In my last blog, the risk factors, symptoms, and treatment of hypoglycemia were discussed. Today I want to continue talking about hypoglycemia and some of the long-term effects from recurrent episodes of hypoglycemia. I believe many times this is a neglected topic for discussion.
It seems a lot of research has been done on this topic in the early 2000’s but I couldn’t find a lot of information published in the past 5 years. We know persistently high blood glucose values can contribute to diabetes complications, but have we been told a lot about the long-term effects of persistent hypoglycemia? If your A1C is 5.5 is that good or bad? While the number looks great, if may not be good if you are having repeated hypoglycemic events.
Recurrent hypoglycemic (RH) events can affect our ability to process information or perhaps better known as Brain Fog, our quality of life, our heart as well as our mental & emotional well-being.
Hypoglycemia and the brain
Sugar is the brain’s main source of fuel. Brain fog describes changes such as decreased concentration, mood swings and memory problems to name just a few. Earlier studies have shown that knowledge scores were lower in children with diabetes who had repeated episodes of hypoglycemia compared to those with fewer events. An increase in dementia has been suggested for older patients who suffer from recurrent hypoglycemic (RH ) episodes. Some readings have concluded that there is little or no evidence for a long-term deleterious impact on RH episodes on brain function. The fear of “brain damage” is a real one and for many people it is a limiting factor to gain good diabetes control (avoid intensive treatment).
Speaking from experience, my health care providers have always dealt with managing my episodes of severe hypoglycemia first before dealing with the higher values. I always get rebound hyperglycemia or I had overdosed with juice in my early years of hypoglycemic management. We need to take this possible effect on our knowledge and understanding capability seriously. The nature of the relationship between severe hypoglycemia and its effect on brain function is still not clear. Until we know more, we must aim for safe blood glucose levels.
Hypoglycemia and the heart
Hypoglycemia can have profound effects on our heart function. Acute onset of hypoglycemia results in the release of epinephrine (hormone in the body) that causes an increase in heart rate, blood pressure changes and raises blood sugar. There is a significant increase in cardiac (heart) workload during hypoglycemia which could prove dangerous in people suffering from any coronary artery disease. Hypoglycemia can put you at a higher risk for increase heart rate, irregular heart rate or sudden cardiac death.
Cardiovascular disease (CV disease, heart disease) is common in patients with diabetes. Frequent low and high sugars influence our heart function. Besides managing our sugars, eating foods low in saturated and trans fats, often found in baked goods, is a wise move. Foods like berries, whole grains, leafy green vegetables are all good things to eat for the heart. We must not forget about exercise, but always discuss this with your health care team before engaging especially if you have heart disease or other complications from diabetes.
Hypoglycemia and Impact on Quality of Life (QoL)
Recurrent episodes of hypoglycemia generates feeling of anxiety, powerlessness, and depression amongst patients and their families. Acute episodes which are short lived result in mood swings, stubbornness and irritability but once the sugar starts to rise, these symptoms usually disappear. It is the long term damage of frequent episodes that can affect your every day life and emotions.
Life skills affected might include:
Your ability to drive safely- a huge loss of independence if this happens. I know it would be for me. This could impact your employment, caring for your family and so many other things only you know about.
Your sleep- being afraid to fall asleep because you don’t want to wake up all sweaty, confused and bother your family at 2 AM to give you juice or whatever you use for your method of treatment. Always keep something at your bedside for easy access.
Your employment- hypoglycemia at work can be awkward, embarrassing and frightening. In some types of work it is totally unacceptable. We often read about truck drivers who can’t do long hauls because of hypoglycemia risks. I’ve heard stories where they have to show they have been hypoglycemic free for several months and have shown improved control before they can resume normal duty. Think of the impact on your emotions and your family’s livelihood if this happened. I plan to discuss Driving and Diabetes in a future blog.
Lack of activity- for fear of hypoglycemia during or after the exercise. Understanding how exercise affects your diabetes is complicated. Again there are guidelines for how much to eat before, during and after depending on the duration and intensity of your exercise as well as the timing in relation to your next meal but even this can sometimes fail. Test, test and more testing at all stages of the exercise is crucial and having a quick source of glucose handy is a good practice. Always check and treat before leaving a gym and driving home. Remember, exercise effects can last up for 24 hours.
Your freedom to travel- rapid travel across time zones can disrupt normal glycemia control and increase your risk of hypoglycemia. Wherever you visit, their eating patterns might be different from yours so foods might contain less carbohydrate than you normally would eat at that time of day. Jet lag and fatigue may affect your appetite. Diarrhea /nausea/vomiting might occur from eating a different type of diet or food poisoning. Be familiar with your sick day guidelines and have some spare snacks and medications with you just in case this happens. Travelling in an area where the language is not understood can raise more troubles.
It is no secret that hypoglycemia is an important complication of glucose-lowering therapy in patients with diabetes. Repeated episodes of hypoglycemia can lead to hypoglycemia unawareness, increase risk of heart disease, increase risk of dementia and a decline in our cognitive function as well as our QoL.
If you have any concerns discuss them with your health care team. I am sure they would be more than eager to help you. For myself, hypoglycemia has always been a concern. All we can do is seek help and stand together to conquer this side of diabetes management.
References:
NIH Public Access
#hypoglycemia& storm
#the cloud
This information does not intend to replace information provided by your health-care team.
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