I’m an overweight 44 year old male who has had type 1 diabetes for 21 years. I am on a morning dose of NPH and Humalog with a sliding scale of Humalog for high blood sugars. I test throughout the day, and my last hemoglobin A1c was 6.8%.

The problem is I have many episodes of low blood sugar, and I can get down to 22 mg/dl [1.2 mmol/L] with no signs that it’s that low. Sometimes, this happens while I’m sleeping too. Can I get any brain damage because my sugars get so low without warning?

It sounds like you put a lot of energy into treating your blood sugars. There is an association between frequent low blood sugars and hypoglycemia unawareness. There is some benefit to decreasing the frequency of low sugars and getting some return in symptoms of low blood sugars.

I would try to work with your doctor in trying to decrease the number of low sugars. It may also help decrease the amount of insulin you take and help you with weight loss. Intellectual deterioration has not been documented in adults with intensive blood sugar control.

JTL

[Editor’s comment: Your situation might well be clarified by monitoring sugar levels continuously for several days to try to sort out what’s happening in more detail. See The Continuous Glucose Monitoring System, and ask your diabetes team about using it.

SS]