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Low blood sugar attack

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#1
robd

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My father was diagnosed with Type 1 diabetes when I was 6. Tonight he had a low blood sugar “attack”, as we call it, this usually occurs in the middle of the night and often times he is hostile and uncooperative. We’ve dealt with this for so long now; we kind of have a routine when this occurs, trying to raise his blood sugar with O.J. or glucose tablets, at times he is cooperative and it is a relatively easy operation. However, if he refuses to take it and exhibits violent behavior, we usually call the paramedics, since I’m not strong enough to hold him down and force sugar into him.

Our family has been dealing with this for over 15 years now, and it’s terrifying at times, besides the middle of the night “attacks”, he’s been in car accidents, there has been a couple times where by chance I happened to come home at the right time, and he’s having a low blood sugar reaction, while everyone else is asleep. I shudder to think what the outcome would be if I ended up not coming home.

He has been moderating his blood sugar very well lately and this the first mid night attack in awhile (there was a point where it was happening every month), as you could imagine this has put a huge strain on our relationship. Other then better monitoring, I know he can’t do anything about it, I try to remember that, and I try not to get angry when an attack occurs, at times it’s not even helpful talking to him when he’s in that state because he just shouts, and repeats the same thing over and over.

I was surprised by the lack of information on the internet regarding violent low blood sugar reactions, I thought it was more common, and this was the only site, where I came across others with similar experiences. Maybe you have some answers to these questions.

What is the reason for hostile, paranoid, and uncooperative behavior when someone has a low blood sugar reaction?

The reactions vary wildly and the level of the blood sugar seems to have no bearing on the reaction, so for example sometimes his blood sugar could be 40 and he’s docile, while at 20, he’s violent. However, the next week it could be the opposite.

Does beer have an effect on raising/lowering bloodsugar?

Is there anything better out there to monitor bloodsugar? My dad's still using a meter from a few years back.

#2
DeusXM

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Aggression and lack of co-operation should be well documented symptoms of a hypoglycaemic attack (or 'hypo', as it's better known).

What is the reason for hostile, paranoid, and uncooperative behavior when someone has a low blood sugar reaction?


During a hypo, two things happen. Firstly, the brain doesn't have enough fuel work properly, meaning you may see symptoms similar to being drunk. The neural connections required to function properly simply stop working.

Secondly, the body's response to a lack of fuel is a panic response, resulting a massive release of adrenalin. Adrenalin, as you probably know, is the fight or flight hormone that can cause aggression and violence. This may be slightly dependent on the person's personality but the fact remains that a huge adrenalin surge is extremely stressful and it can be very difficult to control your actions, particularly if your brain is already impaired from a lack of 'fuel'.

The reactions vary wildly and the level of the blood sugar seems to have no bearing on the reaction, so for example sometimes his blood sugar could be 40 and he’s docile, while at 20, he’s violent. However, the next week it could be the opposite.


I don't really know the answer to this one - everyone has fluctuating levels of how severe a hypo feels. I'd suggest it's perhaps down to the level of adrenalin released. I personally find that hypos that happen during my sleep are 'worse' because my body seems to produce far more adrenalin, in order to wake me up presumably. The point is though that going as low as 40 is very, very dangerous and 20 is even worse.

Does beer have an effect on raising/lowering bloodsugar?


Both. The carbs in beer will initially raise blood sugar but the alcohol will inhibit the steady release of glucose from the liver which can result in a drop in blood sugar a few hours after drinking. The body is also less able to cope when this happens. Usually during a hypo your brain can instruct your liver to release emergency glucose but if your liver is occupied with alcohol, it can't do both.

Is there anything better out there to monitor bloodsugar? My dad's still using a meter from a few years back.


It's not the meter that's the issue, really. It's your father's ability to regularly monitor his blood sugar, track changes and adjust his insulin accordingly. It sounds to me like he needs to test more regularly. I'd say hourly for a few days plus a couple of times at night so he gets a handle on what his blood sugar 'does' during the day, and then he should be able to drop this down so he's only testing first thing in the morning, before every meal, 2 hours after every meal and then just before bed. He'll then need to use this information to work out how to change his insulin doses throughout the day.

I appreciate it's hard on you. You can't blame him for the reaction he has during the hypo but he does need to take responsibility for preventing himself getting in that state.

#3
GeishaGirl

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My mom was the same way, since long before I was even born. My dad worked 12-16 hour days, so ever since I was around 8 and we moved out of my grandparents house, Mom was my responsibility. She wasn't violent, unless she was semi-concious, but she was VERY uncooperative when she was low. She would behave like a child and stamp her feet and refuse any kind of treatment. I'd have to threaten to call my father and then she'd cry. Sometimes, if she was low enough, it was easier to wait until she passed out and treat her then (I found out a few years ago that's how Dad dealt with it sometimes too :P)

We had to call the paramedics about ever 3-4 months. She's punched out ER doctors and cursed out nurses. She's smacked around a cop that came with the paramedics once.

I can see why it's straining the relationship, but don't let it if you can. I've always loved my mother, but I resented her for YEARS -- *I* was the child. SHE should have been taking care of ME, not the other way around. I managed to confess that to my mother a few years ago, and she totally understood, and I've felt better since. My mom is, really, my best friend.
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misDX type 2 8/2007, reDX type 1 8/2008

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Pumping since 11/2008, Purple Minimed 722 named Barney

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#4
Funnygrl

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He should really have a glucagon emergency kit on hand- an injection used to raise the glucose if oral sugar intake is impractical.

#5
DeusXM

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Careful though, that involves big needles - I'd be worried about administering glucagon to someone who is acting violently in case either I or they got injured.

#6
xMenace

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Your father could be me. I'd ask if you were my son, but it's been over a year since I've had a night-time hypo

Careful though, that involves big needles - I'd be worried about administering glucagon to someone who is acting violently in case either I or they got injured.


My wife tried once, but found it too terrifying. Dialing 911 was much easier.


Night time is when many of us drop naturally. He likely works like this

Night - low
Dawn - high
Afternoon - low
Evening - high

What basal insulin is he on? If he takes Lantus or Levemir then they are flat. Nobody can easily match flat to humpy, at least not and stay sane. One plan is to cut back the NPH to match the bottoms of the valleys and add other insulins to cover the humps.

If he's on NPH, a humpy insulin, then the problem is matching the timing and intensity of the humps. Again other insulins can be used.

None of this is easy. He really has to do a lot of focussed testing to figure it out. The basic technique is to skip meals and test to see what he's doing, make edumacated guesses on the insulin action, then make educated guess on treatment. Repeat until stable.

The best way to get a handle on this is with an insulin pump. It's the main reason I got one. Pumps are awesome tools. I won't willingly give up mine. Expensive though. He can match his basal insulins to his body's needs and adjust for conditions such as alcohol consumption.

As far as treatment goes, give short, non-emotional commands, "Eat this!" "Drink this!" "Sit down!" Don't explain and don't argue. Lead. He may very well not follow, but keep at it. Don't put yourself in danger; though there likely is very little real risk to you. I still think we're all bark and no bite in these situations. But of course don't take chances. Call 911 if you have to.

On the positive side, our bodies are very good at pulling us out of these situations. It may take some time, be we almost always recover. I've been 911'd nine times, and I've been awake and fairly lucid 5 or 6 of those when EMS arrived. I've greeted my friend Captain Roger by name three times. Death is generally due to self induced od according to my endo.

The real danger is him driving or doing some other activity while hypo, like boiling water. I have a policy to always "know" my sugars when driving. No exceptions! I don't break this rule.

A couple of other things he should attempt are becoming more aware of his hypo symptoms while awake and of increasing his hypo-sensitivity by reducing his number and intensity of hypos. Chicken-egg I know, but some awareness can be regained. Not enough to wake him at night, but to maybe save his butt while driving.

Finally the alcohol. You mention it so I assume he likes his evening beers. Pumpers should set temp basals for alcohol and injectors should take extra food after drinking. I'd take an ounce or so of protein for every drink.

Edit: one of my biggest risks was an incomplete appreciation of how fast acting insulin works. Humalog and Novolog are designed to last 6.5 hours. He has to account for his fast acting insulins. One cannot assume it's all gone in 2 or 4 hours.

Virginia Woolf: “Consider how common illness is, how tremendous the spiritual change that it brings, how astonishing, when the lights of health go down, the undiscovered countries that are then disclosed, what wastes and deserts of the soul a slight attack of influenza brings to view, what precipices and lawns sprinkled with bright flowers a little rise of temperature reveals, what ancient and obdurate oaks are uprooted in us by the act of sickness, how we go down in the pit of death and feel the waters of annihilation close above our heads and wake thinking to find ourselves in the presence of the angels and the harpers when we have a tooth out and come to the surface in the dentist's arm-chair and confuse his "Rinse the mouth-rinse the mouth" with the greeting of the Deity stooping from the floor of Heaven to welcome us - when we think of this, as we are so frequently forced to think of it, it becomes strange indeed that illness has not taken its place with love and battle and jealousy among the prime themes of literature”
Back on MDI and doing well. Trying Victoza and loving it. A1C 6.0, no major hypos; a few highs; lots of shots. Diagnosed Oct 19th, 1975.
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