# Hypos affecting your brain?



## rachelha (Jan 18, 2011)

I have just been for a hospital appointment with the psychiatrist linked to the diabetic clinic.  They are still convinced that I am verging on OCD in relation to my diabetes.  I am trying to persuade them that I was very obsessed with it but just whilst ttc and pregnant which I think is normal.

The doctor said one thing that worried me a lot, that numerous hypos over a long period of time can affect your brain.  Your memory can worsen and your IQ can lower, almost similar to v mild brain damage.  This has really worried me.  I have a lot of mild hypos, roughly 1 a day, but have never had one where I required help, and I thought this alright, not great, but copable with.  I did not realise there were long term complications of hypos as well as high blood sugars.  Has anyone else been told this?


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## Monica (Jan 18, 2011)

No, I've never heard that before. Yes, I know your brain is affected whilst being hypo and for a few hours afterwards, but that's just temporary.


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## Robster65 (Jan 18, 2011)

I have heard/read it but no idea what level of hypos would have any effect. Bear in mind that drinking alcohol and many other things damage your brain and probably effect your IQ, but not many people give it up for that reason.

I wouldn't worry overly, although better to reduce them if you can for many other reasons.

Rob


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## Robster65 (Jan 18, 2011)

Also, I can understand any of us becoming obsessive about our diabetes since it creates a lot of anxiety when it doesn't go acording to plan (which is most of the time ) and gives rise to thoughts of complications as you've said.

By being very strict with ourselves and obsessing over the detail, we can hopefully get closer to the ideal, but that then creates more anxiety when it all goes awry again, so the obsessing becomes a ritual that makes us feel safer and less anxious, whether it's helping the diabetes or not. 

Comments like the one the doctor made can only serve to make things worse surely ! 

Rob


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## sianee (Jan 18, 2011)

my dad had suffered hypos where he required help 4 or 5 times a week, he died about 3 months ago. the coroners report said his brain was extremely swollen due to numerous diabetic hypos. i also noticed it more and more in the months, even years leading up to his death, his memory was terrible (my dad remebered everything!) he'd tell me things twice or three times in a matter of minutes, he walked past me in the street on a number of occasions and didnt even realise who i was! my dsn and my diabetic consultant told me that, no matter how small the hypo, it causes brain damage everytime.


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## Catwoman76 (Jan 18, 2011)

rachelha said:


> I have just been for a hospital appointment with the psychiatrist linked to the diabetic clinic.  They are still convinced that I am verging on OCD in relation to my diabetes.  I am trying to persuade them that I was very obsessed with it but just whilst ttc and pregnant which I think is normal.
> 
> The doctor said one think that worried me a lot, that numerous hypos over a long period of time can affect your brain.  Your memory can worsen and your IQ can lower, almost similar to v mild brain damage.  This has really worried me.  I have a lot of mild hypos, roughly 1 a day, but have never had one where I required help, and I thought this alright, not great, but copable with.  I did not realise there were long term complications of hypos as well as high blood sugars.  Has anyone else been told this?



Hi rachelha Yes I have been told that hypo's, over a number of years, in time does affect your memory. When I went on the carb course last year, after a couple of weeks, I said something about the ratio of insulin to my evening meal, and the nurse said she told me to reduce the amount the week before and I had no recollection of her telling me this, and Tia's dad has said he told me things before, and I don't remember him saying it!!!!  Sheena


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## Akasha (Jan 18, 2011)

Yes, i have heard this before. 
I was talking to my DSN about results from CGM, Turned out i was 'flat lining' overnight. 
In general chit chat i said i'd had a busy week at work, yet couldn't really remember doing much. 
It's the only time i have seen anyone look quite so white. 
I had to explain that i knew what i had been doing that week, but was that hectic the days were bluring into one.
She then told me about the hypos causing memory loss. 


Ps. 'Flat lining' The lowest glucose level the CGM would measure was 2.2. If glucose level went below that it would still download as 2.2. 
My graph results showed a straight line through the night where i was dropping to or below 2.2 continually. hense flat lining.


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## Lewy (Jan 18, 2011)

*Adds to evergrowing list of worries*


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## chrismbee (Jan 18, 2011)

Fantastic news

I now a first-class excuse for the missus .....

(Laughter - Life's best medicine)


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## grandma (Jan 18, 2011)

yes I have been told this as well the hypos dammage the brain.
Was told this years ago.


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## Robster65 (Jan 18, 2011)

And don't forget that if you go too high you'll end up with liver failure and eye problems.

Unless we control our BG to near normal levels at all times, we're at risk of a lot of things, but there's very few who can get that level of control without a fair few hypos and hypers along the way.

As I said, there's an awful lot of things that cause brain damage and memory loss and the pubs aren't losing customers because of it, so don't start panicking unless you are advised otherwise due to excessive hypos or other complications.

Rob


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## rachelha (Jan 18, 2011)

I guess I always thought that going too low was the lesser of the two evils with regards to long term complications.  I guess I need to rethink this.  I have always felt very spacey after hypos but assumed brain function went back to normal once you recovered from the hypo.


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## redrevis (Jan 18, 2011)

sianee said:


> ... my dsn and my diabetic consultant told me that, no matter how small the hypo, it causes brain damage everytime.



I'm sorry but I have to question this. So technically a hypo is below 4, so if you go to 3.9, that is classed as hypo and according to your dsn and consultant this will cause brain damage everytime. Sounds like BS to me. What about people that aren't diabetic and can easily be lower than 4 for lengths at a time. Are they all suffering this same brain damaged as well? Not convinced. Don't get me wrong, I definitely think that having bad hypos will affect your brain in the long run as you're effectively starving it of the energy it needs. But mild hypos causing brain damage? I'd like to see some evidence of that before I believe it.


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## randomange (Jan 18, 2011)

I've heard that recurrent severe hypos can have an effect on memory and cognition (usually with severe hypos being defined as needing someone's help to get you out of it) and there's certainly evidence of this in the medical literature.  However, I haven't heard anything about mild hypos being associated with the same thing.  Certainly, there are studies that have shown that *during* the hypo, and for a short period afterwards, your cognition is affected, but I can't seem to find anything to say that recurrent mild hypos cause this effect in the long term.  As redrevis says, non-diabetics can have a BG below 4, and not suffer any effects.

I think it's a difficult balancing act trying to maintain BGs with in a narrow range, and sometimes hypos are going to occur as a result of that.  Certainly, I think if you're having issues such as severe hypos on a regular basis, or you are losing sensitivity, than that's not acceptable, but in my opinion, I think a few mild hypos will be less damaging to me in the long term than constantly running with high BGs.


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## Robster65 (Jan 18, 2011)

As far as needing someone's help, I've been down in the 1s and managed to get myself sorted out. And countless times in the 2s.

If they mean by the 'needing help' that you're unconcious, then that would be very severe and understandably would risk damage.

As said, without scientific evidence it's not something that should be of great concern, other than to avoid hypos as much as possible. We've got enough doom to worry about without fretting about ending up in a vegetative state because we want a low HbA1c ! 

Rob


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## Liz! (Jan 18, 2011)

Sorry chaps, but I very rarely need help with hypos, have several a week and am definitely suffereing brain symptoms. Memory, lowering of IQ (I was mensa level, not any more!!) and I'm even noticing that wheras I understood everything, now I don't. Sometimes I really have to stop and think. I never knoew this either, always presuming that to be low was better than high, but not any longer. 

There is evidence as well Robster. Sorry.

Also, I think everyone should know. I find it much more scary than neuropathy. Where is the info o this in Balance? Glossed over.


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## Robster65 (Jan 18, 2011)

Much as I'm willing to accept that this is the case, I can't find anything on the web that shows repeated, properly treated hypos causing long term damage. 
All the articles centre around untreated or severe (unconcious, convulsions, etc) hypos which I've had a few of over the years but not recently.

If there is any info, I'd be interested to read it. My IQ has dropped over the past few years but I put it down to age, tiredness and lack of cognitive challenges. I can still reason as well as I ever could and my memory is as bad as it ever was ! 

I don't mean to drag this out, but it's quite important and I'd like know if there is medical evidence or whether it only applies to repeated severe (unconcious) hypos.

Rob


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## Catwoman76 (Jan 18, 2011)

redrevis said:


> I'm sorry but I have to question this. So technically a hypo is below 4, so if you go to 3.9, that is classed as hypo and according to your dsn and consultant this will cause brain damage everytime. Sounds like BS to me. What about people that aren't diabetic and can easily be lower than 4 for lengths at a time. Are they all suffering this same brain damaged as well? Not convinced. Don't get me wrong, I definitely think that having bad hypos will affect your brain in the long run as you're effectively starving it of the energy it needs. But mild hypos causing brain damage? I'd like to see some evidence of that before I believe it.



Hi It depends on what you call mild.  Some people will have hypo awarness at 3.something some don't.  Some people with Diabetes don't react until it's in the 2's or 1's. So in the 3's some people would say they are not having a hypo. Also, it's not just hypo's or hyper's that affect out Diabetic bodies, it's all the other flipping things that go with it.  Sheena


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## newbs (Jan 18, 2011)

rachelha said:


> I guess I always thought that going too low was the lesser of the two evils with regards to long term complications.  I guess I need to rethink this.  I have always felt very spacey after hypos but assumed brain function went back to normal once you recovered from the hypo.



My thoughts on this were exactly the same, thought it was better to be low than high and that the lows only caused temporary problems.  I've always had loads of hypos, tend to go through phases, going through one at the moment and have had 10 hypos since saturday (all in 2s or 3s).  I have to admit to being a bit worried as I've been saying to my family recently that my memory is terrible!


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## xxlou_lxx (Jan 18, 2011)

Robster65 said:


> . We've got enough doom to worry about without fretting about ending up in a vegetative state because we want a low HbA1c !
> 
> Rob



wow you just described me when I was pregnant! lol 

diabetes is a bag of fun sometimes aint it *sarcasm*


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## Plastirion (Jan 18, 2011)

As a 67 year old diagnosed 2 years ago do I have another excuse for memory loss other than senior moments!  Let's get on with life and try not to worry too much

Joan


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## Liz! (Jan 18, 2011)

Well Rob, 

I have a health file which i bung anything into which I'm interested in... I've found one  link which is not working, but I do have a note of the information, or who it was written by, but I can't remember now if it was a scientific paper or not... I think it was. 
(Frank A. Rubino, M.D., Consultant in Neurology, Mayo Clinic, Professor of Neurology, Mayo Clinic Graduate School
of Medicine, Jacksonville, Florida)  It said something like low blood sugar damages/affects the cerebellum and the hippocampus, the hippocampus is important for memory and the damage can be permanent. Can't remember if that one was bad hypos or medium long term hypos. There's a lot of info out there, some say it doesn't affect the brain permanently, some say it does. 

The whole issue is clouded because: 
"long-term diabetes, which is often associated with accelerated cognitive decline, the underlying cause(s) of which are unclear." 

My own ex- consultant was very worried about low blood sugars and this was the reason why...

Here's some papers about it which I've saved the info for:

Amiel S, Pottinger R, Archibald H, Chusney G, Cunnah D, Prior, PF, Gale EA: Effect of antecedent glucose control on cerebral function during hypoglycemia. Diabetes Care14 :109 –118,1991
Maran A, Lomas J, Macdonald I, Amiel S: Lack of preservation of higher brain function during hypoglycemia in patients with intensively-treated IDDM. Diabetologia38 :1412 –1418,1995
#Hershey T, Craft S, Bhargava N, White NH: Memory and insulin dependent diabetes mellitus (IDDM): effects of childhood onset and severe hypoglycemia. J Int Neuropsychol Soc3 :509 –520,1997
Medline#
Fanelli CG, Paramore DS, Hershey T, Terkamp C, Ovalle F, Craft S, Cryer PE: Impact of nocturnal hypoglycemia on hypoglycemic cognitive dysfunction in type I diabetes. Diabetes47 :1920 –1927,1998

Basically low blood sugar definitely affects the hippocampus. in a very bad hypo that damage can be immediate and permanent. It does make sens that long term lesser hypos will cause small amounts of progressive damage.


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## Robster65 (Jan 18, 2011)

From that list, it sounds like there has been some study and, as you say, some damage has been observed.

My worry is that we may be worrying (too many worries!) about it without knowing if it's a lot of lesser hypos or just the major blackouts that do the real damage and how many and how much. I agree that one is too many for anyone and that it must do some damage, but we lose cognition as we age anyway and alcohol and many other substances such as when lead was in petrol contribute to it all.
I would imagine that, for an average diabetic, the risk isn't more than a moderate drinker, or more would be made of it. The last thing they want is a whole bunch of T1s vying for space in nursing homes in 20 years time 

Thanks for lsiting the studies. I'll mention to my DSN when I see her next month and see if she can find anything more about it. Sadly, I don't have access to a consultant, if such a thing exists in these parts.

Rob


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## randomange (Jan 18, 2011)

It's difficult to find information that is not about either:

a) the effects of severe hypos on long term memory/cognitive function

or b) the effects on memory etc during and immediately after a 'milder' hypo

There doesn't seem to be a huge amount on the long term effect of 'milder' hypos, though I would suspect that may be due to the difficulty in separating the effect of mild hypos out from other contributing factors.

I did find one recent paper that showed (admittedly in rats) that previous mild hypos actually had a *protective* effect on the brain during a subsequent severe hypo, so I think it's not necessarily correct to assume that mild hypos cause progressive damage to the brain - it may be that the brain is able to recover and repair itself from smaller amounts of damage, but not from larger amounts that occur during a severe hypo.

Liz - I'm curious - how do you know that any cognitive effects you're seeing are due to hypos and not some other cause?


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## rachelha (Jan 18, 2011)

Hello all, I have been having a good look on the internet (probably a v bad think) and most of the articles refer to accute hypoglycemia.  

I have found one which states that recurrent mild hypos protect you from the effects of severe episodes (or that is my reading of it)
http://www.medscape.com/viewarticle/720178

How confusing this all is.  I wish I had asked more questions about this at my appointment but did not want to seem overly anxious.  My next appointment is in 2 months I will definitely be asking more then.


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## rachelha (Jan 18, 2011)

Randomange - I think we have been looking at the same article at the same time!


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## Liz! (Jan 18, 2011)

I think what that research is about is your brain sort of gets 'used to' low blood sugar and the next time you have a low episode it copes better. And rats of course do not live as long as us... 

Well I've had an MRI which has proven my brain isn't suffering due to a tumour or stroke or the like. Changes to the brain due to Alzheimers etc are not visible except after death (at least that's what a Dr friend told me very recently).

There is no history of Alzheimers or the like in my family on either side. I do have a LOT of hypos. I've been diabetic since being a child and for more than 40 years. The effects I've noticed are similar to the effects noted which could be due to hypoglycaemia. It may be circumstantial, but there has to be a wieght of likelihood whereafter it would be stupid to think something else is MORE likely!

It all seems only too likely to me. Your brain needs glucose and it needs it so much it even has its own insulin supply to make sure glucose is always available to it.


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## margie (Jan 18, 2011)

The other thing to remember with diabetes and memory loss is that vascular health can be affected by the diabetes and the oxygen supply to your brain can affect your brain function.


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## HelenM (Jan 18, 2011)

Unfortunately most of the recent papers are behind paywalls.
I would like to read this one.
Mini-review: Impact of recurrent hypoglycemia on cognitive and brain function  Ewan C. McNay, a,  and Victoria E. Coteroa



> Recurrent hypoglycemia (RH), the most common side-effect of intensive insulin therapy for diabetes, is well established to diminish counter-regulatory responses to further hypoglycemia. However, despite significant patient concern, the impact of RH on cognitive and neural function remains controversial. Here we review the data from both human studies and recent animal studies regarding the impact of RH on cognitive, metabolic, and neural processes. Overall, RH appears to cause brain adaptations which may enhance cognitive performance and fuel supply when euglycemic but which pose significant threats during future hypoglycemic episodes.


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