Summary:
The conversation revolves around a patient's daily blood sugar levels, medication, and food intake. The patient is being monitored and advised by a healthcare provider. The conversation also touches on the topic of hypoglycemia hyperawareness, a phenomenon where individuals with diabetes become overly sensitive to bodily sensations that may be misinterpreted as hypoglycemia.
_Key words:_
1. Diabetes management
2. Blood sugar levels
3. Medication adherence
4. Hypoglycemia hyperawareness
5. Patient education
6. Healthcare provider-patient communication
The entire PaJR of the patient is archived open access here: https://
Conversational learning transcripts:[04/12, 23:49] Patient DM1 MP Advocate 2: 7:15 am Drink 1 cup black tea without sugar9:10 am before breakfast sugar 1369:15 am1 Paratha with potato fry11:50 am after breakfast sugar 20012:20 pm eat apple2:05 pm before lunch sugar 1582:10 pm2 roti with potato fry4:20 pm after lunch sugar 1685 pm eat 1 guava7:50 pm drink 1 cup black tea without sugar and ate 2 piece fruit cake8 pm insulin lantus 8.5 unit9:40 pm before dinner sugar 1769:45 pm2 roti with Ganth gobhi fry11:45 pm after dinner sugar 178[05/12, 06:23] Patient DM1 MP Advocate 2: Good morning sir5/12/246:25 am fasting sugar 137[05/12, 08:47] PaJR moderator: 👍[05/12, 23:10] Patient DM1 MP Advocate 2: 7:05 am drink black tea without sugar9:10 am before breakfast sugar 1319:15 am2 roti with long beans fry11:50 am after breakfast sugar 19612:20 pm eat 1 apple1:25 pm before lunch sugar 1761:30 pm2 Paratha with long beans fry4:00 pm after lunch sugar 2194:30 pm eat 1 guava7:45 pm eat banana chips7:50 pm drink black tea without sugar8 pm Insulin Lantus 8.5 unit9:40 pm before dinner sugar 2089:45 pm2 roti with long beans fry ,ganth gobhi curry and chalkumra fry11:15 pm after dinner sugar221[06/12, 06:27] Patient DM1 MP Advocate 2: Good morning sir6/12/246:30 am fasting sugar 171[06/12, 11:14] PaJR moderator: 👍can make it 9 today[06/12, 11:26] Patient DM1 MP Advocate 2: Ok sir[06/12, 23:00] Patient DM1 MP Advocate 2: 6:45 am drink 1 cup black tea without sugar9:15 am before breakfast sugar 1319:20 am1 roti with pointed gourd fry11:30 am after breakfast sugar 21012:30 pm eat papaya1:25 pm before lunch sugar 2151:30 pm2 roti with pointed gourd fry4 pm after lunch sugar 2415 pm drink 1 cup black tea without sugar5:30 pm eat 1 apple6:30 pm eat some banana chips8 pm insulin lantus 9 unit9:15 pm before dinner sugar 1262 roti with pointed gourd fry, brinjal fry and kochuri loti11 pm after dinner sugar 265[07/12, 06:13] Patient DM1 MP Advocate 2: Good morning sir7/12/246:15 am fasting sugar 141[07/12, 08:43]pm: 👍[07/12, 23:11] Patient DM1 MP Advocate 2: 6:45 am drink 1 cup black tea without sugar9:15 am before breakfast sugar 1439:20 am1 roti with bottle gourd fry11:30 am after breakfast sugar 15512 pm eat papaya1:25 pm before lunch sugar 2021:30 pm2 roti with bottle gourd fry4 pm after lunch sugar 2354:30 pm eat 1 apple7:50 pm drink 1 cup black tea8 pm insulin Lantus 9 unit9:20 pm sugar 92 trembling and sweatingEat 2 chochlate and then rice and arum curry11 :15 pm after dinner sugar 199[08/12, 07:39]pm: Fasting today?[08/12, 08:55] Patient DM1 MP Advocate 2: Good morning sir8/12/249 am fasting sugar 134[08/12, 17:39] Patient DM1 MP Advocate 2: 10 am Drink 1 cup black tea without sugar10:25 am before breakfast sugar 14710:30 amPorridge12:30 pm after breakfast sugar 106body trembling problemThen eat 1 chocolate,guava,and Oreo biscuit3:25 pm before lunch sugar 1363:30 pmRice with lentil, boiled pumpkin, long beans chutney and sem phali fry5:30 pm after lunch sugar 182[08/12, 23:34] Patient DM1 MP Advocate 2: 5:30 pm eat some seeds6 pm drink 1 cup black tea without sugar8 pm insulin lantus 8 unit9:40 pm before dinner sugar 1589:45 pmRice with boiled pumpkin, long beans chutney and lentil11:40 pm after dinner sugar 221[09/12, 06:20] Patient DM1 MP Advocate 2: Good morning sir9/12/246:25 am fasting sugar 179[09/12, 08:29] pm: 👍[09/12, 08:30]pm: Why was her lantus reduced again by 1?[09/12, 09:18] Patient DM1 MP Advocate 2: Sir, Patient feeling very weak in the body and due to low sugar, insulin has reduced, today I will increase the insulin.[09/12, 09:21] PaJR moderator: None of the sugar values shared by the patient above while on 9U don't appear to be low? I guess the patient was having subjective sensations of hypoglycemia?@Metacognitist Mover and Shaker1@Inner Strength Engineer1 can we review the literature with @Meta AI to see if there's an entity called hypoglycemia hyperawarenes similar to hypoglycemia unawareness?[09/12, 09:21] Meta AI: Yes, there is a phenomenon known as "hypoglycemia hyperawareness" or "hypoglycemia anxiety," although it is not as widely discussed or researched as hypoglycemia unawareness.Hypoglycemia hyperawareness refers to an increased sensitivity and awareness of bodily sensations that may be misinterpreted as hypoglycemia, even when blood glucose levels are within a normal range. This can lead to anxiety, fear, and stress related to hypoglycemia.Studies suggest that hypoglycemia hyperawareness can be more common in individuals with diabetes who have experienced previous episodes of hypoglycemia, particularly if they were severe or traumatic. It can also be seen in individuals with anxiety disorders or those who are prone to catastrophic thinking.The literature suggests that hypoglycemia hyperawareness can be addressed through education, cognitive-behavioral therapy (CBT), and relaxation techniques. It's essential to work with a healthcare provider to develop strategies to manage hypoglycemia anxiety and improve overall quality of life.References:- Cryer, P. E. (2013). Hypoglycemia in Diabetes. Diabetes, 62(12), 4083–4089.- McAulay, V., & Frier, B. M. (2001). Hypoglycemia: A Clinical Approach. Journal of Clinical Endocrinology and Metabolism, 86(10), 4739–4746.- Wild, D., & von Maltzahn, R. (2008). Hypoglycemia and Anxiety in People with Diabetes. Journal of Diabetes and its Complications, 22(3), 175–184.
CBBLE collective cognition nodal processing:
Summary: at least two of the above references were real albeit with wrong citations!
Excellent
From: PaJR moderator >
Date: Mon, 9 Dec 2024, 09:45
Subject: Re: PaJR UDLCO with Meta AI : Hypoglycemia hyperawareness
To: CM <@gmail.com>
Cc: <caregiver7careseeker@gmail.
Date: Mon, 9 Dec 2024, 09:45
Subject: Re: PaJR UDLCO with Meta AI : Hypoglycemia hyperawareness
To: CM <@gmail.com>
Cc: <caregiver7careseeker@gmail.
Thanks. While we are learning things about the human body with AI sometimes it's difficult to keep checking if the references AI cites is real or confabulated. Can you help me to check if the references cited below by meta AI are correct?
From: PaJR moderator@gmail.com>
Date: Mon, 9 Dec 2024, 20:28
To: CM @gmail.com>
Cc: <caregiver7careseeker@gmail.
Date: Mon, 9 Dec 2024, 20:28
To: CM @gmail.com>
Cc: <caregiver7careseeker@gmail.
Thanks for these useful references.
Nice to see that the first reference (at least one of the listed ones by the LLM) was real!
On Mon, 9 Dec 2024, 11:52 CM, @gmail.com> wrote:
I did a quick search for you. The references were pretty old, the most appropriate one was Wild D, von Maltzahn R, Brohan E, Christensen T, Clauson P, Gonder-Frederick L. A critical review of the literature on fear of hypoglycemia in diabetes: Implications for diabetes management and patient education. Patient Educ Couns. 2007;68(1):10-15. doi:10.1016/j.pec.2007.05.003which had the wrong citation.
I attach the us diabetes association pdf with a lot of information and more relevant references.c
_Thematic Analysis:_
The conversation can be grouped into several themes:
1. _Diabetes Management_: The patient's daily blood sugar levels, medication, and food intake are discussed.
2. _Hypoglycemia Hyperawareness_: The phenomenon of hypoglycemia hyperawareness is discussed, including its definition, causes, and management.
3. _Patient Education_: The importance of patient education in managing diabetes and hypoglycemia hyperawareness is emphasized.
4. _Healthcare Provider-Patient Communication_: The conversation highlights the importance of effective communication between healthcare providers and patients in managing diabetes.
_Codes:_
1. Blood sugar levels
2. Medication adherence
3. Hypoglycemia hyperawareness
4. Patient education
5. Healthcare provider-patient communication
6. Diabetes management
7. Food intake
8. Insulin dosage
_Insights:_
1. Effective diabetes management requires regular monitoring of blood sugar levels, medication adherence, and healthy food choices.
2. Hypoglycemia hyperawareness is a real phenomenon that can have a significant impact on patients' quality of life.
3. Patient education is crucial in managing diabetes and hypoglycemia hyperawareness.
4. Effective communication between healthcare providers and patients is essential in managing diabetes.
_Learning Points:_
1. Healthcare providers should be aware of hypoglycemia hyperawareness and its impact on patients' quality of life.
2. Patients with diabetes should be educated on effective diabetes management, including regular monitoring of blood sugar levels, medication adherence, and healthy food choices.
3. Effective communication between healthcare providers and patients is essential in managing diabetes.
4. Further research is needed to better understand hypoglycemia hyperawareness and its management.
Update in the patient's PaJR around this issue today July 25, 2025:
[24/07, 19:37] pajr.in CEO, NHS Endocrinologist: This is a very interesting case of Autonomic Hyper responsiveness from chronic diabetes
[24/07, 19:38] pajr.in CEO, NHS Endocrinologist: Anyone interested in publishing this as a short case report /abstract?
[24/07, 19:39] pajr.in CEO, NHS Endocrinologist: Ideally, aligning with PaJR principles, @Patient DM1 MP Advocate 2 should be the lead author for this as that would make it completely patient led.
[24/07, 20:04] hu1: Any evidence of Heart rate variability or autonomic events noted..?
Autonomic hyper-responsiveness in chronic diabetes is an alteration of the autonomic nervous system (ANS), commonly involving both overactivity and dysfunction, particularly in the sympathetic arm. However, in chronic diabetes, the more typical issue is autonomic dysfunction or neuropathy—but increased sympathetic activity (hyper-responsiveness) can occur, especially in early or preclinical stages.
Key Points
• Autonomic dysfunction (especially Cardiac Autonomic Neuropathy—CAN) is a well-known, frequent, and serious complication of both type 1 and type 2 diabetes. It affects control of heart rate, blood pressure, and vascular tone, leading to clinical manifestations such as resting tachycardia, arrhythmias, and cardiovascular instability.
• Hyper-responsiveness refers to increased activity or reactivity within the ANS. Research shows that in early diabetes (and in prediabetic metabolic syndrome), there can be signs of sympathetic overactivity (increased response) before the development of clear autonomic neuropathy or overt loss of function.
• Mechanisms: This overactivity has been linked to:
• Insulin resistance and hyperinsulinemia, which are associated with increased sympathetic tone.
• Early metabolic dysfunction, even before full-blown diabetes, can cause altered autonomic responses, possibly preceding clinical neuropathy and contributing to risk for metabolic syndrome.
• Over time, persistent hyperglycemia (high blood sugar) leads to oxidative stress, formation of advanced glycation end-products, and damage to autonomic nerves—eventually causing loss of normal responsiveness (hyporesponsiveness), reduced heart rate variability, and impaired cardiovascular reflexes.
• Clinical presentation typically progresses from hyper-responsiveness (overactive sympathetic drive) in early disease toward hyporesponsiveness or failure (neuropathy) as the condition becomes chronic.
• Assessment: Heart rate variability (HRV) and heart rate recovery (HRR) after exercise are commonly used to detect altered autonomic responses, including early hyperactivity.
https://www.perplexity.ai/search/9bb6244d-4b1a-4832-aa8a-af490a454124
[25/07, 00:07] Patient DM1 MP Advocate 2: 24 July fasting sugar 124
6:30 am drink 1 cup black tea without sugar
9:25 am
1 Omeprazole tablet
2 roti with green beans fry
1 Metformin Tablet
11:25 am after breakfast sugar 235
11:40 am eat papaya
1:30 pm before lunch sugar 154
3 roti with green beans fry
3:30 pm after lunch sugar 155
4 pm eat some roasted makhana
9 pm
0.25 mg Glimepiride Tablet
1 Omeprazole tablet
Rice with green beans fry and panner curry
1 Metformin Tablet
11:30 after breakfast sugar 128
11:45 pm drink 1 cup milk with pinch of termeric powder
[25/07, 07:30]hu2: I would like to help too, sir!
[25/07, 08:36] pajr.in CEO, NHS Endocrinologist: You can start right away by preparing a draft.
[25/07, 10:06] hu3: I'll join too!
[25/07, 10:11]cm: Thanks.
Any perplexity style reference links to this perplexity paper on the topic?
@Dr.Abdulsalam Med Ed Leads may be able to get his LLMs to trace them.
Unless they are visible on clicking the link which I am yet to click
[25/07, 10:19] Rakesh Biswas: Just checked the link. Yes all references are linked there along with exttacts (i have pasted from the site below)!
Amazing! Who would really need to publish a separate paper in the coming years?
Title: Autonomic hyper responsiveness in chronic diabetes
Autonomic hyper-responsiveness in chronic diabetes is an alteration of the autonomic nervous system (ANS), commonly involving both overactivity and dysfunction, particularly in the sympathetic arm. However, in chronic diabetes, the more typical issue is autonomic dysfunction or neuropathy—but increased sympathetic activity (hyper-responsiveness) can occur, especially in early or preclinical stages.
Key Points
Autonomic dysfunction (especially Cardiac Autonomic Neuropathy—CAN) is a well-known, frequent, and serious complication of both type 1 and type 2 diabetes. It affects control of heart rate, blood pressure, and vascular tone, leading to clinical manifestations such as resting tachycardia, arrhythmias, and cardiovascular instability.
Hyper-responsiveness refers to increased activity or reactivity within the ANS. Research shows that in early diabetes (and in prediabetic metabolic syndrome), there can be signs of sympathetic overactivity (increased response) before the development of clear autonomic neuropathy or overt loss of function.
Mechanisms: This overactivity has been linked to:
Insulin resistance and hyperinsulinemia, which are associated with increased sympathetic tone.
Early metabolic dysfunction, even before full-blown diabetes, can cause altered autonomic responses, possibly preceding clinical neuropathy and contributing to risk for metabolic syndrome.
Over time, persistent hyperglycemia (high blood sugar) leads to oxidative stress, formation of advanced glycation end-products, and damage to autonomic nerves—eventually causing loss of normal responsiveness (hyporesponsiveness), reduced heart rate variability, and impaired cardiovascular reflexes.
Clinical presentation typically progresses from hyper-responsiveness (overactive sympathetic drive) in early disease toward hyporesponsiveness or failure (neuropathy) as the condition becomes chronic.
Assessment: Heart rate variability (HRV) and heart rate recovery (HRR) after exercise are commonly used to detect altered autonomic responses, including early hyperactivity.
Supporting Details
Studies indicate that delayed heart rate recovery and reduced HRV signal autonomic dysfunction in diabetes and that sympathetic hyperactivity is likely in early metabolic syndrome and prediabetic states.
Clinical features of autonomic hyper-responsiveness may include increased resting heart rate, exaggerated blood pressure swings, or increased vasoreactivity, but true overt clinical manifestations often develop later, after the onset of neuropathy.
The physiological progression in diabetes is: early sympathetic overactivity (hyper-responsiveness) → chronic exposure to metabolic/toxic damage → autonomic failure/neuropathy.
Limitations
The evidence for sustained autonomic hyper-responsiveness in chronic (long-standing) diabetes is limited, because the trend is usually toward progressive nerve damage and loss of autonomic function over time. Most references describe earlier sympathetic predominance, which gives way to global autonomic failure in chronic diabetes. The pattern and timing may vary between individuals.
In summary: Autonomic hyper-responsiveness—primarily sympathetic overactivity—can be seen in early or preclinical diabetes, often driven by insulin resistance and metabolic dysfunction. However, chronic diabetes more commonly leads to autonomic neuropathy and loss of function rather than persistent hyper-responsiveness.
References:
Autonomic hyper responsiveness in chronic diabetes
1. Journal of Diabetes Investigation
pmc.ncbi.nlm.nih.gov/articles/PMC86…
Autonomic dysfunction, diabetes and metabolic syndrome - PMC
Relationships among autonomic nervous system, diabetes and metabolic syndrome.
2. World Journal of Diabetes
pmc.ncbi.nlm.nih.gov/articles/PMC43…
Diabetes and cardiac autonomic neuropathy: Clinical manifestations ...
Cardiac autonomic neuropathy (CAN) is a frequent chronic complication of diabetes mellitus with potentially life-threatening outcomes. CAN is caused by the impairment of the autonomic nerve fibers regulating heart rate, cardiac output, myocardial ...
3. Diabetes & Metabolism Journal
e-dmj.org/journal/view.p…
Diabetes & Metabolism Journal
Schroeder et al. (2005) ARIC study; USA5,410 NFG, 3,561 IFGShort-term HRVNot provided↓RR interval and rMSSD at baseline. No differences in the rate of change in HRVFasting glucose (weak association at baseline) Perciaccante et al. (2006) Hospital diabetes clinic; Italy20 control, 20 IFG, 20 IGT24 hr HRVNot provided↓SDNN, low TP, and ↑LFnu in IFG and IGTHOMA-I
4. Wjgnet
wjgnet.com/1948-9358/full…
Cardiac autonomic neuropathy in patients with diabetes mellitus
Cardiac autonomic neuropathy in patients with diabetes mellitus
journals.plos.org favicon
5. PLOS ONE
journals.plos.org/plosone/articl…
The cardiac autonomic response to acute psychological stress in ...
Background Impaired cardiac autonomic control is common among people with type 2 diabetes. The autonomic nervous system and its regulatory influence on the cardiovascular system also play a key role in the physiological response to psychosocial stressors. It is unclear whether the disease-related impairment of cardiac autonomic control in people with type 2 diabetes affects the stress response. The aim of this study was therefore to examine the cardiac autonomic and the psychological stress response of people with type 2 diabetes compared to healthy control participants. Methods We used the trier social stress test to induce stress in n = 51 participants with type 2 diabetes and n = 47 healthy controls. We assessed heart rate (HR) and heart rate variability (HRV) using six ECG samples before, during and after the stress test. We measured participants’ psychological stress response using visual analogue scales. Results Longitudinal multilevel models showed an attenuated HR increase in response to the stress test combined with a slower HR recovery after the stress test, in people with type 2 diabetes. This pattern was accompanied by significantly lower low frequency HRV but no differences in high frequency HRV between the groups. Additionally, people with type 2 diabetes showed an increased level of self-reported psychological tension 45 minutes after the stress test. Conclusions The impairment of the autonomic nervous system found in people with type 2 diabetes is reflected in the HR response to stress—but not in the HRV response—and partially mirrored in the psychological stress response. Our results underline the importance of considering the interplay of psychosocial stress and disease-related changes in the physiological stress response system in research and treatment of type 2 diabetes.
diabetesjournals.org favicon
6. American Diabetes Association
diabetesjournals.org/care/article/2…
Influence of Autonomic Nervous System Dysfunction on the ...
OBJECTIVE—We investigated whether autonomic nervous system dysfunction, estimated by slow heart rate recovery (HRR) following cessation of an exercise trea
7. Circulation
ahajournals.org/doi/10.1161/ci…
Diabetic Cardiovascular Autonomic Neuropathy | Circulation
To investigate the effect of ACE inhibition or angiotensin receptor blockade and their combination on both DAN and LVDD in asymptomatic patients with diabetes, Didangelos et al 106aexamined 62 patients (34 women) with long-term diabetes mellitus (24 with type 1 diabetes mellitus and DAN). The patients, who were aged 51.7±13.9 years and were free of coronary artery disease and arterial hypertension at baseline, were studied for a 12-month period. Early ACE inhibition or angiotensin receptor...
journals.lww.com favicon
8. journals.lww
journals.lww.com/jfmpc/fulltext…
Comparative study of autonomic function in diabetics and yoga ...
9. ahajournals
ahajournals.org/doi/10.1161/01…
Hyperreactivity to Nitrovasodilators in Forearm Vasculature Is ...
sciencedirect.com favicon
10. sciencedirect
sciencedirect.com/science/articl…
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