DiabeticMinds

In a recent blog, I discuss how difficult it is to die from a low blood sugar. But, what did I mean when I said “low blood sugar?” Almost everyone interprets the meaning differently.

Even different diabetes organizations can’t agree on a number that sugar has to drop below to be considered low. After a high impact cardio workout for someone without diabetes, blood sugar levels can drop to 60 mg/dL. What does all this mean?

It means that different people put different emotional values on the same numbers. When my blood sugar is 60 mg/dL, I think to myself that it is still in the range of the average human being, but I need to have a snack. I try not to put a meaning on any given number but, look at each number as the information I need to make my next decision when managing my diabetes. After living with diabetes for 38 years, and in all of my years helping people manage their diabetes and emotions, I come to the inevitable conclusion that panic doesn’t help any situation.

Don’t Panic!

I always tell my clients not to panic and to side with safety. If your blood sugar is below 80 mg/dL, eat something to bring it up and if it’s lower than 60 mg/dL have some glucose, 4oz of orange juice or hard candy that equals 15 carbs. Wait 15 minutes and check your blood sugar again to make sure it’s returned to a healthy range (90 mg/dL -140 mg/dL.) Other factors need to be taken into account as well: insulin on board, exercise, if you just ate dinner, and so on.

Hypoglycemic Episodes!
When someone says, they know someone who died of a low blood sugar; I always have to ask them, “What does that mean?” The responses are varied, and I will always have to ask them whether there were any comorbid issues or were they in perfect health.

More often than not, people don’t know. Aside from diabetes. Did they have a seizure disorder? Were they carefully managing their diabetes? Did they have extremely high blood pressure or any other issue that would put their life at risk if their blood sugars dropped to low?

The Facts!
According to Philip Cryer, MD: “While profound, prolonged hypoglycemia can cause brain death, most episodes of fatal hypoglycemia are the result of other mechanisms, presumably cardiac arrhythmias.” (1) Dr. Cryer, points out that most fatal hypoglycemia is the result of other comorbid issues. Comorbidity is present in the research for Dead in Bed Syndrome (DBS). According to Dr. Bill Quick, a leading authority in hypoglycemic deaths: during sleep states, “One in 20 apparently healthy people under age 40 or 50 with type 1 diabetes die in their sleep from unknown causes that might not be hypoglycemia.” (2) Dr. Quick also points out that research on DBS varies from study to study.

According to the 2014 CDC’s National Diabetes Statistics Report (3), in 2011, there were 282,000 emergency room visits related to hypoglycemia and no reported deaths.

Conversely, plenty of research shows that prolonged hyperglycemia in people with T1 and some with T2 diabetes leads to Ketoacidosis and Hyperglycemic Hyperosmolar followed by death. According to the 2014 CDC’s National Diabetes Statistics Report, in 2011, there were 175,000 emergency room visits related to server Hyperglycemia. While there was no data available in 2011 for the hyperglycemic crisis caused deaths, in 2010, there were 2,361 deaths among adults over 20-year-old. (3)

No Evidence!
While the research points to some correlations, no evidence points to a direct cause of death from hypoglycemia. I am not saying this to minimize the risks that come from low blood sugar, but it is important to remember millions of people across the world have low blood sugars every day without dying.

Conclusion!
I will agree that profound, prolonged hypoglycemia can lead to death. While most persons who are living with diabetes and taking insulin will have many low blood sugars during their lives, if properly managed, the risk of going into a profound, prolonged hypoglycemia is rare. Use of technology like an insulin pump and the CGM can reduce the risk and may even prevent it.

Aside from proper management, emotional health and building a strong support network is imperative to reducing anxiety and fear. Talking about one’s fear, gaining advanced diabetes education, while learning ways to manages one’s emotions is needed to reduce stresses that causes blood sugar instability. Psychotherapy can help people deal and resolve their fears as well as be a great source of non-biased support.

For information on Diabetes-Focused Psychotherapy and how it might help you; go to my website, www.diabetictalks.com today.

Medical Disclaimer:

All the advice included in this blog is therapeutic in nature and should not be considered medical advice. Prior to making any changes to your diabetes maintenance program, please consult with your primary physician or endocrinologist.

Resources:

1) Philip E. Cryer, M.D., “Severe Hypoglycemia Predicts Mortality in Diabetes” Diabetes Care. 2012 Sep; 35(9): 1814–1816. Published online 2012 Aug 14. doi:  10.2337/dc12-0749

2) Dr. Bill Quick, M.D., “Dead in Bed Syndrome” Health Pro, Published online July 29, 2013 doi: http://www.healthcentral.com/diabetes/c/110/162115/dead-bed-syndrome/ – sthash.RHxtpbVN.dpuf

3) Centers for Disease Control and Prevention (CDC)., 2014. “National diabetes statistics report: estimates of diabetes and its burden in the United States, 2014.” Atlanta, GA: U.S. Department of Health and Human Services. http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf(May 15, 2015)