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Early Type 1 Diabetes Poses a Challenge in Blood Glucose Management
Blood glucose values that are far outside the normal range can be hard on the body. Those with type 1 diabetes can suffer from long-term complications from high blood sugar. These complications are well-known and include kidney damage, heart disease, nerve damage and loss of eyesight.
There are also acute health problems that can occur in a short period of time. People with diabetes can suffer from very high blood sugar, known as hyperglycemia, that leads to a condition called diabetic ketoacidosis, or DKA. People with type 1 diabetes can also suffer from rapid and acute low blood sugar, or hypoglycemia. In those who are in the early stages of a diabetes diagnosis, the possibility of having a seizure from very high or very low blood sugar is a very real possibility.
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Diabetic Ketoacidosis Can Lead to Seizures in Those With Early Type 1 Diabetes
Those who are in the early days of a diabetes diagnosis may come to a doctor’s office or a hospital complaining of fatigue, intense thirst, and an urge to urinate very frequently. They may also be spilling ketones in their urine. High levels of ketones can indicate diabetic ketoacidosis, a condition that is common in those who have just been diagnosed with diabetes or those with prolonged periods of hyperglycemia. The body is seriously out of balance and is dehydrated, with a low pH and lacking in elements such potassium and magnesium. The patient often has symptoms similar to the flu and may vomit.
The frequency of seizures in early type 1 diabetes is not common, and it is a relatively rare complication of DKA, but they do occur, sometimes due to cerebral edema. Cerebral edema occurs more often in children, occurring in 0.7 to 1 percent of children who present in DKA. These children may have a headache and be lethargic, and on an MRI it may show that they have dilated ventricles. One of the severe potential consequences of cerebral edema is a seizure. If severe symptoms occur, the mortality rate for these patients is quite high, around 70 percent. A slow and steady increase in hydration that avoids overhydration and a slow decrease in blood glucose is important when there is a chance of cerebral edema. This reduces the risk of seizures.
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Severe and Prolonged Low Blood Glucose Increases the Frequency of Seizures
Once the patient with early type 1 diabetes leaves the hospital or doctor’s office, management moves from the hands of the doctors to those of the patient and the patient’s family. Type 1 diabetes involves a steep learning curve as the patient learns how to balance insulin, carbohydrates, exercise, stress, illness and all of the other elements of life with diabetes. In this early stage, it is important for the diabetes patient to monitor blood glucose levels frequently to avoid severe low blood glucose, known as hypoglycemia.
While low blood glucose causes shaking, anxiety, sweating and discomfort, severe low blood glucose can lead to coma, seizures, and even death. A recent study with a continuous glucose monitor found that 2-1/4 to 4 hours of hypoglycemia under 60 mg/dl was enough to trigger a seizure. These seizures occur more often at night, since hypoglycemic symptoms are not as obvious at night when the patient is sleeping. 70 percent of hypoglycemic episodes of children with diabetes occur at night time.
Since those with diabetes can also have seizures that are less noticeable than a grand mal seizure, including complex partial seizures and generalized seizures with symptoms of confusion or loss of muscle tone, the frequency of seizures in those with early type 1 diabetes is uncertain. However, the frequency increases with the number and duration of severe hypoglycemic episodes under 60 mg/dl.
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Those With Early Type 1 Diabetes Need to Monitor Blood Glucose Levels to Avoid Seizures
Type 1 diabetes is a serious disease that can lead to long term complications; however, in the early stages of the disease doctors and patients need to be vigilant in monitoring for severe high and low glucose that can lead to seizures.
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Buckingham, Bruce; Wilson, Darrell, Lecher, Todd et al. 2004. Duration of Nocturnal Hypoglycemia Before Seizures. In Diabetes Care.
Trachtenbarg, David E. 2005. Diabetic Ketoacidosis. American Family Physician.