November 26, 2007
Question from Flintshire, United Kingdom:
My daughter has had type 1 diabetes for three years. Since May 2007, she has had almost one “fit” a month. The last one was three weeks after prevous one. Each fit occurs early hours of morning, between 4 a.m. and 7 a.m. Can you say whether this is linked to her diabetes or could we be looking at her having epilepsy? As far as we know, neither diabetes or epilepsy runs in the family.
The relationships between type 1 diabetes and seizures have been studied with no clear results thus far. Young epileptic adults also suffer a greatly increased risk of having type 1 diabetes, according to the results of some studies. The incidence occurs amongst patients suffering from generalized epilepsies of an unknown origin, also known as “idiopathic” epilepsies. On the other end, what is the likelihood of children with type 1 diabetes having hypoglycemic episodes resulting in seizure? Many surveys do not separate forms of severe hypoglycemia, so that loss of consciousness and seizure, hospital admission and emergency department visit are all classified together. But, nightly hypoglycemia is clearly an important problem. Severe hypoglycemia occurring at night is more common in children younger than seven years of age, and is more likely with increasing diabetes duration and lower A1cs. The risk of hypoglycemia is not increased among children with neurologic disorders, but it is increased among children with psychiatric disorders. Of particular concern are children who have already had hypoglycemic episodes. One study showed that 80% of hypoglycemic episodes occurred among the 20% of children who had recurrent events. I think you should check, if not done yet, blood sugar levels in the night around 3 to 4 a.m. If low, even not in the hypoglycemic ranges, you should nevertheless keep your daughter’s blood sugar in the higher ranges and also try to avoid hypoglycemia at the expense of allowing worsening glycemia in order to reduce the risk for fits. Please consult your daughter’s diabetes team about these fits. A neurological consultation seems appropriate to me as well.