Epileptic seizure or Diabetic seizure

[Cint]

Hi again,

Well this morning I was in to see my epileptologist and endocrinolgist, since they are both at University Hospital. My epileptologist dr. was initially thinking of changing my medication again since I had that burn incident a month ago, but when I told her of the generic meds mix-up and that I don't want to change right now, she agreed and from now on she will make sure the pharmacy gets the "real" name brand.

And then an hour later I was in to see my endocrinologist. I've been having episodes of glucose highs and lows that don't seem to make sense to them, the lows more so in the evenings or in the night. When I was burned, it was right before my evening meal and he says he wonders if it could have been a diabetic seizure, but the only way I would have known is if I could have taken my glucose level right before the seizure. I asked him what are the levels of other patients when they go into seizures and he says for patients that don't have epilepsy too, usually they can go into a seizure when their glucose level falls to 50 or just 60 sometimes. Wow! Mine have been down as far as 30 and I'm still conscious. Keeping my fingers crossed, though.
Now my epileptolgist and endocrinologist are working together and keeping in contact.

[Birdbomb]

Clint, the paramedics in the ambulance said my blood sugar level was @ 46 when I had that seizure in February. I had just eaten a huge frozen strawberry yogurt with cheesecake bits and fresh strawberries about 30 minutes before that seizure hit.

My best friend David was a very brittle diabetic. He could still be on his feet and talking @26! I've seen his level drop so low they couldn't get a read. For 10 years I helped bring him back from low blood sugars. His daughter would call me when he would begin his decent (he lived 2 doors down) He would eat for no one, I guess the way I dealt with his belligerent nature made the biggest difference his mother and other family members would get mad, I just stayed calm and put food/glucose tablets/honey or whatever in his mouth. If he could swallow, I could help him back to the real world, but if he was beyond swallowing, I'd call 911 and let EMS treat him with IV glucose.

Low blood sugar and epileptic seizures look very much alike. It can be ugly and scary. Several times we found David on the floor, shaking, foaming at the mouth, eyes rolled back. I taught Sabina the recovery position and to watch his breathing. In all those episodes, no once did he ever loose control of his bladder.

Are you insulin dependent? You may need to evaluate the type of insulin you use. It will make a difference. The one David uses stayed constant unlike some that peak and fall.

[Cint]

Yes, I am insulin dependent. I use two types of insulin, long-acting insulin 1st thing in the morning and fast-acting insulin with every meal and use a correction factor of 1 unit of this insulin when my glucose level is over 135. My endo is a professor and specializes in diabetes and thyroid disorders, which I have both, in addition to epilepsy, and wanted me to try the insulin pump, but I couldn't do it because of the VNS. And, I do think the anti-epileptic drugs do interfere with the diabetes, that's why my A1c level is hard to keep under 7.

[Birdbomb]

Must be hard to juggle all that. David's dr. tried to get him to do the pump too but he said no way. He didn't like the idea of wearing that thing all the time and was quite content with injections. He had kidney failure, almost 20 yeas ago the first time, and opted for home peritoneal dialysis. He hated having all that tubing and was always aware of it so to use a pump would be very close to experiencing that all over again. Ironically his transplanted kidney failed 3 years ago and he was back on home peritoneal dialysis.

His last 2 years were really bad. He developed "pockets" at the injection sites and the insulin would just sit in the tissue and not disperse. I guess this is a common problem for Type I . Several members of his family have Type I and as they get up in years that all have this problem.

David and I discussed our disorders at great length. We both wanted to understand what the other was experiencing and learn about each others disorders. The amazing thing is, we do share many commonalities such as he was hitting the low blood sugars and getting flaky, it was eerily like my simple partial seizures. We are both aware of everything said and done around us even though we may not be in control of ourselves. When his blood sugars dropped so low that he went into his "seizure like" status, the aftermath {post-ictal}was complete exhaustion.

He was a great friend, I loved him so much and miss him everyday. Thank you for starting this thread, Clint. It feels good to remember and discuss the stuff we used to talk about.

[drarvindr]

Wow! Mine have been down as far as 30 and I'm still conscious. Keeping my fingers crossed, though.

What you're experiencing is called hypoglycemia unawareness. It's common in patients on long term insulin. The body's natural reaction to low sugars is to warn you by making you feel hungry , throw up , feel dizzy and in extreme cases , seize. The "normal" threshold for this is about 50-60 mg/dl but once you drop below that chronically , your brain hits the reset switch and the level is set lower for symptoms to appear and you won't even realise something's wrong if you're even at 20-30mg/dl. A similar thing works for electrolyte levels. Elderly people tolerate low sodium much better if they've had a chronically low level. A 20 year old , for example , if healthy in every other way were to suddenly have a sodium of 118 or 120 would faint/seize/collapse , whearas i've had long discussions with patients of mine aged 60 up with levels of 112 and 110. This can be a dangerous thing because when you DO go below the level you get all the symptoms at once and can have serious complications. The best way to remedy the situation is to have good glycemic control for a month or so without hypoglycemic episodes and the reset button will be set to a higher level. As for anti-epileptic drugs interfering with diabetes control , i'll look into it and let you know if i find anything. You need to be completely in control of your sugars for a month or 2 and you'll be fine
All the best and hope you get well soon
Arvind

[Cint]

What you're experiencing is called hypoglycemia unawareness. It's common in patients on long term insulin. The body's natural reaction to low sugars is to warn you by making you feel hungry , throw up , feel dizzy and in extreme cases , seize. The "normal" threshold for this is about 50-60 mg/dl but once you drop below that chronically , your brain hits the reset switch and the level is set lower for symptoms to appear and you won't even realise something's wrong if you're even at 20-30mg/dl.
Arvind

Hi Arvind,

Thanks for your explanation. Very interesting!

I do get that lightheaded, dizzy feeling sometimes, not always, and sometimes feel hungry when my glucose is below 60. The lightheadedness is certainly not the same feeling as an "aura" before an epilepsy seizure.

I do know I need to be in control of my sugars and my endocrinologist sees me every 3 months when I'm having trouble like this, along with break-through seizures. I've been having trouble keep my A1c below 7 and I don't understand why. Could it be because some days I can hardly eat because of the Topamax and my glucose drops?

[drarvindr]

Could it be because some days I can hardly eat because of the Topamax and my glucose drops?

Your eating patterns go hand in hand with the insulin you take exogenously. Because the insulin we give can never match the accuracy of the body's natural response to a meal (or lack of it) , eating at odd hours , skipping meals and eating in differing quantities will alter your response to the insulin and cause you to either have high or low blood sugar. There are two primary abnormal reponses known to occur in diabetics on insuin. One is called the somogyi effect and the other is called the dawn effect.
Somogyi effect -You have a "normal" BSL at night and you take your regular insulin dose. You then become hypoglycemic at night in your sleep , but because of chronic hypoglycemia , are unaware of it. This stress leads to a high blood sugar level rebound the next morning because of adrenalin and glucagon secreted in defense to the "extra" insulin.
Dawn effect- similar to somogyi but not associated with night time hypoglycemia. Insufficient insulin the night before, incorrect dosages or eating carbohydrate snacks at bedtime may cause blood sugar to be elevated in the morning. When necessary, checking your blood sugars around 2 or 3 in the morning will help you determine if you have the dawn phenomenon or if there's another reason for an elevated morning blood sugar reading. usually a dawn phenomenon does not warrant the changing of insulin doses.
Hope i've been of help
Cheers,
Arvind

[Cint]

Arvind,
Yes, you have been of help. Thanks again! I know of the dawn effect because my endocrinologist told me about it, but not the somogyi effect. There have been times he has had me check my glucose at 2-3 a.m. Sometimes my glucose is within limits at bedtime, but when I wake in the morning, it is high again. I do count carbs and don't eat at bedtime and have lost weight lately.

[drarvindr]

I couldn't find evidence of anti-epileptic drugs messing up BSLs in journals.
I spoke to the head of endocrinology here and he says that as far as he has seen , no anti-epileptic drugs cause blood sugars to respond weirdly , but if your epilepsy isn't under control then the seizures will elevate your blood sugars from stress.

[Cint]

Thank you for checking. I DO appreciate it.

We are working on getting these darned seizures under control once again.

BTW, HAPPY BIRTHDAY!!

[drarvindr]

Thanks !!