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December 30, 2005

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Question from Las Vegas, Nevada, USA:

My friend has type 2 diabetes and also Hepatitis C. For a short time, he did take pills for his diabetes, but not now and he takes no medication for the Hepatitis C. He smokes cigarettes, probably one-half a pack daily. Over the last few months, my friend has had periods of mild confusion, forgetfulness, which at times he is aware of, and it is bothering him greatly as he is not used to confusion, etc. His blood sugar yesterday was around 250 to 270 mg/dl [13.9 to 15.0 mmol/L]. This is a most difficult answer to come up with for you, but could the confusion, forgetfulness, etc., be a combination of both disease processes or each disease individually? If placed on medications for his diabetes and the confusion clears, will we then know it was mainly diabetic encephalopathy? Which comes first the chicken or the egg?

Answer:

Encephalopahy is a very generic term that amounts to brain malfunction. There is a form of hepatic encephalopathy that could occur as a result of cirrhosis from chronic Hepatitis C. There is also the encephalopathy of diabetes that may be related to poor blood sugar control, but it also may represent cerebrovascular disease from stroke or multiple small strokes. Stroke is a very severe chronic complication from diabetes. Finally, there may be increased risk of other forms of dementia from long-standing diabetes. It is important that your friend go to his physician and have each of these components addressed as it is not obvious which process is operative to give him his symptoms.

JTL