Sunday, October 23, 2011

Teenagers + Type 1 = Trouble!

Yesterday was a day I would rather forget.

Before I go into what happened I will first provide a quote about observations made of people during episodes of hypoglycaemia not long after insulin was discovered. This quote is from:

Hypoglycaemia: Implications and Suggestions for Research. Christensen, L, Ph.D (1981), Orthomolecular Psychiatry. Vol. 10, No. 2 (1981), pp. 77-92. Published online by

"Kepler and Moersch (1937)* have described the symptoms of hypoglycemia as follows: "In attacks of any severity the attitude and general behavior of the patient are always disturbed. Any one of the following mental states, to mention only the more common ones, may dominate the clinical picture: apathy, irritability, restlessness, fatigue, anxiety, incorrigibility, negativism, automatic behavior, somnambulism, confusion, excitement, disorientation, 'drunken behavior', fugue states, unconscious attacks, delirium, mania, stupor, coma. The motor activity may be decreased or increased. Speech is distorted: there may be garrulity, dyparthria or even aphasia. Emotional instability ranges from all forms of anxiousness to querulousness and violence. The character of the thinking becomes confused and sluggish: the patient may be del- irious. The trend of thought may remain within reasonable bounds, but obsessions, compulsions and even hallucinations or delusions frequently may be present. The mental group becomes distorted, the patient may become disoriented as to time, place and persons. There is loss of memory for events and the patient does not remember the attack. The mental symptoms may be associated with neurologic disorders of varying type, as motor retardation or convulsive attacks of tonic or clonic type" (p. 96-97). As can be seen from this description, the symptoms of hypoglycemia are numerous, difficult to classify, and readily misdiagnosed as some emotional or neurological disorder."

* KEPLER, E.J. and MOERSCH, F.P.: The Psychiatric Manifestations of Hypoglycemia. Am. J. Psychiatry 64,89- 110,1937. 

Within a week of my then 13yo son's diagnosis with Type 1 Diabetes he had a severe violent outburst during a hypoglycaemic episode which was followed by a seizure. My daughter is a few years younger so I was yet to deal with the combination of fluctuating hormones and fluctuating blood glucose levels although I was aware that this could occur.

This episode was terrifying for all of us and of course was discussed in depth with our Diabetes team at the hospital.

My son went on an insulin pump very soon thereafter, which, thankfully, significantly reduced the occurrence and severity of hypoglycaemic episodes, but they did not disappear altogether. Over the course of this first year since his diagnosis he has had at least four additional violent outbursts that have been the direct result of hypoglycaemia and one episode which was the result of hyperglycaemia. For this reason my son attempts to maintain very tight control of his Blood Glucose Levels. Fortunately, I have been able to control these situations to a certain extent to ensure that no one suffers any physical harm.

Unfortunately, when BGL's are kept relatively low (between 4-5 mmol/L, 72-90 mg/dl) consistently there is the risk of becoming hypoglycaemia unaware.

This was what happened yesterday.

And this time, I wasn't able to put myself between my son and harm's way - because there was a glass panelled door between us! He punched through one of the glass panels resulting in some particularly nasty lacerations to his arm requiring hospital treatment.

In these situations the first priority is to remove the risk of any further danger. My son does not handle the sight of blood well at all and has a history of fainting during blood tests etc (yes, that's a lot of fun for a kid with T1D). He has no memory of putting his arm through the glass panel, consistent with Kepler and Moersch's description above; "There is loss of memory for events and the patient does not remember the attack.", so the shock of seeing the cuts on his arm was overwhelming for him. Once I had him in a safe position, had bandaged up his arm to stem the bleeding and his nausea had passed I then made him eat some fast acting sugar - upon the assumption that this incident was the result of hypoglycaemia - while I ran to his father's house (a few doors away) to get him to look after our daughter.

Sure enough, when I was finally able to test his BGL in the car on the way to the hospital it was still only 3.7 mmol/L (66 mg/dl) - which indicates that when this incident occurred he was probably in the range of 2-3 mmol/L (36-53 mg/dl). He had not felt it at all - it hit hard and fast.

So, we spent several hours in the Paediatric Emergency Room while his BGL's were monitored and they tended to his wounds.

Thankfully no serious damage was done and he should heal up well. However, for now, we have to try to get him to run his BGL's a little higher so that he can begin to recognise signs of hypoglycaemia before they get to the point of no return.

Just another aspect of this disease that the wider community has absolutely no idea about.

Although, thankfully, not an everyday occurrence!

NB:        The article quoted above, together with other articles about this subject, can be found on the Type 1 Diabetes Research Resources page of this Blog.

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