Diabetes and Mental Acuity/ Emotional Lability

[Neemo]

Hi All,

Thought I’d start a thread on the above subjects as I feel this is an often misunderstood/little known aspect of living with Diabetes (Type 1 in particular), and it’s very difficult to explain, describe and make understandable to non-diabetics.

Would love to hear opinions/your experiences regarding this issue.

Just a little background to clarify what this post concerns;

Firstly, the brain requires a constant source of glucose to function normally/optimally. It’s an extremely complicated engine that controls all aspects of mental function, movement, emotions etc.

The body (of a normal person) is EXTREMELY efficient at managing/regulating brain blood sugar, and keeps a constant stream of glucose to the brain (as long as they aren’t starving themselves or binging excessively)

However with Type 1 diabetes, we have to regulate those blood sugars ourselves, as our Pancreases/Beta Cells neither produce Insulin or Amylin. It’s Impossible to replicate the body’s efficiency, however ‘relatively good’ control is achievable through vigilance and low GI/Low carb diets/exercise;

Now, what are the (Short Term and Long term) adverse consequences of these fluctuations (just to emphasise, the greater the highs/lows (flux) the more pronounced the effects);

1. Low Blood Sugar causes brain cells (neurons) to die through absence of fuel. In addition, the brain is unable to function at its best; unable to think clearly, reduced cognitive abilities, memory issues. The greater the low the worse the effect; a minor hypo can still have a significant effect, usually an individual will be back to normal an hour or 2 after the episode) however severe hypos (3 and below) disrupt brain chemistry and it can take up to 72 hours to return back to a normative state. – I Experienced regular hypos like this in my formative years; not nice.. Impacts your life significantly.

2. High Blood Sugar also has a detrimental effect and causes ‘brain fog’ in the short term. I find that my concentration reduces significantly if my blood sugar is above 10. Interesting article here pertaining to research on the detrimental effect of elevated blood sugars on the brain; Brain shrinkage, diminishment of brain function markers) (http://www.drperlmutter.com/elevated-blood-sugar-shrinks-brain/?hvid=4x5QO)

3. Emotional Lability; I won’t dwell on the science of this issue, however I can testify to the effect of fluctuations on my mood, outlook and personality. In essence, I feel best when my BS are tightly controlled, going low makes me feel terrible and effects my mood significantly, similarly being high affects my mood a lot too.

In closing, I strongly believe lifestyle choices (being disciplined with food, making sensible food choices, following a robust testing/insulin regime) make a massive difference in both Short and Long term mental function/health of Diabetics. It’s a constant struggle for me, however I’m at a place now where my control is good, and consequently I’m a lot happier.

 

[Spiker]

Definitely I experience these type of imbalances when my BG is out of whack. And yes it takes its toll on me and my life and the people I interact with.

 

[tim2000s]

What it is worth doing is familiarising your brain with running on ketones as it reduces the issues when your glucose levels fall lower.

 

[Robinredbreast]

Sometimes I wish I could be some one else, swings and roundabouts? more like a hurricanes, torrential downpours but with a glimmer of the sun shinning through, but that's how I am feeling at the mo.................

 

[Spiker]

Sometimes I wish I could be some one else, swings and roundabouts? more like a hurricanes, torrential downpours bur with a glimmer of the sun shinning through, but that's how I am feeling at the mo.................

The blood sugar roller coaster so often is also an emotional roller coaster. I don't think a lot of non diabetics understand that. :-(

 

[Neemo]

What it is worth doing is familiarising your brain with running on ketones as it reduces the issues when your glucose levels fall lower.

I agree in principle, however without getting into a convuluted discussion around the brains optimal fuel, gluconeogenisis, practicalities of a ketogenic diet etc, the primary objectives of this post are to:

1.Bring these topics to the fore, as they are seldom discussed.

2.Make those who may not be aware of the significance of maintaining good blood glucose for brain function aware of effects of swings in BS.

3. To show solidarity, as only Diabetics can truly relate to the above experiences.

 

[Robinredbreast]

The blood sugar roller coaster so often is also an emotional roller coaster. I don't think a lot of non diabetics understand that. :-(

Having bad afternoon spiker, some very sad news today and my levels are haywire.

 

[Spiker]

Having bad afternoon spiker, some very sad news today and my levels are haywire.

So sorry to hear that RRB. :-(

 

[tim2000s]

I agree in principle, however without getting into a convuluted discussion around the brains optimal fuel, gluconeogenisis, practicalities of a ketogenic diet etc, the primary objectives of this post are to:

1.Bring these topics to the fore, as they are seldom discussed.

2.Make those who may not be aware of the significance of maintaining good blood glucose for brain function aware of effects of swings in BS.

3. To show solidarity, as only Diabetics can truly relate to the above experiences.

Indeed, and my point is that by specific use of diet it is possible to mitigate the low side when you do see the swings. All part of the same discussion, I'm sure you'll agree!

 

[noblehead]

I agree in principle, however without getting into a convuluted discussion around the brains optimal fuel, gluconeogenisis, practicalities of a ketogenic diet etc, the primary objectives of this post are to:

1.Bring these topics to the fore, as they are seldom discussed.

2.Make those who may not be aware of the significance of maintaining good blood glucose for brain function aware of effects of swings in BS.

3. To show solidarity, as only Diabetics can truly relate to the above experiences.

They are discussed from time-to-time but isn't always the focus of discussion, but Yes wide fluctuations in bg levels can impact on our emotional well-being.

 

[Spiker]

Indeed, and my point is that by specific use of diet it is possible to mitigate the low side when you do see the swings. All part of the same discussion, I'm sure you'll agree!

I also have found greater clarity of mind and mood when doing a ketosis diet. Difficult though that diet can be.

I do understand the point of the thread is to raise awareness first and foremost, as opposed to looking at solutions.

 

[Neemo]

Indeed, and my point is that by specific use of diet it is possible to mitigate the low side when you do see the swings. All part of the same discussion, I'm sure you'll agree!

Yup. But the point I was trying to make was that although what you have suggested could be considered an means to 'mitigate' the effects of effects of lack of glucose fuel for neurons during a hypo, the practicalities and caveats are numerous;
1.It takes a number of weeks for the body to adapt to a ketogenic diet, I.e; utilising ketones for neuron energy.
2.How many people will actually adopt a ketogenic diet, I think you'll find only a small number of people can/do, and sustain it.
3.The body reverts back to its normal energy consuming state once you resume a 'normal' diet, so kind of self defeating to adopt a ketogenic diet temporarily. I'd you adopt it permanantly then it can certainly 'mitigate' hypo effects.
4.Even when your body has adapted to using ketones to fuel neurons, there are still some parts of the brain that cannot use ketones and rely on glucose, hence protein gluconeogenisis Is required to find it (on ketogenic diet)

 

[Spiker]

1.It takes a number of weeks for the body to adapt to a ketogenic diet, I.e; utilising ketones for neuron energy.

Not as long as that. Days.

3.The body reverts back to its normal energy consuming state once you resume a 'normal' diet, so kind of self defeating to adopt a ketogenic diet temporarily.

I have found that readaptation is faster each time.

4.Even when your body has adapted to using ketones to fuel neurons, there are still some parts of the brain that cannot use ketones and rely on glucose, hence protein gluconeogenisis Is required to find it (on ketogenic diet)

In practice I suspect this is not true since in lab conditions humans can go below 1.0 mmol/L BG and feel fine and function fine if suffused with ketones.

 

[Neemo]

Not as long as that. Days.

To clarify; full adaptation, whereby your neurons are able to utilise ketones efficiently and effectively. Yes, preliminary/initial changes can occur aftet a few days.

I have found that readaptation is faster each time.

Sorry is this response based on lab based research, or indvidual perception.

In practice I suspect this is not true since in lab conditions humans can go below 1.0 mmol/L BG and feel fine and function fine if suffused with ketones.

Rather strawmanish response...dont think you can equate this statement to a diabetic who is 'ketogenically adapted' with a BS of 1mmol. how precisely was the infusion/suffusion conducted?
do you have a link to this study?

 

[Neemo]

Not as long as that. Days.

I have found that readaptation is faster each time.

In practice I suspect this is not true since in lab conditions humans can go below 1.0 mmol/L BG and feel fine and function fine if suffused with ketones.

Regarding Ketone adaptation;

http://www.nature.com/ejcn/journal/v67/n8/full/ejcn2013116a.html

"After a person has been on a high fat/very low carb diet for 3 days, their brain gets 25-30% of its energy from ketones. After three weeks, their brain gets about 70% (4). However, the brain can not completely run on ketones and still requires, at the minimum, 30% of its energy from glucose"

 

[Neemo]

They are discussed from time-to-time but isn't always the focus of discussion, but Yes wide fluctuations in bg levels can impact on our emotional well-being.

I think a lot of normal people take this for granted. I am personally of the opinion that even small fluctuations affect mood and thought processes..

 

[Juicyj]

I concur with your post, the mental aspect of this illness is very much overlooked by the NHS, I have at times had a huge battle with fluctuating BG levels and managing my moods and concentration levels. During times where I have successfully controlled my my BG through eating low carb I have been at my happiest, as soon as my levels fall out of range I then also can become down very easily and find it difficult to concentrate at work..

 

[noblehead]

I think a lot of normal people take this for granted. I am personally of the opinion that even small fluctuations affect mood and thought processes..

Depends on how you define 'small fluctuations' as non-diabetics bg levels fluctuate and are not constant.

 

[tim2000s]

I consider that within the range of 4-11 mmol/l has no affect on my cognitive ability or emotion. Above and below that range I acknowledge that I have a shorter fuse. What were you considering small fluctuations @Neemo?

 

[Neemo]

Depends on how you define 'small fluctuations' as non-diabetics bg levels fluctuate and are not constant.

Absolutely. However the body's glucose homeostasis is extremely difficult to replicate; very precise and sophisticated mechanism. A non diabetic only has a very small deviation of blood sugars (please refer to pic below)
Beta cell produced Insulin behaves a lot differently to synthetic Insulin, additionally type 1 diabetics do not produce Amylin, which is an extremely important element in the equation .

So what I mean by small deviations (as it relates to type 1diabetes) is a deviation of 5-7 mmol from 'normal' levels, and in particular regular occurrences .

Non diabetic 24hrs Glucose/Insulin profile: