Hypos And Alcohol/drug Abuse Anxiety

[tnharvey]

Hi, I'm a 22 year old type 1 diabetic diagnosed at 12 years old. For around 8 years now I've - in principle - had a relatively good control of my blood sugars for a long time - never anything over 8.6 and conventionally ranging between 5s and 7s.
Unfortunately, however, I feel like this measurement has served more as a mean average for all the wildly fluctuating blood sugars above and below - and I'm not particularly confident in my actual control. What's more concerning is that for a very long time this lead to a slightly inflated sense of confidence in my diabetes, especially my hypo awareness - I've been normally experiencing at least a few hypos a day for as long as I can remember, never paying too much mind to them because of their generally acknowledged reputation for not causing any long term brain damage. For as long as I can remember, I've always strayed on the side of too low rather than too high as I really don't enjoy the feeling of high blood sugars (aggressiveness, slow thinking) and am frightened of the long term complications associated with it. With this confidence, however, has also come a lot of alcohol and drug abuse, unaware or confident against the symptoms of low blood sugar, especially during my sleep. Even when drinking alcohol, I used to keep my blood sugars at a stable level, only drinking spirits for the most part. I completely abused both drugs like ketamine and MDMA, as well as alcohol, however, on a regular basis, especially alcohol - almost daily. I've repeatedly drank so much straight vodka I've completely blacked out on nights out. I can function at levels as low as 1.2, or even LO on the rare occasions I've gotten there, and I've only had one diabetic seizure, that I'm aware of, in my life over 4 years ago - again under the influence of lots of alcohol and drugs. For over 7 months now I've almost entirely abstained from drugs and alcohol (bar hallucinogenics, which don't disrupt blood glucose functioning). Recently, reflecting on that time (a year ago now), I'm starting to worry myself that I've been experiencing hypos and/or seizures in my sleep and attributing them to hangovers. I've been diagnosed relatively recently with depression and anxiety, as well as a long standing diagnosis of ADHD, so my memory has always been quite sketchy, but I'm increasingly worried this has just lead to a lower awareness of a slowly deteriorating cognitive function. I'm struggling more with reading than I used to, and often confusing words with one another and misreading sentences, I also feel like my vocabulary is slightly struggling, as well as my abstract thinking and sense of humour, which I always took considerable pride in. I kind of feel like I'm losing my sense of self and it's really getting me down - I'd expected these last 7 months to be the brightest and clearest in a while but I seem to keep deteriorating bar the occasional good day. Again, all of these symptoms are also synonymous with anxiety and depression, and it's really hard to differentiate whether they are conventional symptoms of a chemical imbalance in the brain or whether I've done some permanent damage and fried half my brain with low blood sugar. During the beginning of my substance abuse stages, I'd wake up if my blood sugar was low and resolve it, but recently I've been using the Freestyle Libre and it's showing several days a week of multiple hours of low blood sugar when I'm asleep, leading me to wonder when exactly my hypo awareness stopped functioning. Again, other than feeling slightly tired, these low blood sugar events don't seem to be creating any drastic, immediate damaging effects to me. What I'm concerned about is that it's slowly drilling away at my brain at a pace that I wouldn't be able to notice. I know that in principle neuronal loss only occurs at levels below 0.6mmol, but given the alcohol I used to consume and the blackouts I have no idea what was conventional alcohol abuse and what could have been diabetic coma. I was never unconscious for days at a time, and seemingly woke up at the same late hours that any semi alcoholic that spends too much time going out does, but the uncertainty is starting to whittle away at me. Does anyone know if an MRI or EEG would show hypoglycemic brain damage or whether it would clear up by the time I went for a scan despite neurological symptoms - similar to that of a concussion? The large scale survey suggesting hypoglycemia doesn't cause long term brain damage is slightly comforting, but I simultaneously doubt most of the subjects were drinking as much and subsequently wiping out the glucagon response from the liver if I had been encountering hypoglycemia. The agonising part of this is the not knowing. I might be psychosomatically projecting all of my fears of hypoglycemic brain damage onto myself as I'm naturally very neurotic, but I don't know if I'm capable of dismissing it given how incredibly feasible it is that I actually could have done some serious irreversible damage. Exercise is now proven to stimulate neurogenesis in the hippocampus, which is one of the main areas damaged by hypoglycemia, but there's no known way to resolve damage to the cerebral cortex if I've damaged that. I'd just like to know if anyone has been through anything similar, or give an example of a severe hypoglycemic event, or whether there's a reliable way to assess whether or not I actually have damaged my brain seriously as a means of closure.
Thanks a lot and sorry for the essay,
Tom

 

[DCUKMod]

Hi there @tnharvey , and welcome to the forum. What a read, and what a quandry you find yourself in. I'm not a T1, and nor am I a great drinker or have a history of drug use, but I just wanted to welcome you and say I hope there will be others along who may have some wisdom, with or without shared experiences to offer as the day progresses.

Just a point on the content of your post; you talk of a history of drink and drugs, but roughly, how long were you actively using alcohol and drugs in the manner you describe? It feels to me like the timeframe could be helpful to those with knowledge.

As a sign off from me, I would just like to congratulate you on dropping the alcohol and drugs. It's not easy to change those verry heavily habitual behaviours.

Keep edging forwards Tom.

 

[Guzzler]

Hello and welcome to the forum. I am sorry that as a T2 I cannot answer any of your questions but wanted to just point out that there doesn't seem to be any damage to your reasoning or your language skills. This has to be a good sign. I hope that you find the answers that you are looking for and wish you all the best.

 

[Knikki]

Welcome to the forum @tnharvey

First statement I am NOT medically qualified the info below is what I have gained from my own experience and reading around.

First off well done on managing to kick the drug/alcohol habits.

That is is an interesting tale that you tell.

I too run low most of the time and like you Hate being high because of the potential damage that it can do. However hypoglycaemic events, as far as I know, do not do the kind of damage that you are beginning to experience. Yes in cases that you have described the body will do all it can to make sure you stay alive which will mean putting all its resources in too your secondary nervous system, the stuff that powers your muscles, heart, lungs etc, for that, it does not need the brain, hence why most people when they are having a really bad hypo appear to be out of it or have limited functionality.

Unfortunately the MDMA and Ketamine abuse will have had more of an effect on you than the low sugars. Reading around the symptoms you describe, memory loss, cognitive function impairment, reading issues are side effects of these, I am sorry to say.
Plus the spirit/vodka drinking will have played havoc on your liver so maybe reduced its ability to produce glycogen when you needed it.

Like you I can sometimes be functioning when LO and hold a reasonable conversation, BUT, I would never drive when like that, if I did, I guess I would be dead by now.

Which leads to the Lack Of Hypo Awareness, yes that is a well know issue of running very low blood sugars for a long time. Simple because your body is used to it and so does not react to it as it should.

For arguments sake, if you had been running 8 (144) for a period of time and for some reason your blood sugar dropped to 3.5 (63) then you would certainly pick up on that.

I have had some bad hypos that have required third party assistance, but these have fortunately been very few and far between and have so far not impaired anything from the neck upwards as far as I can tell. From what you say above it is difficult to ascertain just how many "severe" hypos you have had over the years and so from an uneducated point of view just how much, if any damage has been done. This I feel could only be answered by someone with far more medical knowledge or deals with things in the area.

I am not sure what to suggest other than seeking help from specialist diabetic teams to help sort your control so that you regain your hypo awareness.

What ever you do good luck.

 

[Grant_Vicat]

Hi, I'm a 22 year old type 1 diabetic diagnosed at 12 years old. For around 8 years now I've - in principle - had a relatively good control of my blood sugars for a long time - never anything over 8.6 and conventionally ranging between 5s and 7s.
Unfortunately, however, I feel like this measurement has served more as a mean average for all the wildly fluctuating blood sugars above and below - and I'm not particularly confident in my actual control. What's more concerning is that for a very long time this lead to a slightly inflated sense of confidence in my diabetes, especially my hypo awareness - I've been normally experiencing at least a few hypos a day for as long as I can remember, never paying too much mind to them because of their generally acknowledged reputation for not causing any long term brain damage. For as long as I can remember, I've always strayed on the side of too low rather than too high as I really don't enjoy the feeling of high blood sugars (aggressiveness, slow thinking) and am frightened of the long term complications associated with it. With this confidence, however, has also come a lot of alcohol and drug abuse, unaware or confident against the symptoms of low blood sugar, especially during my sleep. Even when drinking alcohol, I used to keep my blood sugars at a stable level, only drinking spirits for the most part. I completely abused both drugs like ketamine and MDMA, as well as alcohol, however, on a regular basis, especially alcohol - almost daily. I've repeatedly drank so much straight vodka I've completely blacked out on nights out. I can function at levels as low as 1.2, or even LO on the rare occasions I've gotten there, and I've only had one diabetic seizure, that I'm aware of, in my life over 4 years ago - again under the influence of lots of alcohol and drugs. For over 7 months now I've almost entirely abstained from drugs and alcohol (bar hallucinogenics, which don't disrupt blood glucose functioning). Recently, reflecting on that time (a year ago now), I'm starting to worry myself that I've been experiencing hypos and/or seizures in my sleep and attributing them to hangovers. I've been diagnosed relatively recently with depression and anxiety, as well as a long standing diagnosis of ADHD, so my memory has always been quite sketchy, but I'm increasingly worried this has just lead to a lower awareness of a slowly deteriorating cognitive function. I'm struggling more with reading than I used to, and often confusing words with one another and misreading sentences, I also feel like my vocabulary is slightly struggling, as well as my abstract thinking and sense of humour, which I always took considerable pride in. I kind of feel like I'm losing my sense of self and it's really getting me down - I'd expected these last 7 months to be the brightest and clearest in a while but I seem to keep deteriorating bar the occasional good day. Again, all of these symptoms are also synonymous with anxiety and depression, and it's really hard to differentiate whether they are conventional symptoms of a chemical imbalance in the brain or whether I've done some permanent damage and fried half my brain with low blood sugar. During the beginning of my substance abuse stages, I'd wake up if my blood sugar was low and resolve it, but recently I've been using the Freestyle Libre and it's showing several days a week of multiple hours of low blood sugar when I'm asleep, leading me to wonder when exactly my hypo awareness stopped functioning. Again, other than feeling slightly tired, these low blood sugar events don't seem to be creating any drastic, immediate damaging effects to me. What I'm concerned about is that it's slowly drilling away at my brain at a pace that I wouldn't be able to notice. I know that in principle neuronal loss only occurs at levels below 0.6mmol, but given the alcohol I used to consume and the blackouts I have no idea what was conventional alcohol abuse and what could have been diabetic coma. I was never unconscious for days at a time, and seemingly woke up at the same late hours that any semi alcoholic that spends too much time going out does, but the uncertainty is starting to whittle away at me. Does anyone know if an MRI or EEG would show hypoglycemic brain damage or whether it would clear up by the time I went for a scan despite neurological symptoms - similar to that of a concussion? The large scale survey suggesting hypoglycemia doesn't cause long term brain damage is slightly comforting, but I simultaneously doubt most of the subjects were drinking as much and subsequently wiping out the glucagon response from the liver if I had been encountering hypoglycemia. The agonising part of this is the not knowing. I might be psychosomatically projecting all of my fears of hypoglycemic brain damage onto myself as I'm naturally very neurotic, but I don't know if I'm capable of dismissing it given how incredibly feasible it is that I actually could have done some serious irreversible damage. Exercise is now proven to stimulate neurogenesis in the hippocampus, which is one of the main areas damaged by hypoglycemia, but there's no known way to resolve damage to the cerebral cortex if I've damaged that. I'd just like to know if anyone has been through anything similar, or give an example of a severe hypoglycemic event, or whether there's a reliable way to assess whether or not I actually have damaged my brain seriously as a means of closure.
Thanks a lot and sorry for the essay,
Tom

Hi @tnharvey As an ex Type 1 I can certainly give you an example of a truly severe hypo which occurred 39 years ago when I was a student in London:
1979 At a party in Haringey, hosted by one of Helen’s (my girlfriend and later wife) predecessors: The hostess, called Julie, left for work at Harrods, with Yours Truly unconscious on a sofa. She telephoned at 12.45. “You still there?” After my baffled response, I put the phone down and tried to think about my state of affairs. I had a raging headache, my vision kept disappearing, and worryingly, I was experiencing a total memory loss. I started to pace around the stark room like a leopard in its too confined quarters. What the hell is wrong? This is not a hangover. I need to talk to someone. My father. What’s his name? Where does he work? (He retired in 1985 and I still remember his number – 01 405 9222 ext 6036) Brain’s battery was completely uncharged then. As I sped around the room in increasing panic, I chanced upon a directory. With my focus looming in and out, I flipped through the pages in the vain hope I might recognise anything. Something suggested the word “assurance” and I had enough cognitive function to write it down. Minutes later I was through to some saint (female) at the switchboard. Why she didn’t think “We’ve got a right one here” I’ll never understand. She deserves recognition.
“Er, er, Oh God, what’s his name?”
“Don’t worry love, which department is he in?”
“Er, ....... Oh blimey I can’t think.”
At this point she began reading down the list until she said:
“Job Evaluation?”
“That’s it!”
I’m a great believer in fate. Normally one of three lovely secretaries would have answered the phone, but for some reason my father himself answered. I must have been able to tell him my whereabouts, because I remember him giving me some chocolate in the flat. The rest is blank until 6.30 the following morning. I had been put in Johanna’s bedroom (I think she was away at college in Oxford at the time) and my father put his head round the door to check progress. He found me with the top of my head on the floor, followed by most of my torso. He managed to get me back on the bed and then tried to give me warm sweet tea. I hit him.
About 20 years ago I had a severe hypo in the dining room. I was sitting on a long bench with my legs parallel to the length of the table and I disturbed my wife and daughter upstairs who came down to find me banging the table top with my right heel and right fist. I was having a fit and had no idea what was going on. My sugar level was excessively low.
Interesting what you have to say about cognitive function. I was diagnosed at 11 months and when I was only a few days past my eighth birthday, I went into a five day coma. Bearing in mind that this was caused by excessive hyperglycaemia (which could not be measured at home accurately at the time), my father's comment in the early 1990's was interesting. " Until that dreadful set-back in 1966, you were a very bright little boy." After a moment's carpet gazing I responded, "Does that mean I've been thick ever since?" Even though I was psychologically alarmed at the time, I actually think he is right. I think more research needs to be done on Hypoglycaemia and cognitive function.
I totally agree with @Guzzler and would lso like to point out that although I didn't experiment with drugs, my alcohol intake at university was not good for a diabetic, and in 2005 I bumped into a retired Diabetic Night Sister, Diana Chadney, at King's College Hospital who said "Hello Grant, am I amazed to see you, and looking so well. We didn't think you would survive.
I hope, Tom, that in some way I might have given you hope - I know what it feels like when you suddenly face up to the unpalatable, but it's by no means guaranteed disaster. I wish you the very best of luck.

 

[Alison54321]

Hello @tnharvey welcome to the forum. How high is too high? in terms of blood sugars, and what point do you feel like they are affecting your thinking ability.

I'm not sure I understand what the point is of having very low blood sugars, if you squander the benefits, by drinking too much alcohol, and taking drugs. You might as well have not bothered. But well done for giving them up. They are most likely the cause of your current issues, rather than the hypos.

I don't particularly like too many hypos, they get in the way of my being physically active, I like walking, and too many hypos stop me doing that.

I just reduced my morning dose of Levemir, so that I was running at a higher average, still reasonable, but not super low, and if I want low I have to walk more. I prefer that. Just out of interest, on a cost benefit analysis, which is more healthy? For me to have average day time blood sugar of in the low 6s and be more physically active, or have one, in the low 5s/high 4s and not be able to walk far, because there's too much risk of a hypo?

You know the answer don't you.

I think you need to make a similar cost benefit analysis. You don't need to push your basal insulin up very much to have a few less hypos,but it might make your blood sugars more stable.

It's quite strange, usually we are advising people about the risks of running too high, but in your case there is a risk to running too low.

Managing diabetes is very much about balancing different risks, there is no simple answer, but the body of someone with diabetes is pretty much like everyone else's in that it will be healthier if we eat well, sleep well, and get a reasonable amount of exercise.

If you keep your blood sugar very low, but don't look after other aspects of your health, then you are no better off than someone without diabetes, but who also doesn't take care of themselves, so nothing has been gained.

I think you need to move to a more balanced approach to managing your diabetes, if the purpose of doing so is to remain healthy, you need to ensure there is room for other healthy activities, not just perpetual management of hypos.

 

[Alison54321]

Also, after a bit of googling on other things, I found something that says that severe hypos do undermine cardiovascular health.

I'm not linking to anything, as I don't want to add any more anxiety to the mix. But on balance a few small after meal glucose spikes, are probably less dangerous than too many severe hypos.

 

[kitedoc]

Hi @ntharvey, Life is never straightforward. I am glad your are looking after yourself better these days.
The following is offered not as medical advice or opinion but on the basis of my 51 years on insulin.
As @Alison54321 indicated, THE first step is to prevent the current low BSLs at night. They are what could be risking your health, brain-wise and maybe otherwise right now.
Whatever has happened in the past you cannot go back to undo, but you have the opportunity to do something about what is happening NOW.
Please do this in conjunction with a doctor or Dsn NOW, And it is probably to do with long-acting insulin dose etc.
And maybe these low night-time BSLs are holding back improvement in your thinking - another reason to deal with them NOW. Maybe a medical specialist might have an opinion.
Whether taking charge now of your health now will reverse any past damage from blood sugars, alcohol and drugs sounds like an impossible question to answer with any surety or even % chance.
Day at a time, repeated is probably as relevant to diabetes as it is in some ways to alcohol abstinence although I think in general the contrasts outweigh the similarities.!
For myself, it was at the 45 year mark on insulin that I found night hypos were troublesome despite 8 injections of a combo of long and short-acting insulin. For me the answer was use of an insulin pump, which controlled night-time (and daytime) insulin much better.
Also I have suffered with depression in the past and am on long-term anti-depressants. Recently it was suggested I reduce my anti-depressant dose to see whether I really needed the usual dose. After a week or so on the lower dosage my insulin requirement had to be stepped up 30% or so on the same diet. I stuck with the same reduced anti-depressant dose as instructed for 4 weeks with no change in the increased insulin requirements and with a much less stable BSL control.
After a week or resuming the usual anti-depressant dose my BSLs improved and my insulin requirements returned to past doses and BSL control has been perfect, now at end of the second week.
I suspect the right dose of anti-depressants is the key not necessarily the highest dose possible. Just my guess !
But that is my story and your response to such medication may be different.
In finishing , please consider sorting out your current night hypos with professional help.
Then, and only then look at other things. Maybe any improvement will take a longer time than you expect.
Hope springs eternal !! Best Wishes.

 

[Deleted Account]

Some great advice and insight from the other responses.
I only have one thing to add: are you sure you were really low at night or is that only based on the Libre readings while you sleep?
The reason I ask is that Libre reads low when you apply pressure such as when you lie on it when asleep.

It may be worth setting an alarm one night at about the time Libre often reads low and check your BG with a finger prick.