Behavioral Changes caused by DIabetes or Medications?

[scott_y]

I am writing to try to get some information on what might be happening to my partner who experiences significant mood swings/behavioral changes at times.  He refuses to go to the doctor so I am wondering if someone here can help me.

First some information on his background and condition:
Caucasian Male 39 yrs old.
30 Lbs overweight
Diabetes Mellitus
Hypertension
Tachycardia
Former methamphetamine user (used for many years, but has been clean for 10+ yrs.)
Binge drinker (1 or 2 times a week)

Current medications:
Lisinopril  (Blood Pressure)
Atenolol (Heart Rate)
Valium (for anxiety)
Insulin injections (Humulin R, N)

Basically, his behavior can go from 'normal' (calm, not agitated, clear-headed, etc.) to what I am calling "Altered" in a matter of minutes.  During these episodes his behavior will deteriorate where he will gradually start acting like he is intoxicated, even though he has not been drinking.  It will begin with slight mood changes and speech changes (such as mild slurring, searching for the correct word, etc.).  General mood will be happy and sometimes giddy, unless he becomes agitated by something, which tends to happen very easily.  If he becomes agitated or angry then his mood will further decline to belligerent or even violent behavior.   He will say hurtful things intentionally and become verbally abusive.  This negative mood shift does not always happen.  In either case, it seems the only way for him to return to 'normal' is to sleep for 6+ hours.  

It seems like mentally stressful situations may bring this on, although I have also seen it happen after heavy meals.
His Diabetes is not well controlled, and he often has high blood sugar spikes.  He also does not take his other medications exactly as prescribed, instead choosing to take them whenever he remembers.  He often takes 2 Valium at once, 1 time a day instead of 1 every 12 hours. Sometimes he skips a day.

Any help or insight would be greatly appreciated.

[Peter Forster]

I wonder if he might be having transient hypoglycemia (low blood sugar)? The symptoms you describe make me wonder... it is not likely to be due to high blood sugar, the effects of that tend to be more gradual.
Alternatively, it could be just be just that he is chronically under very high stress and gets tipped over the edge with additional stress.
He could be drinking, or the Valium could be affecting him.
Another possibility, which would require knowing a lot more about him, is that he might have had a past exposure to a traumatic stress and this might be triggering that.
In any event, I am pretty sure that he could be doing a lot better if you could get him to see someone for therapy... for instance to try to figure out why he is not taking care of himself and address whatever issues or distortions are responsible for that.  

[scott_y]

Thank You for responding Doctor.  I am unsure if hypoglycemia is a factor but it may be.  Could a rapid transition from low blood sugar to high blood sugar cause this type of mood swing? It happened again tonight.  Here is a general timeline of events leading up to the 'episode'.

1. Late afternoon I returned home from work.  My partner was in good spirits/normal mood and had been cleaning the house most of the afternoon.  He seemed a little worn out but otherwise ok.

2. About 1 hr 30mins later I left to go to the grocery store.  While I was at the store he called me on the phone to ask me to pick up something extra.  During the conversation he mentioned that his blood sugar was getting low, and that he was drinking a soda.  When I returned from the store he still seemed ok, but perhaps slightly more tired.

3. I began preparing dinner, and after about another 30 minutes my partner came into the kitchen to get another soda because 'his sugar was low again'.  He left the room to watch tv and then drank the soda.

4.  After an hour of preparing dinner I found him to be slightly dazed, and looking tired.  He began to slur his speech slightly.  During dinner the situation progressed to the point where he could barely keep his head up and his eyes open.  He was barely able to finish dinner.  Afterwards he stated that he wanted to go to sleep.  His speech was extremely slurred, as if he was intoxicated.  I had to physically walk him to the bedroom and help him into bed.  As soon as he hit the bed his mood changed and he became agitated/annoyed and began acting somewhat belligerent and paranoid.  (He behaves as if I am going to try to "get him" while he is sleeping and tries to defend himself even though I am not acting aggressively towards him.)  Eventually after I calmed him down he went to sleep, although typically when this happens he will wake up several times during the night and become agitated again.  It is only after 6-8 hours of sleep that he returns to "normal".

I do agree that he needs to see a therapist or psychologist, however, getting him to actually go is a challenge in itself.  
My concern right now is that there may be something else at work here, such as a brain disorder or stroke?  Could that be a possibility or am I just being paranoid?  He seems to fatigue quite easily, even doing simple tasks.  Could this possibly be heart related?

I apologize for all the questions.  I'm just trying to make sense of this so I can try to get him to take the appropriate action.....

Thank you for any help you can give.