Wil Dubois

Diabetes is both painful and a pain to deal with, so it's no surprise to us that it can affect our body in mysterious ways. In this edition of our diabetes advice column, Ask D'Mine, our host, veteran type 1 and diabetes community educator, Wil Dubois fills us in on whether or not lows can cause any permanent brain damage (yikes!) and whether cramps are yet another diabetes complication.

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}



Michael from South Carolina, type 1,writes: My wife can tell if my BG is below 50. "You're getting stupid, better check your glucose." I realize my brain requires glucose to function, but have there been any studies on long-term damage due to prolonged low BG? Not that I believe I'm losing it, but just curious.

Wil@Ask D'Mine answers: Actually, when my wife read your question, she said, "If hypos cause brain damage that would explain a lot." She was just teasing, of course.

I think.

Then again, if I'm brain damaged, I'd be the last to know, right?

So you're correct, that many of us get "stupid" when we get low. The brain is fueled by sugar and when the sugar is low the brain doesn't work right. But is it more like having a low battery or more like drowning? Are we losing brain cells every time we go hypo?

In virtually all the clinical literature about lows you can find a line something like this: hypoglycemia can lead to seizures, unconsciousness, brain damage, and death.

And everyone agrees that the deeper you go, the longer you stay down, the more often it happens, and the older you are—the greater the likelihood of brain damage. The most likely types of brain damage from hypos can result in mild paralysis on one side of the body, memory loss, diminished language skills, decreased abstract thinking capabilities, and muscle coordination and balance issues. Ummm... so really, looking at it, sort of a permanent state of feeling hypo.

But, pinning down any solid statistics or solid clinical studies on the whole brain damage issue is a lot harder. I did discover that cats are more resistant to brain injury from severe hypos than other animals. Oh, and that you can reliably brain-damage monkeys if you keep them below 20 mg/dL for 4-6 hours. (Your tax dollars at work for the greater good of science.)

Now the scary part. Oh. Right. Sorry. I meant to say the scarier part. Several recent studies strongly suggest that the low isn't the brain-killer so much as the rebound high that sometimes comes from fixing the low. Quoting a boxed summary attached to a trio of studies in the Journal of Clinical Investigation, findings "suggest that, at least in the setting of profound hypoglycemia, therapeutic hyperglycemia should be avoided."

Of course, they're talking about the dangers of the ICU filling your veins with dextrose overly enthusiastically if you're lights-out on arrival. Still, when was the last time any of us "corrected" a low blood sugar without having a rebound high? Could our Yo-Yo insulin-infused lifestyles be frying our brains? Maybe so.

But, you've got 1,000,000,000 or so neurons in your coconut in the first place; and around 9,000 of them drop dead every day under normal circumstances, anyway. If you want to speed up the process check out this list of 50 ways to kill brain cells. Sniffing glue, by the way, seems to be the most effective way to do-in your brain easily, snuffing out 300,000 neurons per day.

On the good news front, it turns out that brain cells can grow back after all, and that booze only makes neurons drunk—it doesn't kill them.

Of course booze can make your sugar go low, too...


Warren from Alaska, type 2, writes:Does diabetes cause cramps? I have had cramps in many different parts of my body for at least 10 years. I talked with every doctor I came in contact with and they all had a different answers: exercise more or less, more calcium, less calcium, more magnesium, less magnesium, the same with potassium, salt, and almost every vitamin supplement in the book. Only one doctor had a partial answer. She said drink 6-8 oz. of diet tonic water before bed. Other than water, are there any real solutions?

Wil@Ask D'Mine answers: Diabetes 101 review: Diabetes causes everything. OK, so now that we got that covered...

Let's talk about headaches instead. What causes headaches? Very high blood pressure can cause headaches. So can taking a break from caffeine if you usually consume a lot of it. Sinus pressure can cause headaches. So can chocolate, in some people. No shit. Lack of sleep can cause headaches. So can monosodium glutamate (MSG) in Chinese takeout food. Grinding your teeth can cause headaches. So can wearing glasses with a prescription that is out of date.

Oh. And brain aneurysms can cause headaches, of course. But let's not go there.

In fact, there're four primary types of headaches with over 21 common causes. If you don't believe me, believe the New York Times.

My point here is that when diagnosing the cause of a headache, a dartboard or Ouija Board are as much use as any of the other tools in the medical arsenal. There're just so many things that can cause headaches, and headaches are so common, that it can be nearly impossible to ferret out the root cause. In fact, I'm getting a headache just thinking about it.

Cramps are sorta the same. They can be triggered, as you pointed out, by too much or too little exercise, too much or too little calcium, too much or too little magnesium, potassium, salt, and every vitamin in the book. Cramps can also be caused by some classes of medications, the statin family of cholesterol-lower drugs being the most notorious.

But the difference between headaches and cramps is that headaches are easier to treat. Take two Aspirin and call me in the morning. Cause doesn't really matter if all the sundry headaches respond to over-the-counter pain killers. On the other hand, not all cramps are created equal, and to successfully treat cramps you really need to figure out the cause and fix it, i.e. preempt the cramp before it happens.

So as to your question, Warren, does diabetes cause cramps? Yeah, probably so. But the method of action is a big fat question mark. Diabetes causes many of your body's normal checks and balances to get off kilter. And as you pointed out, being dehydrated is, in fact, one sure-fire cause of cramps, as seen in athletes; but diabetes doesn't cause dehydration (unless your blood sugar is very high). And in any case, tonic water wouldn't be required. Garden-variety tap water would be just as good. Maybe better.

To your second question: are there any real solutions? You bet! But you're going to have to invest some time. As there's no way to be sure if your cramps are caused by too little B-12 or too little magnesium you'll have to go on a lengthy quest to discover the root cause of your personal cramps. Yeah. Good old fashioned trial and error. So get out your dart board or your Ouija Board. Use it to pick one of the likely causes of cramps. Treat that cause for a few weeks and see if your cramps get better. If not, go on to the next most likely cause.

Now if you want to be a real scientist, once you think you found the cause, stop the treatment and see if the cramps come back. If so, quod erat demonstrandum -- meaning you found the cause.

That's your long-term therapy.

But to stop the pain immediately during an acute cramp attack, most people have good results hoping around on one foot, swearing, trying to massage the cramp and praying for a swift death. But, for what it's worth, I find the most successful "charley horse" remedy is two liquid calcium pills.

Sorry, I have no real science to offer on this one. My mother read about it somewhere and has sworn by it for years. I frequently get nasty cramps during sharp blood sugar excursions (the cause of which is no mystery: equal parts gluttony and stupidity in the kitchen) and, for me, popping a couple of calcium pills quickly resolves cramps. Of course, I still observe the hoping and swearing ritual, too. Just to be on the safe side.

Interestingly, both low calcium and low magnesium are believed to increase the "excitability" of nerve endings, one of the leading theories behind the biology of cramps in general. So maybe a shot of calcium mellows out the excited nerves again.

Oh, and one last dose of save-your-bacon myth busting: For many years the malaria drug quinine (also present in tonic water, interestingly) was believed to help nighttime leg cramps. Not anymore. It now carries a strong FDA warning against such use. Apparently science has never proved quinine worked for cramps, but it did prove that it could cause severe bleeding, kidney damage, irregular heartbeat, and stuff like death.

'Nuff said about that.

No quinine. Stick to the hopping and swearing.

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.