Low BG is Not Life Threatening?

Type 1 and LADA
1

I’ve been reading a discussion (Living Alone w D + Low bgs) and am getting conflicting results.

There are many T1Ds out there who believe that having a low blood sugar, including a seizure, while sleeping is not life threatening. That you cannot die from this.

I strongly disagree, as do many other doctors and specialists in the field.

While it’s not something that I worry about every single day, it is still something that is kept in the back of my mind. The lowest I’ve SEEN for my BG is 19. I know (and it’s been documented) that at 10, we would go into a coma. Comas are life threatening.

I know that our bodies tend to take care of themselves, but the whole point is that insulin is manufactured. It is created by man and it takes no regard for what the human body is actually doing because it not bulit to react to our bodies. The insulin is pretty robotic. (please tell me if I’m wrong as I enjoy learning new factual details)

So, I’m wondering if maybe I’ve gotten wrong information?

I know that I actually DO owe my life to my family members, as I’ve actually been in insulin shock comas. So, what I’m not understanding is how so many people can believe that it’s not life threatening to have extremely low blood sugars whlie sleeping?

I’m also concerned that many T1Ds are so blase about seizuring while asleep. I do not want to give the wrong impression to newly diagnosed T1Ds, letting them believe that if they leave their lows untreated, they will be fine.

Does anyone else have thoughts on this?

Thanks,
Marps

2

At a certain point, the liver dumps a whole lot of glucose into the blood stream. I think the BG level at which this happens varies with different people and also varies depending on age, past hypo experiences, etc. So, if you are only on a basal and go into a hypo when asleep, chances are that your liver will trigger the glucose dump and you’ll be fine. Things get serious if your hypo is the result of too large a bolus/too little food for the bolus you took. Then, even the liver’s glucose dump may not be enough to counter the insulin coursing through your blood.

3

I’ve been in the single digits multiple times, and I’ve recovered on my own. I really have no way of knowing, but all I can say is I’ve been below 20 many, many times, and I’m still here. I’ve had seizures hundreds of times – they’ve only been treated by paramedics maybe 20 times, and the only reason paramedics were called in was that someone saw. However, I have heard urban legend stories of diabetics who die from it. But, it’s always someone’s friend of a friends. If you can show me a documented case of someone who died of a severe low, I will believe. However, I tend to think that’s someone who is older (no offense to older people, but a lot fo stuff is harder on the body when you’re old). It’s harder to come back from a hangover then too.

Based on your a1c and things you’ve said, Marps, it sounds like you might have something of a fear of lows, which, to - each his own (though, maybe not, I don’t know you that well). But I can tell you, every single time I’ve had life-threatening hypoglycemia episodes, my body will make sugar.

Obviously, it shouldn’t get that low, but you’re asking if it kills. And the only time I’ve heard a low be deadly is when a diabetic kills themself while driving (I don’t have a car, so that’s not a problem). Also, the paramedics, every single time, tell me that it can and will kill me. (They usually say, “If this had happened and no one had called it in, you would be dead.” Which, no. I would be alive. However, that’s probably also because my body is so used to making sugar for me, that it’s pretty good at pumping the stuff out.)

Anyway, I really have no idea. They probably can and have killed people, but they haven’t killed me, and I’ve had a LOT of very severe lows. (Again, don’t emulate me, I’m just stating fact.)

(Btw, I keep editing this thing, sorry.)

4

Hi Anna

Thanks so much for your feedback. I guess this really does point out the fact that every body is different and relates to the stresses of T1D in their own manner.

I do have a fear of lows, but have been trying to get my A1c down anyway. The most times that I went low while sleeping was when I was taking Lantus. I’ve since come off of Lantus and am doing much better.

My A1c is high for a number of reasons- insulin resistance and antibodies against all but two short acting insulins (Humalog and Apidra are the only ones that work for me now). But, I will agree that I do have a minor fear of lows while sleeping. If I’m low while awake, it’s no big deal- I can treat it, but I am scared of laying the burden of my sleeping lows on my family and fiance. I don’t think it should be up to them to save my life. It just seems like too much. But, ultimately, I don’t attibute my high A1c to my fear of lows. It’s more of a constant battle to get my BG down with the short actings that are left for me to try.

I think I read earlier that you live in Alaska. This is kind of off topic, but I was planning a trip to Alaska for next summer. I love the pictures and stories on that state (I’m from Massachusetts) and am really excited to go! Any cities that I MUST visit?

Again, thanks for your feedback. It’s appreciated.

Marps

5

Hi John

Thanks for your input. I think I agree with you on the basal vs bolus overdosing. Though, I did have trouble while I was on Lantus (basal) with overnight lows.

I hope my body forever tries to keep me alive. I’ve got a lot to accomplish!

Marps

6

This is what I can offer to this discussion: Below I have copied two articles from websites that discuss brain death and neural death as a result of a prolonged hypoglycemic incident. I could not find any empirical evidence suggesting that physical death as a direct result of hypoglycemia is possible (i.e. someone’s blood sugar went low, they went into a coma, they died) but I only spent 5 minutes on google just now looking.
John is somewhat correct in stating that at certain BG levels the liver dumps reserve deposits of sugar to help raise blood sugar, however, there is plenty of empirical evidence that mentions two things: 1) This is not always true for everyone (meaning you are playing Russian roulette with your health by depending on your liver which next time might decide not to release the sugar), 2) And much more importantly Studies have shown that when the liver releases this reserve glucose the glucose levels in your blood rise far to rapidly causing extensive neural and brain damage. Researchers have found that a gradual increase of glucose (from glucose I.V. drips, tablets, liquids, etc) are far safer for treating hypoglycemia.
Anna, I’m sorry but it appears to me that you don’t exactly understand how severe low blood sugar can be to you. There’s a very good chance that next time you have such an episode you won’t wake up from it at all. Being dead and being brain dead to some people is like comparing apples to motorcycles, to others it’s more like red apples to green apples. I was always told that the diabetic golden rule is “Hypoglycemia kills you now, Hyperglycemia kills you later.”

One final thing I’d like to say is that neither low nor high BG is a normal state for the body to be in. Healthy, non-diabetics do not have low or high BGs. While their BG fluctuates just like everyone elses it stays within normal parameters. Allowing your body to reach the point where it needs to take emergency measures to prevent damage (whatever damage that may be) is not safe or healthy. If it were as simple as “my BG is low, i’ll just pass out for a few minutes and wait for my liver to take care of it” we wouldn’t have the entire scientific community up our butts telling us what to look for and how to treat it before it gets worse.

Hypoglycemia, functional brain failure, and brain death
Philip E. Cryer
Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, Missouri, USA.
“Hypoglycemia, including iatrogenic hypoglycemia in people with diabetes, causes brain fuel deprivation that initially triggers a series of physiological and behavioral defenses but if unchecked results in functional brain failure that is typically corrected after the plasma glucose concentration is raised. Rarely, profound, and at least in primates prolonged, hypoglycemia causes brain death.”

New findings on hypoglycemic neuronal death
4. April 2007 11:04
Treatment with insulin revolutionized the life of individuals with diabetes. However, because insulin acts to lower blood glucose levels, it can cause hypoglycemia (low levels of glucose in the blood), which, if prolonged, can lead to brain injury and coma.

Although most brain defects can be corrected by restoring blood glucose levels to normal, extremely prolonged hypoglycemia can cause the death of neurons and irreversible brain damage.
Copied from: http://www.news-medical.net/news/2007/04/04/23103.aspx

The TUdiabetes administration might want to come in and cover their behinds if people are going to be commenting here and making light of low BG.

7

For me the threat doesn’t seem to be death from a hypo coma, but having a hypo and not noticing it. Like while you are driving your car. Or using a power saw. Or… the list goes on and on. From that perspective they can certainly be deadly, not only to yourself, but to others

I guess in the sleeping case, I would worry that I might try to walk to the kitchen and fall down the stairs or try to get in my car… its not one of our most rational moments

8

Pavlos

Thanks for your input. I was hoping someone was going to “back me” on this topic.

I just am afraid of so many veteran T1Ds taking lightly the risks of low BGs will affect the newly diagnosed T1Ds- causing them to believe that it’s not a big deal that they’re in the 30s and lower while they’re sleeping.

Basically, there is no safe-guard against death.

Marps

9

Me personally? While staying within the parameters you set I’d say that I suggest people do the best they possibly can to keep their numbers between 80-120. If night lows is a common occurrence for someone he/she should set the alarm clock and test their BG at specific intervals to try and discover trends leading to those lows. Perhaps a new insulin is in order, or a new dosing schedule. Where there’s a will there’s a way.

Just because you haven’t died or had permanent damage yet doesn’t mean it won’t happen eventually. I stuck a knife in a wall socket once and I survived, does that mean that I should allow my daughter to do it too because nothing happened to me?
If that example is too extreme then how about this. I speed a lot in my new car. Driving on the highway I average 100 mph on my slow days. I haven’t got caught once. Should I keep doing it expecting never to get caught? Or should I take action and decrease my speed before I do get caught or kill someone (driving too slow and carelessly)?

10

I agree with Pavlos on the middle of the nite testing. I know you’re not pumpers Rainbow and Marps, so please don’t take offense, but the biggest obstacle to controlling my overnite numbers was MDI. Personally, I have 4 different basal rates set and I just don’t believe I could ever have gotten that type of control with a long acting insulin. I was on Lantus, but I can’t imagine Levamir being much different

11

so I guess you took offense, sorry

12

I know about CGMs not being covered, but I hadn’t heard of pumps not being covered by insurance. I can’t even imagine what justification they would use for that. If they aren’t covering them for you it might be because you have to meet certain criteria which even if you don’t your endo can help “fake” on paper.

Anyway, I don’t mean to cause any hurt feelings so enough about the pump.

13

Here’s some background reading about severe hypoglycemia in type 1s and why it is of concern:

Glycemic Control and Hypoglycemia: Is the Loser the Winner? “… One such consequence, recurrent hypoglycemia, has been linked to neuronal and retinal cell death, reductions in gray matter, persistent cognitive dysfunction, and even developmental growth deficiencies (24–27). The Diabetes Control and Complications Trial (DCCT) was initiated in 1983 to examine the beneficial effects of tight glycemic control on reducing diabetes comorbidities. The study’s principal finding was that intensive therapy selectively reduced diabetes-related complications compared with conventional therapy (28). However, improved glycemic control came with a cost: severe hypoglycemic episodes. Severe hypoglycemic episodes—those requiring assistance of another individual to avoid or respond to seizure or coma—occurred three times more often in the intensive therapy group. Hypoglycemia was a factor in the deaths of at least three individuals participating in the DCCT and was found to contribute to 2–4% of deaths in diabetic patients (28,29).”

“One important conclusion from these studies was that hypoglycemia was not an equal opportunity outcome. Moderating these outcomes are age, sex, severity of hypoglycemia, number of such events, certain diabetes and hypertension medications, and disease duration (13,14,30–32).”

“The longitudinal study by Musen et al. (43) featured in this issue of Diabetes Care concluded that despite many severe hypoglycemic events, there was no measurable decline in cognition over ∼18 years. While their summary is generally accurate, more detailed examinations may be inconsistent with their conclusion. First, potential participants were excluded from the DCCT if they had a history of severe hypoglycemic reactions, thus limiting the generalizability of the study. Second, 74 individuals chose to discontinue their participation in the Musen et al. study (43), and only 18 of these individuals were accounted for, leaving 56 potential participants unaccounted for. Perhaps these 56 people suffered from more severe hypoglycemic events and/or related cognitive deterioration and terminated their participation. Thus, this discontinuance may be an instance of nonrandom dropout. To further address this possible source of bias, the presentation of complete baseline data for the dropouts would have been useful. Third, it was unclear how old the individuals were when they experienced each severe hypoglycemic episode. Fourth, the statistical support for evaluating the possible synergistic effects of hyperglycemia and hypoglycemia on cognitive function was not reported. The association between elevated A1C and poorer cognitive performance gives more urgency to the possible association of cognition with hypoglycemic and hyperglycemic episodes (28,43,44). Finally, the adolescent sample was of above-average intelligence at the start of the DCCT (IQ ∼110) and included relatively few minorities. In summary, despite this study’s wealth of data, the relationship between hypoglycemia and cognition remains somewhat difficult to decipher.”

Epidemiology of sever hypoglycemia in the DCCT: Intensive glucose therapy resulted in tripling of severe hypoglycemia for those studied with insulin-dependent diabetes.

14

clever . . .

15

She from Canada and the coverage is different there

16

and also, seizures are known to induce vomiting, if you happen to be laying on your back…

17

Rainbow:

Most Insurance Companys do cover pumps. Try ManuLife.

I think I mentioned this before. Four Provinces have now given free pumps and accessories to Diabetic Children. The BC Kids have recently received free pumps. It is only a matter of time before the BC Adults receive their free pumps and accessories like they have in my Province(Ontario). Our Gov. is supposedly going to cover pumps for all Diabetics right across Canada. It takes a bit of time. It’s a Big job.

18

I have been feeling the same way, Marps.

I was reading an article just the other day about a non-diabetic who was given an injection by his wife and caused him to go into a hypo-induced coma and die. She was the diabetic and turned around and killed herself the same way. Of course, they were large doses and he had other medical problems. It was a suicide in order not to go live in a court-ordered assisted living facility and they were both elderly.

But still, to claim that it won’t kill you seems to possess some kind of knowledge about the future and our bodies that I would say none of us can claim to possess. If your liver doesn’t rush in and “save” you, if your heart has a problem, if you vomit in your seizure, if you hit your head on the nightstand, if you…etc… The lax attitude toward nocturnal lows and accompanying seizures seems - and this is likely going to get me yelled at - irresponsible and foolhardy.

19

One 18 year , I knew ,died in her sleep , one 47 year old , I knew died in her sleep ( possible heart problem connection , however she was a marathon runner ) , a 22 year young woman , whose sister I know died in her sleep , a 25 year old chap , whose friend did the 1/2 marathon with me ( Team Diabetes Canada ) died in his sleep …all in the last 3 years. I think lows are life threatening without me having to read medical journals .
Pumps are available in Canada through insurance , however the insurance rate maybe high , if one does not have help through one’s employer .
Terrie , I wonder if I read/understood incorrectly …you stated " our Gov.is supposedly going to cover pumps for all Diabetics right across Canada " …Health care is a Provincial matter, however the Feds do give $$$$ to the Provinces …if you ment the Federal Government would cover pumps , then can you clarify , please .
An opportunity for concerned people touched by diabetes is to lobby governments through the Canadian Diabetes Association www.diabetes.ca. I know the system works , sometimes slowly …signing off as an advocate with the CDA .

20

Hi Marps: Here’s Melitta the science geek, back with her fun (or in this case not so fun) facts. When I was first diagnosed with Type 1, the statistic going around at that time (1995) was that 6% of Type 1 diabetics died of hypos, usually nighttime hypos. On the Children with Diabetes website, they use the term “dead in bed.” Death from hypo is indeed reality. My apologies in advance to Rainbow, but I have found that I have FAR FEWER nighttime hypos on the insulin pump.