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February 24, 2003

Behavior

Question from Houston, Texas, USA:

My daughter is a teenager with type 1 diabetes. During the last three years I have experienced sudden physical attacks from her, from nothing more than normal confrontations between mother and daughter. This has happened approximately five times resulting in my being physically attacked and beaten by my child. The last incident ended with my son pulling her off of me, and my daughter calling the police. They did a very bad investigation and arrested me for assault! I love my daughter with all my heart and this is hard to talk to anyone about. She refuses to admit that she attacked me, even though my 15 year old son saw the whole thing and pulled her off of me. After checking her blood testing book, which her new doctor requires her to do I have found that she had a blood sugar of over 400 mg/dl [22.2 mmol/L] each night that we have had an upsetting incident (not always leading to physical violence). I know a low blood sugar changes people. Can a high blood sugar cause this type of behavior which is totally out of character for a person? I go on trial soon, and my family risks losing all that I have worked for over the past 23 years. I plan to talk to her doctor, but I wanted other's knowledge and professional opinions too! I would be very grateful for your response.

Answer:

I know of no literature on high blood glucose causing such irrational behaviour.

LD
Additional comments from Dr. Stuart Brink:

I agree with Dr. Deeb. This is not hyperglycemia and if there were blood glucose tests just before these episodes, then it would eliminate hypoglycemia as well. If no blood glucose tests were done, then I would suspect hypoglycemia as more common in someone with diabetes then other psychiatric causes. Drugs and alcohol are also possible culprits especially in a teenager. A good psychiatric and psychologic profile as well as observation from people in school, friends and relatives would place this into some perspective. It’s hard to believe that police would arrest a parent under such circumstances, so it seems like there is some “missing information.”

SB
Additional comments from Dr. Tessa Lebinger:

I also know of no literature suggesting people get violent when their blood sugar is high. Perhaps her blood sugar goes high when she is upset. It sounds like she needs a thorough medical/psychological evaluation including making sure her thyroid function is normal (both an underactive and overactive thyroid can be associated with severe psychiatric symptoms) and possibly an EEG to make sure she isn’t having a rare form of epilepsy such as temporal lobe epilepsy that can cause rage attacks and responds to medication. Perhaps if she is admitted to a psychiatric ward, a more thorough investigation of the home situation could be done if you feel you have been unfairly accused of assault and a better evaluation of what precipitates the attacks and the relationship to her blood sugars could be done. If you find no medical cause of her rage attacks and you are cleared of accusations of abuse, there are psychiatric medications that can be used to effectively prevent rage attacks.

It sounds like a very difficult situation involving the entire family (including your son)and hopefully you will find the social/psychiatric/medical support necessary to work this out. I suggest that you try to get family counselling for you and your son in addition to for your daughter.

TGL
Additional comments from Craig Broadhurst:

I would advise a total psychiatric work up to seek answers regarding this unusual behavior.

CMB
Additional comments from Jane Seley, diabetes nurse specialist:

I have never heard of a physical attack related to high blood sugar in my twenty five years of taking care of people with diabetes. It sounds like your daughter needs to be evaluated as soon as possible by a psychiatrist and perhaps a neurologist to look for a physical and/or psychological problem that may explain her behavior. It is very important that your daughter get the help she needs as soon as possible — before she attacks someone else that will not be as understanding as you have been.

JS