Been seeing a CDE and she has been amazing. Have felt on track, although I do have lows. However, needed to visit my endo so she could write scrips for pump supplies. Took 4 months to get an appointment.
She thinks my 5.6 A1C is too low–always has. Today she told me that brain cells live on glucose, and low BGs cause Alzheimers. Then she went on to tell me about a doctor who kept his BGs low, woke up as a quadriplegic, all caused by low BG. She told me it was dangerous for her to prescribe insulin yo me–she doesn’t–only pump supplies. I think she would categorize me as non-compliant, and refuse to provide scrips for meds.
Her bedside manner is horrific.
I do think I run low a lot, and have been working on it. But getting my A1C over 7—so not in my wheelhouse.
How bad and what is the frequency of your hypoglycemia? Do you ever need the help of someone else when you’re hypo? Have you caused any 911 calls due to hypos?
If your hypos are not too many or too deep, I’d ask your friendly CDE for an endo recommendation.
One of the reasons that I wear a CGM is to provide concrete evidence to my doctor that demonstrates that my lows are not overly risky. I spend less than 5% of my time below 65 mg/dl and over 2/3 of that time is above 55 mg/dl. I rarely go into the 40’s.
Did you know that non-diabetics spend about 5% of their time in the hypo range?
I’m in the camp that says the lower the A1c, the better. Provided you’re not taking undue hypo risk.
Good to see you back. Low blood sugars don’t cause Alzheimer’s, I don’t know where she got that from. There is thought that high blood sugars might play a role. If you PM me I’ll give you the name of my endo who won’t give you such a hassle.
Not only do lows not cause Alzheimer’s, but the brain doesn’t need glucose in the diet in order to maintain its supply. The body is perfectly capable of manufacturing the glucose it needs.
I’m also in the low-is-better camp. Given that a normal non-obese, non-diabetic, non-pregnant person will most often have an A1c somewhere in the 4.5 to 5.0 range, I can’t in good conscience view 5.6 as dangerous—unless you are only able to maintain it by experiencing frequent serious lows. Serious lows are bad news for all kinds of reasons, irrespective of any fancied connection with Alzheimer’s.
This isn’t directly relevant to your question, but it’s worth mentioning in passing that the brain maintains its own private 15 to 20 minute emergency supply of glucose. Too bad it can’t do that with oxygen too.
For this study, researchers at the University of California, San Francisco, studied 783 elderly men and women (average age 74) with diabetes. During the 12-year course of the study, about 8 percent had at least one episode of hypoglycemia, and 19 percent had developed Alzheimer’s or another form of dementia.
The researchers found that those who’d experience a serious episode of low blood sugar had twice the risk of developing dementia (34 percent vs. 17 percent) than those who never had a hypoglycemic episode. The increased risk persisted even after the researchers controlled for such factors as age, educational level and other medical problems.
Similarly, study participants with dementia were twice as likely to experience a severe hypoglycemic episode than those who were dementia-free (14 percent vs. 6 percent). It may be that those with dementia and diabetes do not control their diabetes as well, so are more prone to getting to the point where their blood sugar levels become dangerously low.
“Hypoglycemia commonly occurs in patients with diabetes mellitus and may negatively influence cognitive performance. Cognitive impairment in turn can compromise diabetes management and lead to hypoglycemia,” the authors wrote.
Sources: Kristine Yaffe, MD, Cherie M. Falvey, MPH, Tamara B. Harris MD, et al: “Association Between Hypoglycemia and
Dementia in a Biracial Cohort of Older Adults With Diabetes Mellitus.” JAMA Internal Medicine. Published online June 10, 2013. doi:10.1001/jamainternmed.2013.6189.
While I initially achieved my low A1c (4.9-5.2) with frequent lows, I have never had particularly severe lows, and have never needed assistance from someone else to recover fro ma low. (Well, never is a long time… I did solicit my son’s help with a low once, when I had the flu – but that was more because I didn’t want to move from my bed, due to the flu, than the seriousness of the low.) My last A1c has just come in at 5.0 – and that was with just 1.0% lows, none below 50.
I have had two different endos and have talked with my PCP about my diabetes. Despite the lows I used to have, none of my endos, or my PCP have told me that my A1c was too low or dangerous in any way. One doctor was concerned that I was giving myself anxiety trying achieve those numbers, but none were worried that I would suffer from complications from frequent lows.
According to the Alzheimer’s Association, the risk of developing Alzheimer’s if you live to age 75 is about 19% among the population at large. That being so, the UCSF result strikes me as not statistically meaningful. I would have to much see more definitive studies (more than one, to confirm that the result is not an outlier) before giving the hypo theory serious credence.
This was not a “live” study but a statistical one arrived at by number-crunching someone else’s database (Kaiser Permanente’s). In their own words, ”A possible weakness is that our dementia diagnoses are based on clinical diagnoses obtained from electronic medical records, rather than the results of standardized neurological assessments administered periodically to all cohort members. Another potential concern is that due to the observational nature of our cohort study, we cannot be certain of the temporality of our findings, and cognitive problems due to undiagnosed dementia may have contributed to the occurrence of hypoglycemia.”
They freely admit that other studies (some much larger) have not reached the same conclusion: “. . . results from the Diabetes Control and Complications Trial found no association between acute hypoglycemia and an accelerated rate of cognitive decline.” And, “Numerous studies have evaluated whether hypoglycemia interferes with cognitive function, and some of these studies suggest that hypoglycemia affects certain cognitive domains while others found no effect.”
They looked only at severe hypoglycemia, i.e., “hypoglycemic episodes severe enough to require hospitalization or an ED visit”, not the milder lows that most diabetics experience.
When speculating about causation, the language is carefully hedged with conditional phrasing such as “could increase”, “may accelerate”, “possible mechanism”, etc.
They are at pains to point out that there were variables they could not account or adjust for, e.g., “it was impossible in this study to adjust for subclinical cerebrovascular events”. Probably this was again because they were crunching previously compiled data and were limited to what had been collected, but whatever the reason, they are careful to mention it.
So, interesting food for thought? Yes. Conclusive? For me, the jury is still out. So once again . . . “maybe”.
It depends a lot on where you live. In some places, R and NPH are available without a prescription. I started insulin on my own, because where I live you can. My doctor (who is great) got involved later. You need to find out what the law is in your locality.
I think it is more dangerous not to prescribe insulin to you obviously. I have never heard of the link between lows and alzheimers or if I did I had forgotten- no joke intended here, lol. I am very forgetful and I don’t think I have any form of dimentia yet.
I do worry about the effect of lows on me though, I tend to drop very low when I sleep sometimes. I was just looking at my dex pics today when deleting photos off my phone and I was worried by how many times that happened this summer. I’m also concerned about how I feel like I’m getting brain damage when my bg is high for hours and how hard it is to think and function.
When I wake up from my sleeping lows my bg is often normal or higher but I know when I feel very groggy that I was probably really pretty low so it kind of sticks with me through the day.
I also don’t feel most of my doctors are on my side at all.
So I have had books and my son found in one that possible Alzheimer’s could be Type 3. Lack of insulin in the brain. I have had sugars all over place lately and I’m very disoriented and can’t remember in the moment or from second to second.
