratic lows. Menopause, and a growing list of allergies and illnesses of unknown origin and etiology have made control of blood sugar and lows very difficult. I have found that a week without lows sometimes allows return of symptoms, altho the symptoms and intensity vary. Am very happy to find out about the continuous monitoring options, and to find others who know what this is like. I am also married to a wonderful person who has saved me more than once, can recognize low symptoms when I don't, even over the phone, and has called 911, and retrieved me from the emergency room. I am very grateful and happy to be alive. Wish balance wasn't so hard/complex.

Posted by LisaDuda on 10 September 2008

I was very relieved after reading your article. I AM NOT ALONE. I was recently diagnosed being type 1, after being treated for type 2 for five years. Insulin is very tricky to regulate at first, and I found that out the hard way. It is amazing how fast a low blood sugar can come on. One day I was home with my 5 year old son. I was walking into my kitchen and all hell broke loose. I felt like I was having a heart attack. Heart racing, my body shaking like I was having a seizure, and sweat dripping off of me like I just got out of the ocean. My son ran and got me 3 bottles of Sunny D! My reading was 35. That was the lowest I have ever dropped to, and I learned to monitor my sugar by taking readings over 10 times a day. I have learned more from this article than I have learned from my Endo. Thank you!!!!

Posted by Anonymous on 1 November 2008

As a male type one from 1974 (at age 25) with A1C's in nondiabetic range, have had many hypos over the years, & awareness of them has decreased over the years. For last five years have used Lantus & then regular before meals & am beginning to experiment with fast acting Novolog mainly for lunch at work when most serious problems occur.
I agree with comment to use protien (esp. at meal start) to help even out BG levels. This of course does not apply when treating low BG . I also suspect that sufficient good omega fats (esp. fish & fish oil) in diet help with mental as well as emotional balance & function.
Emotions can, at times, affect my glucose levels as much as exercise/activity. Generally have been agreeable during hypos, but occasionally can get emotionally upset due to difficult circumstances. The more grounded and understanding the individual dealing with me is, the better the outcome often is. Times I have passed out, or nearly so, have ranged from during meditation, to computer punching at work, to walking thru Walmart. Probably happens to me more often sitting inactive cause I may have my guard up less than when being active-always try to carry snack, but during some hypos have had snacks in pocket or even food on the plate, but not the brain function to use such correctly/efficiently.
I've been diagnosed by traditional Chinese medicine practioners as having a "Kidney Yang Deficiency" along with the diabetes. Knowing this has helped with diet & lifestyle modifications to provide better balance.
I've noticed that hormones including insulin, can be affected by everything from time of day to time of year, as well as by emotional
variablity & even intensive meditation practices.
As was mentioned previously, "know thy self" is key.

Posted by Anonymous on 30 January 2009

Stress makes my BS go down also and usually very fast. The stress is unfortunately caused by work at the moment (love my job but management are useless!) and wake up every morning with a hypo or seizure and the bed is soaking wet with sweat. Have already got a formal warning from work as docs cant 'prove' that work stress is causing my hypos as this is not normal and stress is usually supposed to put BS up, so management wont mitigate the hypos and seizures from my sick record under the Disability Discrimination Act. Told to record this, but I hate monitoring my BS, but even if I didn't, a matter of a minute wasted doing a BS just to record for work that I have went low again could be potentially fatal. Have hit my head a few times when eventually drop to the ground due to a hypo (luckily usually at home, but unluckily have no-one with me!) or wake up with new bruises over my body. My partner is getting very angry with me now as have missed so many days of work and may get dismissed. Apparently there has been a case study done on this (stress causing hypos) but I cannot locate it on the net. It would be a great help for my docs and to prove to work that I'm not mental! Can anyone help??

Posted by Anonymous on 23 February 2009

I have been Type 1 diabetic for 42 years,since the age of 5. Sometimes, I feel fine at 40 and I don't realize that my sugar is low but sometimes at 70 I get the full blown symptoms, numb lips, inability to concentrate, and a sort of euphoric feeling. It is at that point I don't have the ability to help myself, either with juice or glocose tablets as my brain doesn't recognize the fact I need some form of glucose or carbohydrate. But at 40, I know to get juice. My worst hypoglycemic episode happened one evening as I left work. I was developing what I thought was a migraine but turned out to be hypoglycemia. I got on the expressway and the lanes were going diagonally and I knew that if I closed my left eye the lanes would straighten out, so I did. I remember passing the 1 exit I should've taken, but didn't. I remember tractor trailor trucks blowing their horns, and being in the HOV(High Occupancy vehicle) lane and I thought I shouldn't be in this lane and I just changed lanes without even looking to see if the lane was clear. Well, 30 miles up the expressway, it took 6 police cars to get me to pull over. I don't remember seeing their flashing lights or the blockade they had formed around my car. Once I noticed the blue lights and the fact that they were instructing me to pull over, I did, in the far left lane. An officer came to my passenger window and instructed me to put the car in park, which I did, he asked me if I was a diabetic, I didn't answer him as I was giving him the "Deer ib the headlights" stare. I heard him say "She has a pump" and then I passed out. They broke out my passenger side window to get to me and pulled me out of the car. I barely remember lying on the stretcher and I heard some say "26". I woke up in the ambulance on the way to the hospital after they had given me a glucagon injection. I cried all the way to the hospital. By the grace of God, I didn't kill myself or anyone else or even wreck the car. I now check my sugar before I leave the house or leave work. I had to get a letter from my endocrinologist stating that I was in good control of my diabetes, which I always have been, except it would seem, this 1 evening. I cry when I think of all the things that could've happened to me and other innocent people and how I came out of this without a scratch. Next time I may not be so lucky. This disease shows NO favoritism, I am a retired RN,CDE and SO BLESSED to be alive. I pray for all affected & afflicted by this disaese.

Posted by Anonymous on 4 October 2009

I almsot alwasy have my lows in the middle of the night. I date a non-diabetic whose mother was one, he doesn't seem to care. Welcomes my way of eating as a way to avoid it himself. Most of my lows are 50-60, but have had a few that were 30-40. Basically I wake up inthe night and wonder why. Go to the bathroom an dif that is not it, I am prbably low so I test and eat if necessary.

Posted by Anonymous on 13 December 2009

I am 85 years old. I am having Type 2 Diabetes for the last 10 years. In my recent consultation on 17/9/2009 I was advised for the fist time to administer Insulin -Lupisulin M 30 dose 10 30 Min. before breakfast. In my second visit on 5/11/2009 the Doctor increased the Dosage to 14 before breakfast which I followed. On 8/12/2009 around 10.30 p.m - while I was retiring to Bed after watching TV programme I suddenly felt numbness in my right hand palm and I could not even lift a biscuit bottle. After closing and opening my fist for some time I became normal. On Contacting the Doctor about this incident, I was advised to take a CT Scan (64 Slice-CT Brain(Plain) the next morning and then consult a Neuro with the report. The Impression of Consultant Radiologist in is report reads as follows:CT SCAN BRAIN (PLAIN) DID NOT REVEAL ANY SIGNIFICANT ABNORMALITY. I went with report to Neuro Doctor and was waiting. All on a sudden I was sweating and with confused state. After taking some rest I came to normal. By then the Neuro Doctor arrived and tested me and also studied the scan report.The Doctor informed that I am normal as per the report. He prescribed to take STROCIT 500 for 10 days - one in the morning and one in the night. The next day I reduced the intake of insulin from 14 to 8 without any event. The following day I again reverted to Insulin injection to 14 in the morning before breakfast. Around noon I suddenly experienced sweating and confusion before taking lunch at 12-30 p.m. After taking food I came to normal. I want to know whether the incident is due to low sugar(Hypoglycemia)symptoms development or due to the CT Scan taken earlier. I had bypass surgery in the year 1992 and pacemaker implantation in the year 2006. This is for your information and detailed advice.

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