When Hypoglycemia Attacks

The devastating effects of long-term diabetes and recurrent hypoglycemic events


It was close to midnight by the time I returned home after a paramedic class “dinner.” I lived in my parents’ house at the time, so I attempted to go in quietly. The moment I reached my room, I heard my phone ring and knew the precise timing was too close to be a coincidence. I silently cursed as I reached for the phone, assuming that my mother would be on the other end with some choice words for me. Instead of angry, her voice sounded weak.

“Yaeli, I don’t feel well. I think my sugar is low. Can you come down to my room please?”

I hung up the phone and headed to her room. My mother has been dealing with insulin-dependent Type 1 diabetes since before I came along. As I grew up, I became accustomed to things like blood sugar checks 10 or more times a day. I always knew where the extra candy was kept and knew to leave her alone when she laid down on the couch and said, “I’ll be fine. I just need a few minutes.” She knew how to manage her high and low blood sugar spikes like a pro. That night, though, something was different.

“What’s wrong, mom?”

“My sugar is low. Really low. I already checked and it’s 18.”

“Your blood sugar is 18? How did you remember my phone number? How are you even conscious?”

“I’m not really sure. I was having some of those weird nightmares I get when my sugar is low, and they woke me up. So I figured I should check my sugar.“

She reached into the top drawer of her night table and handed me a plastic red box with what looked like a prescription label on it.

“Here, take this. Just in case…”

She didn’t have to finish her sentence. I knew “just in case” meant for use in the event of altered mental status, or worse. I looked down at the case again, and read the label: Glucagon 1mg/mL 1mL

I still wasn’t sure how she was able to function and had retained her ability for cognitive thought with a blood sugar of just 18 mg/dL. As long as she was stable at that moment I was content, but, I took the small case, “just in case,” and headed downstairs to the kitchen, where I hastily made a peanut butter and jelly sandwich, grabbed a handful of candy and bounded back upstairs. Over the next half hour, her blood sugar slowly but steadily climbed. When it hit around 100, she felt well enough to turn on the television, and we finally fell asleep watching cartoon reruns. Crisis averted this time, but why was my mother able to stay awake and relatively unscathed by an extremely low blood sugar that would have other diabetics combative, confused, seizing or unresponsive?

Definition

My mother’s “resistance” to hypoglycemia is related to a condition that occurs particularly in patients with Type 1/insulin-dependent diabetes called hypoglycemia unawareness.

Her brain and central nervous system have, over the years, become desensitized to hypoglycemia due to repeated and sustained low blood glucose levels. The brain adapts to recurrent states of decreased glucose availability, and the deprived cells learn to function within, or close to, normal parameters even under duress.

The Event

Hypoglycemia unawareness can have more than one component or cause, and in most cases is due to several contributing factors. Although patients with this condition can be entirely unaware that they have extremely low blood sugar levels and may appear to have superhuman ability to retain intact neurological function (like my mother), they may also present with atypical symptoms ranging from general malaise, weakness, fatigue and difficulty concentrating to lightheadedness and headache. They can become increasingly emotionally charged and moody, as evidenced by increased anxiety, irritability and stubborn behavior, or excessive sadness or crying for seemingly no reason.

Pathophysiology

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