My 12 year old, diagnosed at age 10 months, has had seizures at a blood sugar of 55 mg/dl [3.1 mmol/L], but the other day at school, he was 23 mg/dl [1.3 mmol/L] and although he was shaky, pale, and flushed, he did not have one. What are the long term effects of seizures from severe low blood sugars? How come my son does not have a seizure when he is awake?

There is some association with other tests of central nervous system function and recurrent seizures associated with diabetes. However, most of the time this is not clinically apparent. Most seizures associated with hypoglycemia are transient and also, therefore, different from epilepsy since duration is shorter. If they occur frequently, many would suggest some anticonvulsant protection to stop the seizures.

Seizures often are more likely to happen when someone is asleep, for reasons not entirely clear, but perhaps related to other hormones (counterregulatory hormone abnormalities are a likely culprit with diabetes). This is also called the hypoglycemia unawareness syndrome.

You should discuss all this in great detail with your diabetes team to be sure that a safe treatment plan is in place, risks identified and minimized and consideration for anticonvulsant therapy reviewed. Some overnight blood glucose testing is also often helpful to identify asymptomatic nocturnal hypoglycemia. Efforts to decrease hypoglycemia without enormously increasing day to day glucose control and hemoglobin A1c are also reasonable.

SB