INS and Hypoglycemia: Hypoglycemia unawareness impairs counterregulatory hormonal responses during hypoglycemia, which reduces symptom awareness and heightens the risk of severe hypoglycemic episodes.151,152 The prevalence of hypoglycemia unawareness among individuals with diabetes on intensive insulin therapy can be as high as 30–40%.114,152 Clinically, patients may not recognize hypoglycemia until neuroglycopenic symptoms manifest, such as confusion or seizures.153