There are a few things to keep in mind.
As mentioned above, it does sound like classic denial which can accompany depressive behavior, and such behavior is EXTREMELY common as a result of irregular BG levels (hypo or hyper).
A little about me, I was surprised diagnosed at 21, and have been T1D for about a year now. I had next to no honeymoon phase, upon diagnosis, pancreatic function was <1%. My A1C was at 12.9 and my diagnosis BG was at 498. It was questionable as to how I made it to the doctor’s appointment. Within the timespan of my next a1c (3months on the dot) I managed to bring it down to 5.1 and have since stayed comfortably between 4.8-5.5, the latter when I’m being rather exceptionally lazy with control. I started on pens, but within a month I had my Dexcom, and a few weeks later I obtained an Omnipod. Whilst the pod in and of itself it great for many reasons, there’s no reason in practical application you cannot obtain near similar results with injections (vial or pen). The CGM however, especially with dexcom’s clarity app, can provide you with a lot of acute insight into your SO’s metabolic functions.
Addressing the problem at the source, the hypoglycemia itself, keep in mind how and why it occurs, what triggers it, and how metabolic functions will cause the rate of this condition to accelerate/decelerate depending on a few variables:
If she is taking any form of stimulant, legal or otherwise, it would be wise to reevaluate the amount, time of ingestion, or use altogether. Stimulants, particularly amphetamines and dextroamphetamines, rapidly ramp up all metabolic processes which will, 99 times out of 100, cause a drop in BG levels than can cause a hypo in and of itself. These medications are commonly used to treat AD(H)D. Stimulants like caffeine can have a similar effect, but the amount required on average is not really worth mentioning.
2.)Stress. This is understated a LOT overall, but stress can cause hyperglycemia. This, at a glance, one would assume is the opposite of your issue. However, stress can also have a negative effect on metabolic functions and rate, and in turn cause the REVERSE by extension of these effects. Combined with a lack of sufficient complex carbs, and you could see a spike following a rapid decline, or just a straight up decline directly into a hypo.
As a type 1, the average pancreatic function is <5%. There are a few odd examples of function over this limit, but by extension of being diagnosed as type 1, anything outside of this range is usually still within the honeymoon phase, which has been known to last for years in some people. This is not likely the case for you, which means 99% of the insulin in her body is that which she gives herself. If she is low, she has done it to herself (likely inadvertently, obviously). This can get tricky as her idea of insulin dosages for ‘X’ carbs may be vastly incorrect due to the scar tissue, which will cause an uneven absorption rate and can eventually lead to a hypo due to overall too much insulin or too many overcorrection boluses. My personal recommendation to test this theory would be either to use an injection site never used before (ANY subcutaneous tissue is safe, but the absorption rate will vary,ie if you tried to do legs, especially lower, it may take 30-40 minutes even with rapid acting insulin) or an intramuscular injection. These can be annoying, but it would only take one to affirm if the aforementioned issue is the case. Muscular shots will absorb much more rapidly than subcutaneous injections (2x faster on average). As a result use less insulin than currently used to dose the same amount of carbs if you want to prevent yet another hypo. I would recommend not doing it during a meat but instead a snack of carefully measured proportions (ie exactly 15-20g carbs, x insulin for her, note dietary fiber if present, record results).
4.) Carb-Intake and/or Ketosis.
Carb intake is rather self explanatory. If you aren’t eating carbs, your BG will go down unless you also stop taking insulin. This includes STOPPING basal insulin as well. I do not recommend doing this as a type 1 unless you are very well versed into the metabolic changes that occur during Ketosis (the process by which your body no longer runs on glucose, and instead metabolises fat for energy producing ketones), whilst also having testing equipment to test your blood ketones (not urine, that information is hours late). Doing this would require you not to eat anything with calories, otherwise you would have to resume taking insulin to prevent a hyperglycemia episode, as when there are no nutritionally available carbs via diet, the body has no issue converting fat and protein into it. It becomes dangerous for a Type 1 because if you do not eat anything at all, your own body is fair game when it comes to a source of fat and protein. When your body starts to break down muscular tissue for nutrients, a lot of ketones can flood the blood and cause overall PH imbalance, essentially making your blood acidic. This process of cannibalizing your own muscular tissue is called catabolism. With insufficient carb intake however, hypos can occur with a lack of carb supplementation since glucose will continuously get used as intended, with not enough to replace it. It is worth mentioning that despite 70 being the overarching “low bg threshold”, damages to the body do not begin until you hit 60 and below. 70 was established to gives us diabetics a threshold, so if/when shes at say 65,67,69 it doesn’t mean you need to go grab the glucagon asap and expect the worst, but it does mean you should locate carbs asap, whilst suspending insulin delivery (if pump) until you do eat and the just bolus (you can resume after at this point).
Without knowing her treatment options, I’m kind of having to explain two different methods in parallel (pump vs not pump). If she’s on a pump, look at the daily insulin usage. It should be roughly 50% basal 50% bolus for an average day. Running a little high on basal, especially if you skipped a meal or didn’t eat as much is fine, provided no lows as a result in this timespan. If it is at that proportion, I would recommend cutting your current basal rate by about 1/4th, and if your still running the risk of hypo then by one half. Worth the basal rate up from the reduced value until you find your sweet spot. This can change often, so being used to changing this is nice. If you ever cut too much off, it isn’t a big deal provided you use that CGM to your advantage, bolus a bit if your bg is rising during a semi fast state and slightly increase the basal. Repeat until you find your desired result! — If on MDI, adjusting basal is slightly less accurate and annoying. I’ll go off my experience with lantus and basaglar. When making adjustments, I generally started low to begin with (so say you take 20 units, maybe switch to 10-15). you may require more bolus at a meal, just watch your bg to see a trend. If you need to increase the bolus, wait 3 days to average your results, and then increase it by 2 units at a time (ie you reduce to 10, take measurements for 3 days, decide that’s too low - your bolus amount has gone way up and you need more of them, so you increase on the 4th day to 12, so on so forth)
These four things contain 95% of the reasons one may have frequent hypoglycemia. This doesn’t take into account other factors such as illness, other (non stimulant) medications, and a few various disorders or conditions that could further complicate average BG values or rapid spikes and hypos.
As to her saying she has hypoglycemic unawareness, it isn’t really something you can train, so I would take her word for it. I never needed to check my BG when i was diagnosed either, I could literally feel and guess almost spot on what my BG was during the first months of being T1. After being in the A1C range of 4.9-5.5 for so long, the feeling has completely disappeared. I keep such a stranglehold on my BG levels that I don’t feel hypos until I’m at 30-40 usually, and that’s mostly speculation as it’s only happened twice (both due to negligence on my part). The tighter control you have, the less awareness (biologically) you’ll have of your blood sugar in most people. Your body doesn’t know whether or not you are low blood sugar per say, it instead notices a change in blood sugar. Going from 250 ----> 150 feels the same as going from 150—>50 relatively when you’ve been at those levels (250, and 150 respectively) for a long time. I know when I was going from 400 to normal after first getting insulin, I literally thought i was going to die. It was an awful feeling.
As for testing, the only thing I can recommend is to shop around for better lancing devices, or to use meters that can allow testing (accurately) from other (non-finger) sites. The system that recognizes pain is called a nociceptor, and if it is not triggered, there will be no pain. Scar tissue can cause extra pain since it can not only be more sensitive, but thicker, and push area of pressure around multiple nociceptors, amplifying the pain. When on MDIs, my first lancelets were annoyingly painful, so I ended up just poking myself with my MDI needles, they were ultra fine 4mm needles. Freestyle Strips require a very low amount of blood, so it worked out. They also can be pretty cheap with or without insurance, so if you don’t have them and want to try them, insurance shouldn’t be an issue. Check into their programs if desired.
This post got entirely too long for what I hope will be helpful information to either yourself or others. The above is what happens when you get diagnosed as T1D as a College Student majoring in Physics with minors in Biochemistry and Astrophysics. When I’m not doing homework, I’m still doing homework, just of the diabetic variety.
If you have any other questions, feel free to ask
I am not a doctor and am merely offering advice in medical affairs. Almost all of my information is obtained via publicly released abstract research documentation, which can be easily located if you should so desire. I do not endorse information without first using myself to verify both its integrity and safety.