Should I be worried about him?

[belladancer]

I've been with my boyfriend, who has type 1 diabetes, for six months now, and the longer I'm around him the more I notice that he's having low-blood sugar attacks pretty often.  He virtually never has a high BS incident, but he has a low one every couple of days.  They are usually "minor"--he gets a little quiet and spacey until he eats something, but every once in awhile they get scarier.  He is very diligent about testing and injecting, eats regularly, and he goes to his endocrinologist (and other physicians) on a regular basis, so it seems as though he has his diabetes under control.  But it still seems as though he "crashes" pretty often.  I was wondering if this is a common combination of symptoms, or if I should be concerned that this happens so much.  I am trying not to bother him about my concerns (until I know more) because he's almost forty and has been dealing with it for almost twenty years, and I'm sure he knows what he's doing.  But all the same, I'm worried to even leave him alone or let him drive.  

Thanks for your input!

[JDRF-Team-dm]

Dear belladancer,

Thank you for reaching out to the Juvenile Diabetes Research Foundation. I have a son, diagnosed at 8 and who is turning 28 in September.

Two thoughts jump into mind. The first is, he seems to be in very tight control with his blood sugars. Do you know what his last A1c test was? Low blood sugars are what we like to see, however,the downside is that they can also experience more low bs's. The genuine goal of someone that has type 1 is 80-120

What concerns me the most is his unability to recognize when his blood sugar is dropping. This can be caused by many things, but he needs to talk to his endo. He may need an adjustment with his insulin and/or diet.

I know this is very hard to see, but he seems very responsible with it. You are such a wonderful, supportive person to reach out this way and to be so very proactive says a great deal about you. I would love to hear back from you to let us know how he (and yourself) is doing.

Best to you both,

dm

[JDRF Team SGG]

Folks who know me know that I am one who takes this situation very seriously, for I have been there. He may have lost some of his warning symptoms of lows. This happens to many diabetics who keep glucose levels low enough that they have a tendency to drop too low when timing of a meal is off or a carbohydrate count was not quite right. But the great news, and the reason I am taking the time to write this, is that he can get those early warning symptoms back so he can feel the glucose levels dropping before they get low enough to disable him as you write about. Do let him read this information, for most diabetics are unaware of the results of a study done just a few years ago. This was a life-saver to me, for no doctor has ever given me this information.

I read about this study in my hometown newspaper about 3-4 years ago, published through the AP wire. Apparently, a study was done on hypoglycemia and lost warning symptoms.

The loss of the symptoms is due to what happens when the brain needs glucose but doesn't get a quick "fix" of carbohydrate when glucose levels drop low. After sending warning symptoms (the hunger, shakes, sweat, etc. that are normal warnings) to the body so the person will go get some sugar, the brain then sends out to the liver to release emergency stores of sugar to protect itself from starvation (the brain's main fuel is glucose). If this happens, those emergency stores elevate the glucose levels some to protect the brain so it can do its job of regulating the body. This is why many diabetics will find themselves with high glucose after a severe low. Now, if ANOTHER low happens while some of those stores of emergency sugars are still detected by the brain, it won't send out the warning signals the next time, for it thinks it already has glucose to work off of. A snowball effect happens, with each low causing more of these emergency sugars to be released and the brain then to not send warnings the next time it happens if the next low happens fairly soon after the first one. Soon, the diabetic doesn't feel any warning symptoms at all, and is in danger of passing out without feeling the drop happen.

So here is the solution, according to the study I read about. I have tried this, and my warning symptoms are great now, so I can attest to this really working:

1. The warning symptoms WILL return if the diabetic raises glucose levels just enough to go for a period of 2 weeks without any hypoglycemia at all. It apparently takes that long to clear out all residues of the emergency sugars so the brain realizes that it needs glucose again when glucose levels drop.

2. When a low DOES happen, it is very important to get the quickest possible "fix" of carbs into the body. Now, most diabetics eat something when low, but the foods we eat take a long time to digest. Meanwhile, the brain is still seeking aid in the form of glucose, and so it has time to send to the liver for emergency stores. So the trick is to get carbs into the body to relieve the brain's distress BEFORE it can send for emergency stores from the liver. So if low, your boyfriend should always go for the juice,soda, sports drink or glucose tablet rather than other foods which take longer to digest. Even if a glucose test before a meal is low, it is wise to drink a little juice before eating so the body quickly gets some carbs to elevate the blood glucose while he digests his meal. This is a very new concept to many diabetics, but it really does work.

Frankly, if my glucose is between 65-75, and I feel low, I can afford to eat a snack rather than go for the juice, for that is only low enough to make the beginning sympoms happen, but not low enough for the brain to start emergency procedures. But if lower than that, or if feeling particularly low even if glucose when tested is only in that range, I do go for the juice first.

My bet is that his warning symptoms will improve if he reads this and follows these steps. He may have to do this occasionally if he seems to have a run of lows in a row, even after his warnings come back, for too many lows that are prolonged and not treated quickly will damage his ability to feel them coming on again. I do hope this helps him.

[belladancer]

Thank you so much for your input.  It has helped me to better understand how diabetes works, and it's so reassuring to know that it's actually better that he's having lows (as opposed to highs).  I'm going to show him this information, and hopefully he'll figure out how to recognize that one is coming on again.  That would also help me feel better, because my biggest fear is that he'll have a big drop when he's alone, and no one will be there to help him.  

Orange juice is his best friend--he always has some on hand just in case.  On our first date, I had to run around my kitchen getting him some, as he sat on my couch rapidy turning from the intelligent, ariculate person I'd met into someone who could hardly form a sentence.  It was quite an introduction to the disease!  But now things have become pretty routine, and I can see it coming, often before he can.

So thanks for helping!  Before I met him, I never would have thought diabetes would be such a big part of my life, but I know that it is simply a part of who he is, and so I have learned to love all of him, even the disease.