August 4, 2004
Question from Leonia, New Jersey, USA:
My daughter is nineteen years old with type 1 diabetes, initially diagnosed at age eight. She was just released from the hospital last night for a one time idiopathic episode of violent behavior which required her to be restrained. She was extremely combative, biting and kicking and required handcuffing and sedation en route to the local emergency room. The original episode began when my son and I were awakened around 7 a.m. hearing loud noises downstairs. My daughter appeared at the bottom of the stairs disoriented and not violent. Her initial appearance was similar to a automatic hypoglycemia response that may have awakened her to get some juice for treatment. However, when I attempted to talk to her, she was non-responsive, and I was unable to find her meter to check her blood sugar immediately. Since we were unable to find the meter (she handles her diabetes very independently) and she couldn't tell us what was going on, I proceeded to assume that hypoglycemia was the initial cause. She wouldn't drink so we called 911. She started to become combative by the time the paramedics came. Although she is not a big girl, they could not restrain her due to her strength, presumably due to an adrenalin rush. When they able to restrain and sedate her, about 15 to 20 minutes later, they checked her blood sugar it was 110 mg/dl [61 mmol/L]. They concluded it was non-diabetic episode. Her toxicology screening was negative as were an MRI, EEG and CAT scan. Her A1c was 8.6. She has also been having major headaches for the last few weeks. She has a full college work load and is working part-time. They released her with no explanation of what happened. She has no recall. We have an excellent endocrinologist at the Columbia Presbyterian Naomi Berrie Diabetes Center in New York City who was very surprised to hear of this event, but felt it was diabetic related. However, this bizarre and frightening episode is distressful in regard to questions regarding her being alone which will be happening while I am on a medical seminar and my son will also be out of town. She is resisting us having someone stay with her. In your opinion can this be diabetic related? Can it be preventive? Can it be neurological? She had a neurological consultation and the neurologist felt it was not and suggested maybe biofeedback may be next step. Sleep walking combined with a hypoglycemic episode was rejected. My daughter indicated she felt she was in a dream and people were holding her down not knowing why. I will do anything to gain more knowledge and get involved in research to further investigate this phenomenon.
It does not sound like it was related to a hypoglycemic episode. However, I have seen people respond this way with low sugars. The low glucose value is the only thing that is missing to make you think it was. I do not think you can say anything about whether it will recur or can it be prevented when you do not know what caused it in the first place. There are many issues that remain unknown. Is there any follow-up with a neurologist or psychiatrist to keep an eye on this? Atypical seizures can occur like this, but the neurologist should have something to say about it after having had an EEG. Until more is known, it seems reasonable to have her around someone to look after her if this were to recur.