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October 24, 2001

Hypoglycemia

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Question from Boston, Massachusetts, USA:

My 28 year old boyfriend, who was diagnosed with type 1 diabetes when he was 10, has been in the hospital in a semi-comatose state for the past seven weeks. While I was out of town, he had a hypoglycemic episode that I’m guessing began in the morning, lasted from 12-15 hours and probably involved at least three seizures. Although he is very careful about testing and taking care of himself, he’s always had problems with low blood sugar, never high, and seizures aren’t uncommon for him. After I got home that night and called the paramedics, they tested his sugar and found it was a 21 mg/dl [1.3 mmol/L].

At this point, he is largely non-responsive, although his reflexes are quite good, and he does seem to focus his eyes on people at times. CAT scans and EEGs have shown signs of brain damage, but no one seems to be able to tell me how much or what it will mean in real terms. How much damage can a lack of sugar over such a long period of time do to the brain? Is it possible to know what areas of the brain are likely to be affected? I realize this is a pretty specialized question, but none of his doctors have given me any real answers and I just want some kind of idea of what likely happened to his brain.

Answer:

I’m sorry to hear about your boyfriend. He had a life-threatening hypoglycemic episode with seizures. Unfortunately, if the seizures continue, they continue to have damaging effects to the brain. The damage stems from the fact that the brain requires glucose for its fuel supply. It is dependent on a continuous supply. When sugars fall, there are mechanisms to bring it back up. However, these mechanisms are altered in diabetes where persistent hypoglycemia occurs. This results in hypoglycemia unawareness and is associated with an inability of the body to bring the sugars back up. With regard to his recovery, I am afraid I can’t help you with that. This requires more information than e-mail can provide.

JTL