I had an appointment with a dietitian today and was surprised to learn that running low can have long-term negative effects, beyond just making someone unable to detect lows. I know long-term hyperglycemia has negative consequences, but had never heard of problems from hypoglycemia. Has anyone else heard of this, and if so, what are the side effects?
My understanding is that those complications are due to the secondary complications of severe hypoglycemia (seizure, coma, or other events that interfere with the cardiovascular and nervous systems), not hypoglycemia itself.
I haven’t seen any studies or actual research but had heard (can’t even remeber where so take it for what is is worth) that hypoglycemia is proposed to hasten the development of dementia but until I see some research it is not something I put a whole lot of stock in.
One doctor mentioned once that it kills brain cells, sort of like drinking too much. I didn’t look it up or research it or anything like that.
I have heard that it can cause memory problems & such, but I have never seen a study showing that it actually does.
Here’s come recent research
Hypoglycemia was long considered to kill neurons by depriving them of glucose. We now know that hypoglycemia kills neurons actively from without, rather than by starvation from within. Hypoglycemia only causes neuronal death when the EEG becomes flat. This usually occurs after glucose levels have fallen below 1 mM (18 mg/dl) for some period, depending on body glycogen reserves. At the time that abrupt brain energy failure occurs, the excitatory amino acid aspartate is massively released into the limited brain extracellular space and floods the excitatory amino acid receptors located on neuronal dendrites. Calcium fluxes occur and membrane breaks in the cell lead rapidly to neuronal necrosis. Significant neuronal necrosis occurs after 30 min of electrocerebral silence. Other neurochemical changes include energy depletion to roughly 25% of control, phospholipase and other enzyme activation, tissue alkalosis and a tendency for all cellular redox systems to shift towards oxidation. The neurochemistry of hypoglycemia thus differs markedly from ischemia. Hypoglycemia often differs from ischemia in its neuropathologic distribution, a phenomenon applicable in forensic practice. The border-zone distribution of global ischemia is not seen, necrosis of the dentate gyrus of the hippocampus can occur and a predilection for the superficial layers of the cortex is sometimes seen. Cerebellum and brainstem are universally spared in hypoglycemic brain damage. Hypoglycemia constitutes a unique metabolic brain insult.
Another…
The normal range for blood glucose concentrations is 3.9–7.1 mM (1 mM = ∼18 mg/dL), and hypoglycemia is broadly defined as blood glucose concentrations below this range. Studies using mice and rats indicate that brain injury does not generally occur unless blood glucose concentrations fall below 1 mM and the cortical electroencephalogram (EEG) is isoelectric (silent) for at least 30 min (Auer et al. 1984a, b; Auer et al. 1985a, b; Suh et al. 2003).
Another done in rats in 2011…very interesting…basically states if you are hypo all the time you are less likely to lose brain cells then one server hypo every once in awhile
Antecedent recurrent moderate hypoglycemia preconditioned the brain and markedly limited both the extent of severe hypoglycemia–induced neuronal damage and associated cognitive impairment. In conclusion, changes brought about by recurrent moderate hypoglycemia can be viewed, paradoxically, as providing a beneficial adaptive response in that there is mitigation against severe hypoglycemia–induced brain damage and cognitive dysfunction.
Where is the link to the actual study? I like to see who does it, whether they are studying 10 people or thousands of people.
Every scholarly article on the subject since 2009
Isn’t that what happened to Sunny von Bulow? Her husband allegedly injected her with a lot of insulin, and she went into a coma from which she never recovered.
Can you actually cite a real study? I clicked on several – there were studies on rats, one was for elderly Type 2 people, one was one man had brain problems after being low for a prolonged state … nothing what I would consider “proof.”
Yes, she was supposedly injected with insulin by her husband and never woke up from her coma.
I would suspect that there aren’t any studies proving the damage either, because there’s no one with “the right stuff”, willing to “light the candle” and study people with hypoglycemia, because it is so dangerous, cough cough. During the recent cardiac scare I had, it made perfect sense to me, given my history uh, partying, that getting loaded out of my gourd on insulin might make my heart beat a bit strangely. Everyone would say “maybe, but you could go see a cardiologist for another $15K, just to see if there might be something that the first $15K worth of tests didn’t find…”.
I don’t think they actually induce lows though. The one I looked at with the elderly T2s, they tested memory before the start and after they were done. It was more like they said they had lows – I don’t think they were actually encouraged to go low.
With a lot of studies, I wonder what is the control like for these people? Since most people don’t manage to meet the goals, is it high blood sugar causing the problems?
Gen. Chuck Yeager didn’t break the sound barrier by saying he broke the sound barrier!
Another POV? They are just protecting you and the rest of the world…
-IF you run Too low and go hypo while driving a Car? Whan can happen?
-Your Cutting stuff up for Dinner and go hypo, and that knife is now cutting your Fingers.
-Your Out jogging and go hypo and Pass out on some Trail… not found for Hours
-Thus they have to be more Flexible and not tell you to run Tighter Control, Running tighter control leads to more Hypo’s and unless your testing 8-12x a day? I wouldn’t even try it…
-And tight control requires a Routine and very little Deviation from that routine to get Optimum results…and doing everything just right and having alot of Self Discipline…and Consistancy…
-I ave 2 Near Hypo’s a Day… But by catching them early ( in the 70’s) 1-2 hrs after a bolus, I take glucose tabs for head them off at the pass…
-But when I am not in a Controlled Envirorment? I do not go for tight control and let them run in the 120-140’s
-Thus it’s Russian Roulete going for Tight control with current systems and Insulins when your outside your home and not in a controlled enviroment.
But , since it is about all we, as Insulin D’s can do to head off getting those complications, is to strive for Non D levels… But the secret is? Good BG’s Isn’t the only thing , that Effects our Getting those Complications . it’s our having our Resistance reduced dramatically and other Things going on that they just don’t know yet…
It’s only “Russian Roulette” if you don’t have enough test strips. Which seems to be an ongoing problem for quite a few people.
One thing my endo mentioned was some research (I think it’s fairly recent research) that shows some correlation between repeated hypoglycemia and heart disease. I have not done any research into this myself, but might look into it. This is one of those really frustrating aspects of D…some days I feel like I’m damned if I do, and damned if I don’t. Just no winning with this disease!
John Walsh’s “Pumping Insulin” briefly touches on this in an earlier chapter. From my memory it goes something like this: Brain cells really like glucose and get mad fast when there is not enough (hypo feelings and stuff). The rest of the body can cope with it much better. Repeated hypos have been noted to cause short term memory loss, like forgetting people’s names that you just meant.
This happens to me all the time. I will not remember a new person’s name 2 minutes after I met them no mater how hard I try to remember. Does this happen to any other veteran diabetics?
Pumping Insulin also adds: It is a theory that the brain “adjust to lower” BG from hypos and this may cause hypo unawareness.
Concerned about running too low and further decreasing my ability to remember things like new people’s names I asked my endo about it this year. Her response seems very justifiable and legit, but impossible (for me) to prove. She said that you will find that the short term memory can suffer. She said that you start damaging your brain when you have a BG lower than what a normal person would run. I normal person can and will have fasting BGs in the 60s, therefore you are damaging your brain when you get your BG into the 40s and 50s.
I also logically surmized that you damage your brain more the longer and/or lower you go (I did not as for my endos opinion on it though).
Well after getting my A1c down to low 6’s because of the control I have with my Dexcom all during Covid, I am going in today to have stents put in my vertebral (internal head arteries). I can’t count how many times I’ve let my blood sugars get below 60 for a few minutes because I new exactly where I was with my cgm. I hope research can figure this out for all of us.