August 20, 2001
Hypoglycemia
Question from Laramie, Wyoming, USA:
Last week, my 26 year old wife, diagnosed with type 1 diabetes at age 11, had a seizure because her sugars dropped. She has only had one seizure previously (at around 4:00 am) that she is aware of, and that was six years ago. A week later, she had two more seizures on back-to-back days approximately six hours after her insulin dose (she takes Regular and NPH). During the third seizure, I managed to get her blood sugar which was at 18 mg/dl [1 mmol/L]. The emergency room doctors discovered a bladder infection, but seemed to think that the infection wasn’t the reason that her sugars have been dropping so radically.
We’ve been testing her blood sugar six to eight times a day and it’s been peaks and valleys. In one instance, she dropped 150 points in an hour and a half — doing nothing but sitting on the couch. We visited an internist yesterday who adjusted her insulin levels, but she’s still dropping low at bed time (10:00 pm – 60-80 mg/dl [3.3-4.4 mmol/L], and the past few mornings she’s been in the 350-410 mg/dl [19.4-22.8 mmol/L] range. My wife has not modified anything in her daily routine (diet, exercise, stress, insulin).
My wife had blood work done this morning, for a hemoglobin test and a few others. The doctor said that they would have a better time figuring out what it wasn’t than what was causing the problem. He also said that there may be a problem with her kidneys or that her body is producing small levels of insulin.
We’ve been feeding my wife much more than she is used to in order to maintain her blood sugar levels and avoid any further seizures but it’s only a temporary fix. Specialists are hard to come by in our state, so any information you could provide would be greatly appreciated.
Answer:
For someone who has had as much difficulty as your wife, it is important to work closely with a physician. The key is to stop all low blood sugars in contrast to working hard to decrease the blood sugars.
There are many things that can cause low sugars, such as changes in diet, increased activity, changes in schedule, decreased gastric emptying, and problems with insulin absorption. The infection was probably not the cause of the lows because infections (and other intercurrent illnesses) tend to raise sugars because hormones produced in increased amounts during stress antagonize insulin’s effects on blood sugars.
An additional problem may be that your wife cannot sense low sugars [hypoglycemia unawareness]. This is a tremendous problem because she doesn’t perceive the usual symptoms. The first symptoms could be symptoms where the brain runs out of glucose.
JTL
