Hypo's and long term brain damage

[donnellysdogs]

Hi Everybody

I don't know whether anybody can help me with this question, but I hope so.

I have been type 1 since 1986, and since diagnosis I have had many hypos's.

5 years ago I was diagnosed with pernicious anaemia after being referred to a stroke clinic at hospital who found I had low B12 and folate levels. I was age 41, and had real signs of dementia, absolute confusion and forgetfulness. I then went on to having 13 weekly B12 injections.

6 weeks ago my new GP undiagnosed the pernicious anaemia as 5 years ago I was not given an Intrinsic Factor test, and one he did for me came back negative. My B12 injections have now been stopped, and all signs of demntia are coming back.......well, today the GP said that he had been reading up on diabetes, hypos and longterm brain damage......and he believes I have damaged my brain from previously having many hypo's.....when I asked him what he classified as hypo, he said that it was basically any level for a type 1 diabetic that measured under 5.0 when testing BG. He said that he thinks my confusion and forgetfulness may be down to having hypos......has anybody ever heard of this?? He also suggested that although my sever hypo's have had a marked improvement for a few years, that the damage may result years later from having bad hypo's.

He has ignored the fact that after my B12 injections started my brain acted a lot better, and he has also ignored the fact that B12 injections can help with diabetic neuropathy, which I also have symptoms of.

Has anybody ever had it suggested to them that hypo's can cause longterm brain damage?

 

[kegstore]

There's quite a vociferous thread active at the moment on the subject of hypos, but if anyone ever suggested to me that below 5 mmol/l was hypo territory, I'd probably suggest they get THEIR head examined. And if that same person was my GP I'd be looking to change practice fairly smartish. 5 is slap bang in the middle of a "normal" blood sugar range. Just because someone has type 1 diabetes, that doesn't change their entire physiology!

There are some cases where extremely low blood sugar has lead to permanent brain damage, but we're talking at MUCH lower levels.

 

[catherinecherub]

There must be a lot of non diabetic people with brain damage according to your Dr's reckoning.

This article about B12 needs to be read by him, http://www.medicalnewstoday.com/articles/172774.php
and you need to ask him why things improved on the B12 injections before you ask at the practice for a change of Dr.

 

[noblehead]

donnellsdogs

I'll be the first to admit that long term brain damage is a major concern to myself. Never really heard it mentioned before until recently, and there seems to be a lot of researcg ongoing regarding frequent hypo's and the effect on the brain.

I would agree with Kegstore, 5 isn't hypo territory in my book, more like below 4. The general advice is to stay above 4, hence '4 is the floor'. My diabetes consultant has confided that he does have concerns with patients experiencing frequent hypo's for the same reasons as we are discussing hear.

Regards

Nigel

 

[cugila]

I am in full agreement with Keg,Catherine and Nigel here.

The evidence for this thinking may not be 100% but after the antic's of some I have witnessed over the years.........it certainly makes you think there might be some truth in the idea.... :wink:

As Keg say's '4 is the floor.' So I too would question the good Doc's sanity at quoting '5', was he just quoting from some ancient text book perhaps ?

 

[jopar]

I would ask your doctor to check your B12 levels are still ok..

The lack of B12 can impair the brains function, presenting similar symptoms at Dementia which the doctor should be aware off, as this is one of the tests they carry out on an elderly person if they start to show signs of dementia, slong side UTI, concipation or if antoher infection is present, called ruling out physical medical reasons...

People who suffer lupus, also can have problems with asorbing B12 needing B12 injections, always know when my friend who has lupus is due her B12 jab by her behaviour...

But medical thought have now starting to indentify and understand the long term impact that frequent hypo's or low blood glucose can have on the long term diabetic brain functioning..

 

[donnellysdogs]

Thanks for the comments everyone, to be quite honest, I don't really care what level the GP thinks is classified as hypo. I think he was balancing it with normal persons and saying that under 5 can cause brain to have less functionality.

My only concern is that my GP thinks my previous hypo's have caused me long term brain damage, and this is reflecting years and years later. I was always made aware of long term damage from raised bloods but I have never been made aware of hypo's causing me long term brain damage. This statement is totally new to me and I would have screamed at the top of my voice to get help with the hypo's a lot quicker had I known I was going to cause myself brain damage further down my life.

I still think it is B12 related but until my levels drop to 'below normal' the GP will not allow anymore B12, despite a lot of people with Perncious Anaemia saying they don't function at 'normal levels' (I didn't think I di) he is going to make me go 'demented' until they fall. The intrinsic factor test for Pernicious Anaemia has only got a 30% accuracy rate, and is not gold standard compared to the tests for diabetes. So the fact that my test came back negative, it has a chance of being 70% inaccurate.

I can see that I will be researching this on the net for the next few weeks till I see him again.

 

[janabelle]

Hi,
I've been type-1 since '89, and experienced lot of hypos and 1 coma. I, like previous poster, have only heard of brain damage being caused by very severe hypos. I've always been lead to believe that if a type-1 is inconscious for over 1 hour, then brain damage is highly likely.
Doctors can make diagnoses without much evidence, as happened to me recently. I was told I had neuropathy in my feet earlier this year; turned out I was experiencing a side-effect of the contrecptive pill. My sister had same prob with her feet when she went on the same pill, and she's not diabetic. The problem resolved when I discontinued the pill.
I was also mis-diagnosed with Fibromyalgia 3 years ago, which has similar symptoms to ME; including memory problems, cognitive dysfunction, exhaustion, pain, sleep problems,etc.
I discovered the problems I was having were again due to a drug side-effect, this time it was my insulin. I was taking Lantus, and the problems had developed since taking it, including erratic BG control, resulting in many hypos and severe illness. Again , the problems were resolved by changing insulin; I changed to animal insulin.
I just wondered, as you are so young, whether it is worth consideration that you may be experiencing a problem with whatever insulin or medication you are on. I don't know what insulin you are on, but many patients report very serious problems and reactions to synthetic insulins, and the new analogue long-acting ones.
This link may interest you. http://www.diabetes.org.uk/Guide-to-dia ... h-insulin/
Best of luck
Jus

 

[donnellysdogs]

Hi Jus

Thank you for your response.

I am actually undergoing tests and referrals and discussions with GP have gone along the lines of a possibility of fibromyalgia.......I am only 46 and have been on synthetic the whold of my 20+ years, and nobody will alter the insulin to human because as the GP's have all said as with my simvastatin - 'I have been on them too long to moan about side effects'. I have wondered whether I get the bad side effects due to the Simvastatins. I have been moaning about pain for past 15 years, and it is only just this GP that has done an ANA test that has come up positive. Even 5 years ago when my rheumatoid factor was over 300-I wasn't informed (and normal level is 14).

I have now got a GP that is referring me to neurologist and rheumatologist now for my confusion, forgetfulness, legs, spine ...basically my brain and pains.

GP I have now is fantastic, but I just didn't have any understanding that hypo's scar your brain and can cause long term damage. I think I have a fair way to go for confirmed diagnosis of my problems, but GP did say he wasn't a specialist and would leave it to the people that are, so, but did state about the hypo's too.

Thanks though, it is another thing to question the neurologist......

Shax

 

[hanadr]

My T1 husband has been T1 for about 35 years. In that time he's had countless hypos, often endong up in casualty, particularly after a change of medication. He's also spent a couple of weeks in ITU with DKA(25 years ago) He DOES NOT have brain damage. He can be pretty stubborn, but he always was.
I'd press to have more investigation done on the B12.
Hana

 

[donnellysdogs]

Thanks for response Hana ref T1 husband...very encouraging.

I really think I know what is causing me problems.....Simvastatin 40mg. GP won't let me come off it, but weighing up the problems with my brain and muscles and the side effects of Simvastatin, this I think is the major problem. GP won't listen to me, I have asked a number of times about the statin. My high speckled ANA can come from drug induced lupus, which comes from simvastatin 'poisoning'. Simvapoison can also give anaemia too....this was diagnosed originally 2 years after statins were given to me. It can take up to 20 years to lose B12 from your liver, but I am now convinced that Simvapoison lowered my B12.

I am going to a rheumatologist and neurologist, and am hoping that they may help me ref the simvastatin. I have stopped taking Simvapoison, as my cholesterol wasn't high when I was put on 20mg, it was just another recommendation for diabetics, which then got upped to 40mg, again as it was found 40mg was 'just as good as 20mg'. I know that reversal of simvapoisoning can take an age, but I have read that I should be taking far higher CoQ10 qtys than I was taking. I have also read that higher Vit C intake can help reduce cholesterol, and if it is simvapoison lowering my B12 then that too should start to come good. I really just want my life back.

 

[cugila]

Has anybody ever had it suggested to them that hypo's can cause longterm brain damage?

DD.

For most people with type 1 and some with type 2 diabetes the body’s ability to produce glucagon during a hypo becomes impaired thereby undermining the bodies next line of defence. However, a backup response known as the autonomic response is activated, releasing anti-insulin hormones – adrenalin, cortisol and growth hormone. It is this that causes the anxiety, fast heartbeat, sweating and shaking experienced during a hypo. The release of these hormones eventually raises glucose levels but cannot always correct the low blood glucose levels in time to avert the lack of glucose in the brain. If levels fall low enough brain function becomes disturbed leading to symptoms such as blurred vision and speech. If the brain continues to be starved of glucose, confusion, irritable or aggressive behaviour may follow eventually giving way to convulsive fits, possibly unconsciousness, coma and even death.

Although cases are extremely rare it is possible that if blood glucose levels drop low and long enough brain damage can occur. There is also concern about the long term effect of recurrent hypos on the brain. It has been suggested that repeated severe hypos may be linked to permanent changes in mental functions and cognitive behaviour including mood or personality changes, reduced IQ, memory loss and even dementia.

Research is continuing but a number of studies suggest that the risk of recurrent severe hypos leading to mental impairment is greater in children.

 

[Debloubed]

.

when I asked him what he classified as hypo, he said that it was basically any level for a type 1 diabetic that measured under 5.0 when testing BG. He said that he thinks my confusion and forgetfulness may be down to having hypos......has anybody ever heard of this?? He also suggested that although my sever hypo's have had a marked improvement for a few years, that the damage may result years later from having bad hypo's.
also have symptoms of.

Hi Donnellysdogs, nope, never had it suggested to me that bad hypo's can cause long term brain damage but I was involved in an incident about 10 years ago when I was hypo for about 2 or 3 days (no warnings, symptoms were vague and unrecognised by me) and I actually lost my memory?! I lost about 2 weeks and after my family and friends had diagnosed me with all sorts (ranging from panic attacks to short term amnesia!) I saw a Doc and he said that I must have been hypo for several days to have lost 2 weeks of my life!! had my lowest Hba1C shortly afterwards (can't remember exactly, but it was around 4!!) so it all added up..........but no permanant or long term damage to my brain! although I am often forgetful and confused but I put that down to being blonde :wink:

 

[hanadr]

donnelly'sdogs
Read Dr. Bernstein's Diabetes solution. It will give you a new perspective on hypos. and on what constitutes the "Right" BG.
Your doctor's info seems a bit off to me. "no lower than 5"
7 is probably the point at which high BG damage begins, so he's not leaving you much space between. AND people like me would be classed as hypo, quite a lot of the time. I don't think I'm brain damaged.
Hana

 

[Fujifilm]

Has anybody ever had it suggested to them that hypo's can cause longterm brain damage?

Asked my doctor about this after my last serious hypo, and he pointed out pretty much what Cugila has said, your body does everything it can to protect its vital organs.

He explained it to me like this ..

If you drive your car and the over heating, water warning light comes on, you have two choices, ignore it or top up the water. (hypo symptoms) If you ignore it, the engine will eventually overheat and blow the head gasket which is the engines way of protecting itself from serious damage. (hypo -shuts your body down)

Fix the head gasket and away you go. Keep blowing your head gasket and one day it will not be enough and you will seize the engine. So keep hypos to a minimum and your chances of brain damage decrease.

So what he was saying is, the body has a remarkable self preservation system, but its not fail safe. You could have 100 hypos and never have a problem but one day its possible it might cause a problem even death. But then again if your Aunty had balls she would be your Uncle. :lol:

You never know what might happen so the morale of the story is keep balanced and hypos and hypers to a minimum.

I have had a couple of serious hypos and I am OK or am I :twisted: :lol: :twisted: :lol:

 

[jopar]

I think some are getting slightly confused by ‘brain damage’ assuming that it will be blatantly apparent in the suffer who will show obvious signs of this damage… This isn’t quite the case, much depends on where the brain has been damaged and to what extent to how the damage will be presented and at what levels, some damage can go unnoticed, but it’s still there and can accumulate over time, with each episode adding a fraction more until it comes apparent something wrong…

Hana is a good example, as she says she has in the past suffered a stroke fortunately the damage was limited and she recovered but the brain is still damage, in hana case the damaged isn’t at a point that knocked an apparent function and her brain is able to continual to function fully without these cells, but fundamentally there remain damaged…

There are around 96 different types of dementia that can effect us, from Lewi body to Alzheimer’s one of the most common dementia which used to be called senile dementia is quite often caused by very tiny stokes, that are very small and do little damage which can occur without the person being aware this has happened until accumulative damage has occurred that can be observed… Sometimes is so subtle that for the observer its pure cut instinct that flags something wrong…

So with the case of any hypo it is possible that yes the brain is damaged it could be so small that it doesn’t effect the brains ability to function, but to continual to add to this damage, then you getting closer and closer to the point where the brain is unable to work around this damage, so it starts to become apparent could be with a increase inability to solve a problems or become apparent to an observer..

As to Bernstein several things do need to be remembered, that the information he suggests are based on what he has said he found in a small group of diabetes, many of his theories are hear say and unproven or researched either by himself or other researchers, they are all to underpin and promote his own ideologies concerning his perceptions of diabetic care and control. Bernstein has a vested interest, suggesting damage above 7mmol/ml as he’s selling a ultra low very restricting carbohydrate diet to achieve diabetic control, so to suggest that the body could go higher without harm wouldn’t be conducive to a sales pitch of a very difficult regime to follow.

In a diabetic book I have from the early eighties, it suggests that if the blood glucose rises above 17mmol/ml for more than half an hour, it starts to damage our body… But this has to be treated with caution though, as this would have been based on old research and I suspect that more up-date research is available…

 

[catherinecherub]

Another good article on hypo unawareness.

"A study using tight control in Type 2 diabetics showed that severe lows occured in only 4% as often in Type 2's compared to Type 1's." That means that contrary to some people's beliefs,hypo's can occur in Type 2's.

"Hypo's may be triggered by:-

.....A recent history of frequent low BS.
.....A rapid drop in BS.
.....Stress or depression.
.....Situations where self care is a low priority.
.....Alcohol consumption in the last 12 hours.
.....A previous low blood sugar within the last 12 - 24 hrs.
.....Use of certain medications such as beta blockers."

http://www.diabetesnet.com/diabetes_con ... reness.php

 

[evilgenius]

I have had a lot of hypos in the night over the years and I do think that it has had a significant impact on my brain function. To be more specific I sometimes have slightly shaky hands and my verbal memory (as oppoesed to working memory) is not as good as it was when I was younger. It is pretty depressing to think that I have lost any mental capacity as a result of poor glucose management. I can only hope that improving glucose management would allow me to regain what I have lost but as I understand it the brain cannot recover from such damage.

 

[leejones70]

Hi Everybody

I don't know whether anybody can help me with this question, but I hope so.

I have been type 1 since 1986, and since diagnosis I have had many hypos's.

5 years ago I was diagnosed with pernicious anaemia after being referred to a stroke clinic at hospital who found I had low B12 and folate levels. I was age 41, and had real signs of dementia, absolute confusion and forgetfulness. I then went on to having 13 weekly B12 injections.

6 weeks ago my new GP undiagnosed the pernicious anaemia as 5 years ago I was not given an Intrinsic Factor test, and one he did for me came back negative. My B12 injections have now been stopped, and all signs of demntia are coming back.......well, today the GP said that he had been reading up on diabetes, hypos and longterm brain damage......and he believes I have damaged my brain from previously having many hypo's.....when I asked him what he classified as hypo, he said that it was basically any level for a type 1 diabetic that measured under 5.0 when testing BG. He said that he thinks my confusion and forgetfulness may be down to having hypos......has anybody ever heard of this?? He also suggested that although my sever hypo's have had a marked improvement for a few years, that the damage may result years later from having bad hypo's.

He has ignored the fact that after my B12 injections started my brain acted a lot better, and he has also ignored the fact that B12 injections can help with diabetic neuropathy, which I also have symptoms of.

Has anybody ever had it suggested to them that hypo's can cause longterm brain damage?

I know exactly what you are talking about. My stats are not too far off yours. I'm 44 now - diagnosed type 1 in 1997. I've had many hypos in the last 18 years. I had my first appointment with a memory specialist (and another doctor and another consultant) yesterday. The memory specialist did a whole bunch of tests with me - both for memory and cognitive function. I was told that (almost undoubtedly) that my memory issues and noticeably slow cognitive function has been caused by the recurrent hypos. I have particular problems with short-term memory and struggle to rapidly process information provided to me and provide an immediate response. I'm scheduled for a brain scan to see if the damage is visible.

Feeling quite down about it to be honest. Gotta stop those hypos.

 

[tim2000s]

Hmmm. What happens if your brain become used to functioning on a fat based metabolism? How many people that have mentioned issues here take statins for example?

It's very easy to point at Hypos as a driver of effects on the brain, but there's also evidence to show that dementia can be alleviated with certain fatty acids, suggesting that there are a lot of factors.

Most diabetics have spent a lot of their last 10-15 years taking statins, and yet they also have a correlation with dementia like symptoms due to affecting Cholesterol levels.

My issue with this whole area of study is that there are a now a number of factors suspected of affecting the brain's function. Low blood glucose is only one of them, and the majority of the subjects that are affected have in the past been affected by multiple risk factors.

And then there is just the getting older factor. I remember years ago, in my early twenties, I attended a client meeting with a colleague in his early fifties in great health (he ran marathons). He was struggling to remember a word which I plucked out very easily. His comment to me was that that was a side effect of getting older. Remembering things does become more difficult.

I think the GP talking about below 5 is likely to be talking rubbish.

The largest studies that have looked into this are DCCT and EDIC. They didn't find any link between hypos and cognitive function. The two studies followed 1144 people with Type 1 over an average of 18 years. Forty per cent of this group reported at least one hypoglycemic coma or seizure. However, no evidence of substantial long-term declines in cognitive function was found in this large group of patients with type 1 diabetes, despite relatively high rates of recurrent severe hypoglycemia. N Engl J Med 2007; 356:1842-52

Here's the published report that looked at this:

http://care.diabetesjournals.org/content/22/8/1273

And the meta-analysis that concluded that micro-vascular damage caused by complications was the biggest factor in diminished cognitive function:

http://care.diabetesjournals.org/content/28/3/726.abstract