Hypo unawareness: our researchers are on it – by Emily Burns

Going low

Hypo unawareness is a condition where your brain can’t sense that your blood glucose levels are going low: in other words, your body doesn’t know that it’s about to have a hypo. Lots of people with Type 1 diabetes can experience this to some degree, but severe hypo unawareness can be devastating.

You can read about Richard Lane’s story on our website, as he explains his experience of how hypo unawareness changed his life:

“My warnings of hypoglycaemia gradually disappeared to the point at which I had literally no real warnings. As a result, I had to rely on my wife, my children, friends and work colleagues to take the necessary steps to avoid comas.”

Islet transplants – the first fix

Luckily, in 2001, Diabetes UK supporters raised enough money to put islet transplants on the NHS – a revolutionary treatment that was shown to restore hypo awareness. Diabetes UK funded the first 15 islet transplants in the UK, and Richard was one of the first recipients.

Islet isolation and assessment at King's College London (L) and Newcastle University (R)
Islet isolation and assessment at King’s College London (L) and Newcastle University (R)

Islet transplants are still available today, and lots of research is ongoing to improve the transplants: we need to find ways to protect the new insulin-producing cells from the immune system and keep them healthy, as well as a way to overcome the current challenge around a limited number of donated pancreases.

What else can we do?

Aside from islet transplants, researchers are working to understand why some people can’t detect their hypos – and whether it can be restored using methods other than islet transplantation.

Having low blood glucose levels should trigger feelings of stress or anxiety, so that people act on them. In people with hypo unawareness, they might not get this alarm – low blood glucose levels don’t feel as unpleasant. Interestingly, this sometimes means that they can find it really difficult to follow treatment recommendations to reduce hypos: their brains don’t think that hypos are bad.

We need to study the brain to understand hypo unawareness
We need to study the brain to understand hypo unawareness

We’re funding Dr Pratik Choudhary, at King’s College London, to study the brains of people with Type 1 diabetes that can and can’t detect their own hypos. He wants to see if brain activity is different in people with hypo unawareness, and if that specific activity can be reversed to restore awareness. We hope Pratik’s work will help us to understand how hypo unawareness happens, and in the long term, help to develop future treatments.

We’re also funding Professor Simon Luckman, at the University of Manchester, who’s taking a different approach. His team have found the specific cells responsible for sensing low blood glucose levels in an area of the brain called the hypothalamus. He’s now trying to work out why these cells lose their sensitivity after they’ve been exposed to multiple hypos. We hope that his work could help to develop new drugs to treat or prevent hypo unawareness in the future.

You can help too

We can only fund researchers like Pratik and Simon thanks to your generosity: all of the money we invest in world class research around the UK is down to our supporters. If you’re interested in supporting a specific project – perhaps something around combatting hypos – then head to Our Research Projects and find out how to adopt a project.




This blog is brought to you by Dr Emily Burns, Research Communications Manager at Diabetes UK.

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