Wil Dubois

It's no big secret to those of us in the diabetes world that low blood sugars can be scary, and can bring out the worst in us. Today at our weekly diabetes advice column Ask D'Mine, veteran type 1 and diabetes educator Wil Dubois does what he can to offer some advice to a teenager with diabetes whose "hypo twin" has been surfacing more frequently..

NOTE: This is the first of a two-part answer, so be sure to stay tuned for next week's follow-up column.

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


Ask-DMine_buttonShelly, type 1 from California, writes: I have type 1 diabetes and I’m 16 years old. I was diagnosed at the age of 12. I’ve been in a long-term relationship for over a year now and my blood sugars have been up and down for well over two years. My relationship with my boyfriend, friends, and family are all affected due to my blood sugar and mood. When I have low blood sugars I’m cranky and snap at the littlest thing and feel like I’m about to burst into tears at times. The ones I love the most get the sharp end of the stick. When my sugars are high, I feel slouchy, dazed, and go crazy at the littlest things. I was wondering if there was any way to control this?


Wil@Ask D’Mine answers: First off, you’re not alone. All of us struggle with the same thing, and the issues of blood sugar and altered moods have been part and parcel of diabetes since day one. It’s even documented at the very dawn of the age of insulin. Robert Tattersall, in his book Diabetes: The Biography, relates a report from pioneer diabetes doc Otto Leyton, who in the late 1920s “told of one of his patients who, during a meal, pressed his friends to help themselves to more pepper. Then in a loud voice, he insulted his wife, who -- realizing that he was hypoglycemic -- asked him to take some sugar. He replied that, of course she wanted him to take sugar, something the doctor had specifically forbidden, so that she could get rid of him and marry someone else. Eventually he was forced to take sugar, became normal within a few minutes, and had no recollection of what had happened.”

He didn’t remember, but for his guests, it must have been a dinner party to remember.

More recently, a “Must Know Health Info” brochure from Johns Hopkins introduces us to Ed and Alice. You can think of them as the diabetes version of Dick and Jane. Alice is the type 1, Ed is her long-suffering husband. We’re told (warned?) that when Alice gets low she becomes sort of emotional. More specifically, that in the middle of the night once, she “got angry and collapsed in tears” while standing in front of her refrigerator unable to mentally process which juice to drink to reverse her “bout of low blood sugar.”

Does this sound familiar, anyone?

Anyway, what makes this health education brochure rise above and beyond the pack is the following line: “Ed gets through these times by telling himself that he’s not dealing with Alice. Rather, this is her confused, evil, low blood sugar twin. If he stays calm and does the right thing, his dear Alice is soon back on the scene.”

I don’t know about all of you, but I just love the idea of having an evil low blood sugar twin.

Unfortunately, the brochure then goes on to urge Ed to ask Alice to check her blood sugar if he notices she’s low. I can’t confirm it, but I heard through the grapevine that Alice has asked Ed for a divorce.

Evil Diabetes TwinBut it might have just been her evil low blood sugar twin talking. 

Luckily, diabetes relationship mechanic Dr. William Polonsky is on the case and is currently working on a tip sheet for couples in mixed marriages (diabetes-wise) to help them negotiate zones of responsibility, and agree on code words or procedures in advance to enhance safety and reduce relationship stress.

Which leads us nicely into a somewhat related issue that results in jangled emotions in the absence of blood sugar problems: The assumption among our loved ones that anything less that perfect behavior on our part must be due to our blood sugar. We’re not permitted to be in a garden-variety bad mood like every other human on the planet without being interrogated about our blood sugar.

All of this isn’t anything we all don’t already know, but still, what’s the cause? Actually, the biological mechanism behind evil low blood sugar twins is pretty straightforward. The human brain is a frickin’ sugar hog. It uses the lion’s share of the body’s glucose load at any given time, and is highly sensitive to a reduced supply. A brain short on glucose quickly malfunctions. Thinking processes get distorted. Emotions run amok. All the normal social safety valves and circuit breakers in our minds malfunction. In short, low blood sugar can turn normally sane PWDs into sobbing emotional basket cases or raving lunatics. Sometimes even resulting in violence.

But what about on the high end? My wife states that I get “pissy” when my blood sugar is over 250, to which I normally snap back, “I am NOT pissy, damn it!”

Oh. Wait. Maybe I am. I knew I shouldn’t have eaten that frickin’ cupcake.

Anyway, like lows, the impact of high blood sugar on mood is well documented in both the scientific and the popular press, as well as in the blogosphere; but I couldn’t find any studies that could shed light on the biological cause behind it. And interestingly, while most of us fall into various shades of pissy when we are high, I did find one study that showed many PWDs actually report feeling an improved mood with elevated blood sugar. Huh. Oh well, YDMV.

Still, if I had to guess as to the cause of the more common emotional upset with high blood sugar, I’d probably say it is simply because that when your sugar is high, you really don’t feel well physically. I suspect that just like a lack of sleep can make a sugar-normal person cranky because their body isn’t at 100%, we’re probably suffering something similar.

And there’s more to this than just highs and lows. I think the commute between the two is the greater issue. In my personal glucosphere, I’ve noticed that I’m most off-kilter emotionally when my blood sugars are bouncy. And I suspect that you, little sister, are having the same problem. I’m thinking the rapid shifts are too much for the emotional part of our brains to keep up with. In fact, there’s some evidence that glucose variability, rather than the average glucose “elevation” may play a larger part in fueling complications than previously believed. If bouncy sugars are bad for the body, is it any surprise they're bad for the brain, and thus our emotional states?

So, what to do? You told me that your blood sugar had been “up and down” for a couple of years. You need to break that bucking bronco, sister. You need to find a way to cap the highs and stop the lows. It sounds like your therapy isn’t working, so I think it’s time to chuck a Molotov cocktail into the works and start over.

I suggest you ask your diabetes team to treat you like a newly diagnosed person, rather than a veteran. Look at everything with fresh eyes, starting with the basal insulin and that whole alarm-clock-in-the-middle-of-the-night blood sugar check thing. I’d also adjust my sites upwards. I think, given your current mental state and diabetes exhaustion, you’d be better served trying for an A1C that’s higher but made up of a tighter set of numbers than one that’s “in target” but built on a foundation of greater variability.

It probably wouldn’t hurt to eat really low-carb during this process, too. Boring. Yeah, I know. But anything that makes the blood sugar easier to control will get your emotional roller coaster under control more quickly.

And then, rather than being your roommate, your evil twin will become just the occasional (not entirely welcome) house guest.


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.

* Stay tuned for our next week's column, offering more advice for Shelley who also wants to know if she might be suffering from depersonalisation disorder.

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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.