My close family member was diagnosed with type 1 diabetes at approximately two years of age. He is now in his early 30s. Despite early counseling, he has never taken care of his diabetes as he should. In the past 10 years, he has seen his specialist only once. For a long time, we have realized that he cannot even feel a reaction coming on (I believe the term is hypoglycemia unawareness). His reactions are, and always have been, quite intense. They can vary from extreme giddiness, to violence, to completely irrational behavior (for example, we once found him naked trying to jump from the second floor window). He never has any memory of these events and is obviously quite embarrassed about his behavior.

As his diabetes progresses and he has had to deal with fluctuating and out-of-control sugar levels for more than 30 years, can this have a long-term and permanent impact on his behavior and his ability to think rationally? He has been demonstrating some disturbing behavior lately, and although I realize that he needs some psychiatric assistance, I can’t help but wonder if there is any medical evidence that his diabetes may be a contributing factor. I’m aware of the obvious emotional issues that come with living with an illness, I’m looking for something more scientific about how blood sugar levels may affect behavior. I ask for this so that I can make sure that his treatment plan addresses all of his needs.

As you describe your family member, several things come to mind. First, what are the barriers to his ability to get better control of this blood sugars? Does he has a physician who sees him on a regular basis? Does he have depression of some other reason for not being more aggressive in the treatment of his diabetes? There have been several large trials that have evaluated intense blood sugar control versus usual blood sugar control in patients with type 1 diabetes. The studies have been in both kids and adults. The consistent message is that tighter control results in fewer complications long-term with the short-term side effect of more hypoglycemic reactions. Psychological testing has been done and it has not been associated with long-term impairment in intellectual function. This is more controversial in children where there has been some evidence that recurrent hypoglycemia may have more long-lasting effects. When hypoglycemia unawareness is obvious, the most important therapeutic direction is an intense program of avoiding hypoglycemia. This requires working with a physician and diabetes care team, regular reporting of blood sugars, and interactions to avoid the problem. After weeks to months of avoiding the lows, it is possible for some of the symptoms of lows to return that might protect people from having the more serious reactions. Therefore, you can see that this process requires an intense process over time with a dedicated team. If you have an impact with him, I would recommend he dedicate himself to working on this so that he can remove himself from acute harm when he has such lows.

JTL

[Editor’s comment: If you know the name of your relative’s doctor, you might consider contacting the doctor to find out the name of a counselor/social worker/psychologist, someone who can guide you on how to encourage your relative to take better care of himself, including seeing the doctor more frequently.

BH]