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Low blood sugar - Omnia mutantur, nihil interit.
October 2nd, 2005
11:08 pm
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Low blood sugar

This is disturbing. Please read it if you care about me. If you don't care much about me, and you don't want to be disturbed, you might want to skip it.

Last Wednesday, I had an endocrinologist appointment—the first I've made since being in Dallas. I was all set to be the recalcitrant patient, telling the doctor “Just give me my prescriptions, do the tests you have to, and get me out of here.” I've become pretty wary of doctors. And the visit did not get off to an auspicious start—the nurse and the receptionist seemed obsessed with tracking down my prior doctors (on whom I wasn't able to provide much information) because Dr. Berger is a “consulting doctor” or something like that, which means he wants me to have a general practitioner in this area as well. I don't go to the doctor for non-serious ailments at all, so this seems entirely pointless to me, since if anything is seriously wrong the diabetes doctor should catch it during one of the regular (every 3-4 months) checkups. Nevertheless, I may end up doing it because this doctor wants it and I don't want to find another one.

I only actually saw Dr. Berger for about 40 minutes out of a 3-hour visit. He was an old guy, and I was prepared for him to be a bit stuck-in-a-rut, but he was actually extremely intelligent and interesting, and very convincing. He looked over the medical history the nurse had taken (which had some vague points, since I was diagnosed with diabetes 15 years ago and can't recall all the details) and asked me some questions, and did some tests. When I told him that I had low blood sugars 6 or 7 times a week, he looked at me almost as if I had two heads. He said something about low blood sugars causing cumulative damage over years, and I said I had been thinking the same thing.

Now, that's true, but I hadn't been thinking about it all that seriously. But after the visit, I did, and it clicked. I've been having low blood sugars about that often for probably the majority of the time I've had diabetes, see. I think I've suffered significant brain damage over that period of time.

Low blood sugar definitely produces substantial brain misfunction in the short term, and for good reason—neurons are the only cells in the body that can run directly off of glucose without insulin, but if there's no glucose in the bloodstream, that doesn't work out so well. Furthermore, I have plenty of personal evidence of this. I remember one time when Mark and I were going to operating systems class, and I had low blood sugar and was going to buy food, though it would make me late for class. Mark didn't want to come with me, and I literally tried to drag him down the stairs (unsuccessfully) while babbling semi-coherently about how I needed someone along with me (I remember being paranoid that I would collapse on the way, but also having very little rationality). The mental effects of an episode of low blood sugar last for 30 minutes to an hour after the blood sugar itself has returned to normal, also.

I've noticed a precipitous decline in my mental abilities over the last couple of years, particularly my memory (which used to be near-photographic and is now frighteningly bad—I'll frequently forget what I was doing by the time I walk into the room where I meant to do it, or be unable to recall even fairly major details of my own life) and my attention (I frequently get locked into major web-surfing segments that aren't even all that entertaining, but I suppose serve to distract me from the fuzziness that often comes into my head when I try to figure out what to do next). My abstract thinking has also taken a bit of a hit, though I took several online IQ tests and the consensus was around 140, and I never remember scoring much higher than that, so maybe that effect hasn't been very large yet.

I'm kind of stunned, frightened and disturbed by this. Part of me wants to deny it, and another part wants to think that my brain can regenerate if I'm more careful in the future. (I have read that, contrary to popular consensus, adult neurogenesis may be possible; but, on the other hand, how would this regeneration create such perfect structures as I had as a child?) Since that visit I've managed to avoid all but 1 (maybe 2) low blood sugar, but at the cost of a huge increase in the number of highs. I've been testing my blood sugar almost every 2 hours, and I often can't guess ahead of time what it will be to within 100 mg/dl! (Keep in mind that “normal” blood sugar is 100 mg/dl or thereabouts.) I guess I was paying no attention to my diabetes at all, viewing it as entirely an action/reaction kind of situation, and I didn't realize until these last few days how poor my ability to estimate how much insulin to take—even when I'm trying—really is.

The worst part of this is that I'm doing the best I can. Most diabetics (even type 1 diabetics, I'd wager) don't test anywhere close to every 2 hours. How the hell am I supposed to do this?

I guess this does change one thing. I said not all that long ago that I wouldn't be willing to go on immunosuppressant drugs to keep replacement pancreas cells from being destroyed (a therapy that they're currently working on). Well, fuck that. I'd be more than willing to have 5 times as many colds if I could just stop doing brain damage to myself.

Please offer advice or help if you can. I've been trying not to show it outwardly, but this has been bearing really heavily on me lately.

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From:(Anonymous)
Date:October 3rd, 2005 04:37 am (UTC)
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*hug* :)
From:aletea
Date:October 3rd, 2005 04:37 am (UTC)
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i should sign in more :)
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From:boredatheist
Date:October 3rd, 2005 11:46 am (UTC)
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You have an IQ of 140 and a high paying job as a computer programmer. It takes a pretty large stretch of the imagination to consider you "brain damaged." I tend to value your insights in our conversations more than anyone else (since I currently perceive you as the person most similar to me in ways I consider important, with intelligence being one of those important characteristics).

Your mental experience may be different, even vastly different, now that you're older. But so is everyone's. I spend the majority of my days surfing the same 6 sites and masturbating over and over again. I have far more pity for myself and my own lost potential than I'll ever have for you and yours.
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From:martinivixen
Date:October 3rd, 2005 01:25 pm (UTC)
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Wow. I don't know what to say--I know nothing on this subject. But if you ever need a hug or anything I'm around.

<hug>
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From:kenoubi
Date:October 4th, 2005 04:02 pm (UTC)
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Thanks for your support.

People are amazingly flexible, and they often learn to deal with problems a lot more severe than the ones I seem to be facing. I'm a little disappointed that the state of knowledge of these issues when I was a kid was so bad (and is still not great) that I wasn't informed of this risk, and I'm a little disappointed in myself for not taking all the warnings that I was given a bit more seriously. But it's possible that I'm just being paranoid, and in any case, there seems to be not much reason that I can't at least prevent further damage and learn to manage my blood sugar better... though this does seem to be surprisingly tricky (I've been sort of complacent about the possibility of a cure for diabetes, but this really makes me a lot more enthusiastic about it).
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From:annecognito
Date:October 4th, 2005 04:35 am (UTC)
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Talk about being caught between a rock and a hard place. :( Is there anything you can modify in your habits to maybe make controlling your blood sugar easier? Also, have you considered an insulin pump?
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From:kenoubi
Date:October 4th, 2005 04:05 pm (UTC)
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Yeah, the dietician strongly suggested that I eat breakfast. (She probably would have ordered me to, if she'd been a bit more authoritative.) This is a major pain in the ass for me because I already have trouble getting to work on time, and because eating within the first few hours after waking up makes me nauseous, but I guess I do have to at least give it a try.

I have a follow-up appointment with the endocrinologist next week. When I was in high school I ignored the insulin pump because it seemed too inconvenient with swimming, and since then I've justified ignoring it by saying that my control was okay anyway (when it probably wasn't really) and that the idea of having a catheter constantly in my body is disturbing. But yes, I definitely intend to at least mention it at the follow-up appointment.
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From:theadana
Date:October 4th, 2005 09:36 pm (UTC)
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Erg. I'm glad I was randomly reading LJ and caught this. I don't have much advice (except to say hang in there, research is coming along [Emily actually started working with a research group doing diabetes clinical trials])... A pump seems like a good idea, too, since it takes the guesswork out, doesn't it?

But while you may have suffered damage, don't stress about it too much. What will stressing accomplish? Progress will be made by being determined to refine your response to the issue. You Still Function! So, well, function. :)

Miss you a lot, and keep in touch to let me know if you'll be in my area anytime. I'd like to see you. (Especially if you get a pump, because I love looking at those. So freaky!)
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From:kenoubi
Date:October 5th, 2005 04:08 am (UTC)
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A pump seems like a good idea, too, since it takes the guesswork out, doesn't it?

No, you still have to know how much carbohydrate is in what you eat. The pump doesn't have a built-in glucose sensor. The advantage is that it gives you a constant baseline level of insulin (which is also what the slow-acting insulin I'm currently taking is supposed to do) and that it makes it really convenient to take the extra dose you need for a meal. I do intend to talk about it at my follow-up appointment, but it's not a panacea, and could easily cause more lows if not used carefully.

But while you may have suffered damage, don't stress about it too much. What will stressing accomplish? Progress will be made by being determined to refine your response to the issue. You Still Function! So, well, function. :)

Yeah, I've calmed down a lot since I wrote the post.

Miss you a lot, and keep in touch to let me know if you'll be in my area anytime. I'd like to see you. (Especially if you get a pump, because I love looking at those. So freaky!)

I have a layover for an hour in DC on December 23...

More seriously, I'll be in Pittsburgh for New Year's, starting the evening of Friday, December 30 and ending some time (I forget exactly when) January 2. I assume/hope you'll be around.

It seems unlikely that I'd ever randomly swing by where you happen to live, but I could try to plan a trip there if you'd like. Not right now, though, cause I spent $1000 on plane tickets last month. :-)

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