While the neural control of glucoregulatory responses to insulin-induced hypoglycemia is beginning to be elucidated, brain sites responsible for behavioral responses to hypoglycemia are relatively poorly understood. To help elucidate central control mechanisms associated with hypoglycemia unawareness, we first evaluated the effect of recurrent hypoglycemia on a simple behavioral measure, the robust feeding response to hypoglycemia, in rats. First, food intake was significantly, and similarly, increased above baseline saline-induced intake (1.1 Ϯ 0.2 g; n ϭ 8) in rats experiencing a first (4.4 Ϯ 0.3; n ϭ 8) or third daily episode of recurrent insulin-induced hypoglycemia (IIH, 3.7 Ϯ 0.3 g; n ϭ 9; P Ͻ 0.05). Because food intake was not impaired as a result of prior IIH, we next developed an alternative animal model of hypoglycemiainduced behavioral arousal using a conditioned place preference (CPP) model. We found that hypoglycemia severely blunted previously acquired CPP in rats and that recurrent hypoglycemia prevented this blunting. Pretreatment with a brain penetrant, selective orexin receptor-1 antagonist, SB-334867A, blocked hypoglycemia-induced blunting of CPP. Recurrently hypoglycemic rats also showed decreased preproorexin expression in the perifornical hypothalamus (50%) but not in the adjacent lateral hypothalamus. Pretreatment with sertraline, previously shown to prevent hypoglycemia-associated glucoregulatory failure, did not prevent blunting of hypoglycemia-induced CPP prevention by recurrent hypoglycemia. This work describes the first behavioral model of hypoglycemia unawareness and suggests a role for orexin neurons in mediating behavioral responses to hypoglycemia. diabetes; perifornical hypothalamus; serotonin; awareness HYPOGLYCEMIA UNAWARENESS AND concomitant failure to activate behavioral defenses against hypoglycemia (such as feeding) contribute to the problem of hypoglycemia-associated autonomic failure and the vicious cycle of insulin-induced hypoglycemia (IIH) in Type 1 diabetes mellitus and advanced Type 2 diabetes mellitus patients undergoing intensive insulin therapy for tight glycemic control (8, 9). The neurogenic symptoms generated by adrenergic and cholinergic activation (such as palpitations and diaphoresis) and neuroglycopenic symptoms generated by central glucopenia per se (such as diminished cognitive function) result in awareness of hypoglycemia and stimulate corrective behavioral responses (such as feeding or glucose administration). However, the central neural substrates for awareness of the hypoglycemic state and the neuronal mechanisms underlying the blunting of this awareness following repeated bouts of IIH are not well understood. More importantly, no animal model of blunted awareness following repeated bouts of IIH exists.In this series of studies, we attempted to develop a behavioral measure by which hypoglycemia unawareness could be modeled in animals. We first evaluated whether or not the robust feeding response to IIH is blunted by antecedent hypoglycemic episodes, a...