November 5, 2000
Hypoglycemia
Question from Mahwah, New Jersey, USA:
My husband, aged 29, has type�1, diagnosed three years ago. He recently has had two seizures in the middle of the night. During the first one, the paramedics did a fingerstick and his blood reading was 40 mg/dl [2.2 mmol/L]. His first seizure was very characteristic of a grand-mal seizure with jerking and convulsing. However, during his second seizure (six weeks later) his blood reading was 120 mg/dl [6.7 mmol/L], by the paramedics once again. There was about 10 minute lapse time between when he started seizing and when the paramedics tested his blood. No glucose was given on the second seizure because his blood glucose was rising by itself with no intervention. This most recent seizure was very different from the first as he was very stiff with arms crossed in front of his chest, and he was aspirating and foaming at the mouth. Is it possible that he seized due to low blood sugar and somehow the level raised to 120 mg/dl [6.7 mmol/L] within 10 minutes before he was tested?
We are now seeing a neurologist who believes the seizures (particularly the second one) are not related to diabetes. My husband is being tested and treated for epilepsy, even though his CAT scan, EKG, EEG, and MRI are all normal. Our endocrinologist thinks otherwise. What are the classic movements/symptoms of a severe hypoglycemic seizure in contrast to an epileptic one, if there is a difference?
Answer:
I think he has to have the full work-up for seizures, even if he had hypoglycemia. You wouldn’t want to miss another cause. It is possible that the sugar rose during the course of the second seizure. It may have been low originally, but you may never know. There is nothing specific about a seizure that occurs with hypoglycemia versus other causes. The nerves in the brain are required to use glucose as their source of energy. Without it, they don’t function properly. Even though your endocrinologist may be correct, I would still listen to what your neurologist says about other causes and make sure they are ruled out.
Seizures and epilepsy are nonspecific terms which refer to the same event, even though there are many different causes.
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.
WWQ]
