Welcome back to our weekly diabetes advice column, Ask D’Mine — with your host veteran type 1 and diabetes author Wil Dubois. This week, Wil's addressing a question related to diabetes seizures that can be quite crippling. Take a look at what he has to say...

{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Zach, type 2 from New Hampshire, writes:I have had type 2 diabetes for the past 12 years, and 6 years ago I was diagnosed with non-epileptic seizures (NES). They happen when hypoglycemia is underway. I’ve had numerous episodes since my diagnosis, each lasting about 10 minutes each. I always to try to keep my blood glucose at 90-110; and always make my New Year’s Resolution to not have a seizure for the whole year (only 4 this year). But my question is: Am I en route to brain damage? I can only find that diabetic seizures are potentially fatal, but nothing about mental illness. Thanks for the answer. 

Wil@Ask D’Mine answers: Well, hell. That sucks. That’s a lot to have on your plate. And I’m about to make it worse, as you’re not going to like my answer to your question. Still, on the bright side, I think I’m in a position to help you with your New Year’s Resolution this year, so please stick with me to the end.

To answer your core question: Are you en route to brain damage? Pretty much so. Yeah. Sorry about that. The latest evidence is that both seizures and low blood sugar independently cause brain damage. You have a double-barrel shotgun pointed at your head.

Maybe.

Because there’s something we need to consider, and that’s your diagnosis of non-epileptic seizures (NES). That’s a very unusual way of describing seizures associated with diabetes. Typically, they’re called hypoglycemic seizures, not non-epileptic seizures. Or sometimes they’re called acute symptomatic seizures. So the question is: Are your seizures really being caused by low blood sugar? Or something else? 

Here’s the deal: According to the UK Epilepsy Society, there are two broad types of NES and many sub-types. The broad types are organic and psychogenic. Organic NES have physical or biochemical causes. And, in fact, the society does include diabetes as a possible root cause of organic NES, but again, we don’t usually see the NES diagnosis in diabetes care. Meanwhile, psychogenic NES are triggered by mental or emotional processes, and include dissociative seizures, panic attacks, and factitious seizures. The Epilepsy Society says the organic type are easier to deal with, optimistically going on to say that once the underlying cause is discovered and treated, the seizures will stop.

If only it were so easy.

Still, one thing you need to be clear about with your medical team is this: Do they believe the NES is caused by the diabetes? Like I said, it’s an unusual classification, but not necessarily inaccurate. I guess, like your diabetes: Your doctor may vary. Still, you should be clear on why your medical team gave you that diagnosis. 

But backing up, just what the heck is a seizure in the first place? All seizures are electrical in nature. They are electrical storms in the brain that temporarily short-circuit the nervous system, causing the hallmark jerking movements of the head, body, arms, legs, or eyes. And while there’s a ton of info on brain damage seizures, for decades it was generally accepted that the seizures themselves were harmless to the brain. But that’s changing, and new research is starting to the old assumption into question. Sadly, a growing body of evidence suggests that seizures are bad news for the brain.

And for those of us with diabetes, the news gets worse. While any seizure is caused by unchecked electrical activity in the brain, with low blood sugar seizures, there’s more going on than meets the twitching eyes. Here’s the deal: Your brain is an absolute sugar hog. It uses fully 20% of the body’s fuel. So when your blood sugar gets low, the brain runs out of fuel. Quickly. Depriving your brain of sugar is no different, really, than depriving it of oxygen. And just like running out of oxygen, when brain cells are of enough sugar long enough, . As an FYI, it’s this lack of sugar that can make a hypo fatal, not the seizure itself.

Still, it looks like, regardless of cause, electrical storms in the brain can cause or worsen brain damage. And although there is some conflicting science, the bulk of the research out there suggest that the lack of sugar in hypoglycemia also causes brain damage. Like I said, it sure looks like a double-barreled, brain damage-inflicting shotgun is pointed at your head.

So what would this brain damage look like? It’s usually described as a reduction in cognation. Memory problems. Muddled thinking. Long term reduction in IQ. Stuff like that. It sounds worse than depressing, but not all is lost. Here’s the deal: We are talking about oh-so-subtle changes, not overnight Alzheimer’s. Although it is quantifiable, it may be so slight as to make no difference. Maybe that shotgun is a BB gun.

Meanwhile, the degree of brain damage aside, simply having brain damage won’t make you mentally ill, like you worried about. At least, not necessarily. Brain damage and mental illness are about the same as spear fishing and hunting for grizzly bears with a bow and arrow. Sure, they both use a pointy stick, but that’s where the similarities end.

Mental illness is defined by the American Psychiatric Association as “health conditions involving changes in emotion, thinking, or behavior.” They go on to state that these changes rise to the level of interfering with social, work, or family activities. And here’s the kicker: Mental illness is treatable. 

Brain damage, on the other hand, is broken into two types by the Brain Injury Association of America: traumatic and acquired. Traumatic brain injury is either a “penetrating head injury” or a severe blow to the head that “disrupts the function of the brain.” Acquired brain injury (while not “hereditary, congenital, or degenerative”) is caused by medical conditions or metabolic disorders. Hypo damage falls into this category. Is brain damage treatable? That depends on the type, but damage is, well, damage. Given an unlimited budget, if you total your car, you can make it as good as new again. Total your brain? Well… all the king’s horses and all the king’s men…

All of that said, however, in some rare cases, apparently, brain injury can lead to mental illness. But we need to be careful in our word choices when talking about things that go wrong in our heads. And we need to be careful about assuming one will lead automatically to the other. And we need to remember that the amount of brain damage we’re talking about with low blood sugar and seizures is very minimal in the first place. Perhaps the worst that will happen is that your low seizures will leave you a hair more forgetful. You’ll tend to leave your house without your keys more often, not turn into a psycho killer or a drooling vegetable. (No offense intended to psycho killers and drooling vegetables.)

Still, why have any brain damage at all, if it can be prevented, right?

So let’s assume that your NES, is, in fact, caused by hypoglycemic seizures. The “cure” is to not have any hypos. I suspect you already know that. What I’m not sure that you know is the best way to go about that. You said you try to keep your blood sugar in the 90-110 range. Why? That’s the “normal” non-diabetic range. It’s virtually impossible, using today’s medicines and tools, for a PWD to keep his or her blood sugar that tightly controlled without frequent episodes of hypoglycemia.

And, worse, it’s unnecessary. 

All our shows that blood sugar doesn’t really start to get dangerous until A1Cs go above 9%, which works out to an average of 212 mg/dL. I think you’re over-controlled, and that’s leading to lows. As you have seizures when you’re low, you’re in more danger being on the low side than on the high side. So lighten up on that control a bit. Talk to your doc about higher—but still safe—targets for the new year. That will reduce both the hypos and the seizures.

And the brain you save will be your own.

PS: One last thing. Typically, seizures, even in epilepsy, last under 4 minutes, so yours, at 10 minutes, run frightfully long. In fact, seizures over 5 minutes have their own name: Status epilepticus, and they are regarded as life-threatening. Severe seizures like these are most commonly caused by over- or under-dosage of anticonvulsant meds, but they are also triggered by strokes, some liver and kidney problems, and even alcohol withdrawal. So if flailing around part of your seizures really lasts 10 minutes, I urge you to find a specialist. If you’re just “out of it” for 10 minutes, with a shorter period of body jerks, then that’s OK. 

Well, not OK, but you know what I mean…

 

Disclaimer: 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.