What are the real consequences of hypoglycemia ?

There is some evidence( not much) that repeated hypos can cause cognitive impairment and a suggestion that they may be the cause of "dead in bed" cases. These are rare events. I cannot find much about diabetics being mistaken for drunks and dieing in police custody( as apocryphal stories tell us). I did find evidence of a couple of examples where hypos caused road accidents, including fatalities in Canada. There was even one shown on that police video programme on TV. the comentator, not understanding diabetes at all, and saying that was the first time a driver got into trouble for not taking drugs.
In fact considering that medics now say that diabetes is progressive, I cannot find any evidence that hypos are more dangerous than constant hyper glycaemia.

A couple of years ago a car crashed head on whereby people in the other car were injured along the A27 near where I live. It was raining heavily that day but after the inquest the crash was a result of a man falling unconscious. The chap had type 2 diabetes treated with Metformin. He had stopped for something to eat and he said he did not have any alcohol with his meal. I couldn't believe it when quite recently there was another accident on the same road whereby it was claimed was due to low blood sugar of the driver but I have not heard any more about this incident to date so don't know if this person was type 1 or type 2 or anything else about it and don't think anyone was hurt in the incident but reading about these in the local newspaper and on the radio worried me enough to be careful about driving. Apart from driving I have read that constantly having severe hypos can damage the brain in the long term, as well as can be dangerous in the short term. I read of a cyclist who died from a hypo near the New Forest a while back too. My stepson has a friend who has type 1 diabetes (he is a teenager who is struggling with having diabetes) who has had a lot of hypos and he has ended up in hospital a few times. I hope he comes to terms and control it much better soon. My opinion is that if hypos can be avoided then it is best to avoid them. The majority of people with diabetes whether type 1 or 2 do manage their diabetes without having severe hypos. I don't think having hypos that cause symptoms but are not low enough to be dangerous will cause long term health problems but I am not a medical person so don't know about this for sure.

I think one of the consequences of having regular hypos is that you may eventually lose awareness of their onset. The results of this are many and varied and have been discussed widely in this forum, but I was given another statistic by my nephrologist last week: For a diabetic with hypo unawareness, the risk of death from hypoglycaemia at night increases 10-20% each year. Throw in the other delights, and you wouldn't wish it on your worst enemy.

However, persistently high blood glucose levels can rapidly increase the degradation of nerve tissue, leading to autonomic (and other) neuropathy, a symptom of which is, you guessed it: hypo unawareness. Along with all the other concomitant joys that are textbook complications resulting from long terms exposure to elevated blood sugar.

So we are stuck between a rock and a hard place, trying to keep on a straight and narrow path, some managing to better than others...

Sobering posting Kegstore.
I think the consequences of frequent hypoglycaemia is possible unawareness and the consequent risk of endangering oneself or others.
Now a ramble, because its hard to explain
When first diagnosed I read a posting from someone whose consultant had apprently said that that he attributed the deaths of 2 of his patients ( overnight hypos) to trying to control their levels too low. ( He also blamed the advice given on internet forums).
At the time I didn't pay much attention, paying far more about how to use insulin skilfully. I learned well and am normally able to avoid high blood glucose levels however lows can be far more difficult to control. On MDI you can't stop the insulin, all you can do is spot the problem and do something about it as soon as possible. It was fine to start with, but as I found, if you run at low levels, the level at which you spot the hypo gets lower and lower. I appear to function well at low levels and can correct quickly but I began to worry. I began to spot more and more cases of people who suddenly had very serious hypos (coma, fitting etc) or who reported incidences 'out of the blue' when they became unable to help themselves, of falling and injuring themselves or of crashing cars. I also
remembered and looked up the post I mentioned earlier .

I decided that I was becoming far too blasé, I had a great HbA1c (4.9%). To get to that level you have an average of 5.2mmol, even if you never deviate by more than 1.5mmol either way it means that you are quite often hypo.. The hospital team were quite worried, one nurse felt I had a psychological fear of hypers, well I had and have but I was beginning to tread on the wrong side of a line :roll: .
I thought long and hard and decided to raise my average levels. Luckily my docs were so worried, i got offered a pump. I can now avoid many of the hypos by lowering my basal or if necessary suspending insulin. My first HbA1c on the pump was 5.6%, fewer hypos, both my docs and I were happy with that.

I can't lay my hands on the research at this minute, although I will post it when I find it again, but the evidence is rapidly accumulating that hypos lead to short term memory loss, dementia and Alzheimers (less research on the latter, but it is becoming a 'hot topic'). The problem is not only the 'hypos' however, insulin may be good at getting rid of high BGs, but an excess of insulin is also toxic. For example, it is known to cause the proliferation of tumour cells and can stress other systems leading to heart attacks and strokes etc. As far as I know, it is pretty much impossible to maintain 'exogenous' insulin levels sufficiently well within optimum levels to avoid some impact on your body. It is indeeed in between a rock and a hard place we find ourselves! This is why anyone who has the option of controlling their BGs by diet and exercise is well advised to do so, for those of us who can't, I fear the reality is that we just have to choose which problems we'd rather have. I realise that this may not be seen as a very 'PC' comment on this site, as it is a bit depressing, but I think this is the reality which neither medics nor patients really want to acknowledge. If they did, then maybe we would find more attention paid to resolving the causes of diabetes rather than treating the symptoms only. :?

Here is a link to some research and findings entitled, 'What every person on Insulin should know.'

http://www.diabeteshealth.com/read/1997 ... ould-know/

This may be what you refer to ? A sobering thought for everybody and an illuminating read.

Ken.

Over time probably about 20 years, people do find that their hypo awareness starts to diminish. I was warned of this when I was in my early 30's, but opinion changes from consultant to consultant. My hypo awareness is now variable. To overcome this I do make sure that I test at least 6 times a day so that I have time to sort out my low or high bg levels. I also always make sure that I have some glucose tabs at close hand on my dashboard of my car and always have some fruit pastels or jellybeans etc to nibble while driving. Unfortunately MDI isn't that great as fast acting insulins do exactly what is written on the info leaflets. The unfortunate side effect is that the duration of action with these insulins sometimes continues to linger resulting in people going hypo.

I am hopeful that Oral-lyn and Viaject will become a reality for many as they should help prevent hypos because they will have a fast onset and very short duration.

Hi Ken,

Thanks for the link, yes it does list some of the studies I was thinking of

I like the watch/ring analogy Dillinger. But to take it further, I think you'd notice if either item suddenly became too tight, and continue to do so until the pressure were released by loosening the strap, or having the ring stretched... :?: