Diabetic Hypoglycemia?

[Bilberry]

There is a somewhat famous artist in Florida that I'm familiar with that has been known to have diabetic rage. Last time I saw him, his girlfriend described a frightening incident as the two were driving in the car, and he was behind the wheel, when he became agitated.

Along the same lines, on Dr. Briffa's sight I read a story in the Uk the other day about a high court judge punching his wife over his hunger - or his drop in blood sugar levels.

"Could hunger have a part to play in domestic disharmony?"

http://www.drbriffa.com/2011/05/26/could-hunger-have-a-part-to-play-in-domestic-disharmony/

Excerpt:

Yesterday, my blog was based on a piece that appeared in the UK’s Daily Mail from melanoma specialist that urges us to get more sun (and quite right too). While reading this piece, my eye was caught by another article in the same publication with the headline High Court judge ‘beat up his wife because she hadn’t cooked his dinner’

In short, a man and wife are currently in court and he stands accused of punching his wife during a row. I in no way intend to make light of this couple’s plight or the accusation of assault and domestic violence.

What interested me about this story was actually to the reference that the dispute might have been sparked by the fact that the man’s wife had failed to cook his dinner. In my mind, this might be more relevant to the case than is immediately obvious.

If you read the article you’ll see that it is claimed that when the man came home from his work as a judge, his wife was comforting the household cleaner. Apparently, he had not eaten all day. Then he went to his bedroom to work for an hour and a half. And then the trouble started it seems.

My experience in practice is that hunger is a major cause of disharmony in the home. Let me paint a picture of a typical scenario…

Someone has a sandwich for lunch at work at about 12.30, and then eats little or nothing before they come home, often at 7.30 or later. By their own admission, they are often ‘starving’ at this time. Hunger and a bit of blood sugar dysregulation from eating a sandwich may well have led to a bit of low blood sugar (hypoglycaemia).

One potential effect here is for the body to turn on the ‘stress’ response through, for example, the secretion of adrenaline (epinephrine). Low blood sugar can causes quite profound changes in mood, not least of all because it can cause increases in the levels of glutamate in the brain, which increases excitability.

Some of you will know this from your experience of kids. If children, especially quite young ones, are not ‘fed on time’, they can morph into ‘little monsters’. They’re not monsters, of course, but when their brains don’t get the fuel needed for proper functioning they can sure look that way. It’s pretty much the same with many adults, though.

So, someone coming home in this ‘heightened’ state is normally not the best version of themselves they can be. Here’s a few ways this phenomenon can manifest:

Worker comes home ‘frazzled’ and partner wants to hell him/her about important things that have happened during the day. The worker’s attention, however, is on the fridge or kitchen cupboards.
Worker comes home and reaches for wine, beer or gin and tonic in an effort (unconsciously) to get their blood sugar levels up (alcohol now being used a substitute for food).
Worker comes home and in their ‘excitable’ state manages to fund fault with something quite minor like the fact that there’s some toys in the hallway or, ahem, dinner is going to be ‘half an hour’.
I cannot tell you how often individuals fall foul of this. My experience is that it affects the majority of workers I talk to. The other problem with coming home too hungry is that it generally leads to overeating (and over-drinking).

These issues are so very often ‘cured’ just by ensuring that rampant hunger and low blood sugar are kept at bay in the late afternoon and early evening. For most people, what this amounts to is eating a handful or two of nuts between lunch and dinner....

 

[CassandraJade]

Wow, thank you all so much for your advice! Lots of food for thought here, and I'm taking every bit of it very much to heart.

We had a long talk last night after his sugar finally came up. He's every bit as freaked out as I am that it happened again. We're definitely going to see the doctor again when we get back home (traveling extensively this summer). I want him to see an endocrinologist, and his insurance will pay without a referral. We're still discussing that one, since he adores his family doctor, but we'll see.

As for the rest of it, he used to test religiously before driving, etc, and he used to always carry snacks. We agreed that since his sugar's been generally under control, we've both become complacent about it and let things slide. Another contributing factor is that this is the first real experience for both of us with spending protracted time in tiny towns. We're used to there being a McDonald's on every corner which, while not our first choice for a variety of reasons, is a great emergency fallback. Now we realize that we both have to be proactive about making sure that he has something to eat WITH him at all times.

This is also our first experience with dry heat--we're from Florida, and used to the humidity. Both of our bodies are going nuts from the dryness, and I think that may be further throwing his sugar off. That and the sheer amount of walking he's been doing--way more than he's used to.

So for now, he's going to test more often and carry snacks. I'm going to stick an extra snack or two in my purse in case he forgets, and we're going to go see the doctor when we get home.

Thank you all again, so much! Bella, I wrote a nice response to your PM, but I can't send it until I have 10 posts. So I'll send it when I can--in the meantime, please just know that you're not alone.

 

[crashbb]

Wow, thank you all so much for your advice! Lots of food for thought here, and I'm taking every bit of it very much to heart.

We had a long talk last night after his sugar finally came up. He's every bit as freaked out as I am that it happened again. We're definitely going to see the doctor again when we get back home (traveling extensively this summer). I want him to see an endocrinologist, and his insurance will pay without a referral. We're still discussing that one, since he adores his family doctor, but we'll see.

As for the rest of it, he used to test religiously before driving, etc, and he used to always carry snacks. We agreed that since his sugar's been generally under control, we've both become complacent about it and let things slide. Another contributing factor is that this is the first real experience for both of us with spending protracted time in tiny towns. We're used to there being a McDonald's on every corner which, while not our first choice for a variety of reasons, is a great emergency fallback. Now we realize that we both have to be proactive about making sure that he has something to eat WITH him at all times.

This is also our first experience with dry heat--we're from Florida, and used to the humidity. Both of our bodies are going nuts from the dryness, and I think that may be further throwing his sugar off. That and the sheer amount of walking he's been doing--way more than he's used to.

So for now, he's going to test more often and carry snacks. I'm going to stick an extra snack or two in my purse in case he forgets, and we're going to go see the doctor when we get home.

Thank you all again, so much! Bella, I wrote a nice response to your PM, but I can't send it until I have 10 posts. So I'll send it when I can--in the meantime, please just know that you're not alone.

You've had some good suggestions (and are making some smart changes) but this bit jumped out at me. He is not a child and you should not feel responsible for his complacency about his body.

 

[SandrA9810]

I hate the Texas dry heat, the first time I visited it was an entire week over 100, and I'm from Florida as well. Florida heat is nothing... but that first time in dry heat really got to me. Although most the time, people's response is "Dry heat is so much better than that high humidity".

Another thought, which I don't know if it would work for you or not, what about a dog to detect his lows? Especially if travelling and being out of the norm is something you plan on doing often.
A couple of benefits to it, is A) the dog is doing his job when he detects a low, B) it can be trained to help alleviate the stress/temper.

 

[esbrick]

I am a type 1 diabetic so I can share some insight on this. I have frequent hypo episodes, usually heat/exercise related. First and foremost, please know that when your spouse is being like this it is out of his control. Many times people become immune to the warning signals of low blood sugar over time. You need to talk to his doctor and readjust the amount of medication he is taking especially when he is going to be more active and in the heat. Second, he needs to eat BEFORE he exerts himself-something small, and complex. (Granola bar, cheese and crackers). I also suck on hard candy to give me a little boost. Keep regular soda around because a glass of that will boost his sugar very quickly. Do not let him drive if he seems symptomatic to you-get a glucometer and use it regularly. I test EVERY time I get behind the wheel-no matter how I feel or how far I am driving. The dose of medication your husband is on does not have to be the same every day depending upon his level of activity-if you are on an active vacation, maybe he needs less than on a day that you are just laying low at home, KWIM? Talk to your doctor.

I agree with the pp Maryr1. I am also a Type 1. I do get snarkey when I am lucid and heading down but not as much any more. The one piece of advice, from personal experience, that I can give is that your sensitivities are hightened at this point so anything is an annoyance. What I taught my friends was that if they notice what is going on to tell me that they notice. If I don't react or say I'm fine and don't test or get nasty not to keep at me. They should just react and put a glass of soda or orange juice in front of me or hand me some candy. By the time I have gotten to the point where my mood is changing I'm ready to eat just out of frustration so you will leave me alone. Knock wood it's been a while since this has happend. I still get grouchy when I'm hungry though, however now it's compounded by the fact I'm eating for two!

 

[Tinker'n'Fun]

Forgive me for using a new screen name, but I'm a regular here and wanted to get some anonymous advice.

My other half has Type 2 diabetes, along with several other health conditions. He's been diagnosed for about 6 years now, and generally handles it very well. He takes Metformin exclusively--was on glipizide for awhile, but it made his sugar consistently run too low.

The problem is, even with the Metformin, he sometimes experiences diabetic hypoglycemia (low blood sugar). Normally he can feel it coming on, and he takes glucose pills and then eats, and everything's fine.

For some reason, his body occasionally skips that step. He goes from fine to super-low with little or no warning. It seems to be worse when he gets a lot of exercise in the heat.

When that happens, he goes into what I call a black rage. He's never been physically abusive AT ALL, so I'm not scared for myself, but I'm worried about him. He becomes verbally abusive, combative, mean and, worst of all, flatly refuses to take glucose or eat.

We're in Texas at the moment, and the temperature is around 102. We were on the top floor of a lightly air-conditioned three-story museum (no elevator) when it hit. I suggested he take glucose pills (he always carries them) and he refused--said he'd be okay until we got out and got some food.

Well, in this small west Texas town, Mexican food is about the only option. And he hates Mexican food. We drove around for literally an hour and a half, discovering all the now-closed fast food places that showed up on our GPS. I finally suggested that we go back to the room, where we had a dozen zero-preparation options that I was glad to fix for him (PB&J, instant soup, waffles, Hot Pockets, stuff like that).

He flipped out. Accusing me of "shrieking" at him and telling him what he was *going* to do, he drove back all right (he won't let me drive when he's like that either). And flatly refused to eat. And spent the next hour and a half screaming at top volume and berating me for not *letting* him go out to eat.

As always happens in these situations, I finally ended up crying and begging him to eat something, while he continued to pour on the blame about how it was MY fault that he no longer felt like eating. Eventually I guess I had cried and begged enough, because he checked his blood sugar. It was dangerously low. He then consumed exactly enough carbs to get him out of the danger zone, but not enough to raise his sugar high enough to get him out of the black rage. And here we sit in our hotel room, four hours after leaving the museum, going around and around in circles.

Please don't tell me that I need to leave him, or how emotionally abusive he is, or anything like that. This sort of behavior ONLY occurs when he has a sudden, massive blood sugar drop, and has not happened at all in well over a year. I'm not going to leave him over something medically induced and rare.

What I would like to know is, does anyone else have any experience with diabetic hypoglycemia, particularly the rage aspect of it? What can I do to better help him help himself? I know his blood sugar's not my responsibility, but I'm pretty eager to avoid these situations, or at least lessen the duration and severity.

Thanks for anything you have!

My Dad was like this, finally my mother, without saying a word, she would walk out of the room call 911, then get him an orange juice with sugar *yes I know that is not he proper things to do*, and she would go to another area until they showed up. Some times he would drink the OJ and be okay, other times, the EMT's would restrain and take care of it.

As much as I know you love him, letting him drive you around for hours is extremely reckless and dangerous. You have to step up and do what is right.

I really hope everything gets better and he learns to control his rages.

 

[Judy from Boise]

I agree with Bumbershoot, the exciting piece in all of this is how well he responds to exercise to decrease his sugars. It sounds to me like a plan could be crafted with input from his care provider to become diet and exercise controlled.

 

[book_junkie]

Wow, thank you all so much for your advice! Lots of food for thought here, and I'm taking every bit of it very much to heart.

We had a long talk last night after his sugar finally came up. He's every bit as freaked out as I am that it happened again. We're definitely going to see the doctor again when we get back home (traveling extensively this summer). I want him to see an endocrinologist, and his insurance will pay without a referral. We're still discussing that one, since he adores his family doctor, but we'll see.

As for the rest of it, he used to test religiously before driving, etc, and he used to always carry snacks. We agreed that since his sugar's been generally under control, we've both become complacent about it and let things slide. Another contributing factor is that this is the first real experience for both of us with spending protracted time in tiny towns. We're used to there being a McDonald's on every corner which, while not our first choice for a variety of reasons, is a great emergency fallback. Now we realize that we both have to be proactive about making sure that he has something to eat WITH him at all times.

This is also our first experience with dry heat--we're from Florida, and used to the humidity. Both of our bodies are going nuts from the dryness, and I think that may be further throwing his sugar off. That and the sheer amount of walking he's been doing--way more than he's used to.

So for now, he's going to test more often and carry snacks. I'm going to stick an extra snack or two in my purse in case he forgets, and we're going to go see the doctor when we get home.

Thank you all again, so much! Bella, I wrote a nice response to your PM, but I can't send it until I have 10 posts. So I'll send it when I can--in the meantime, please just know that you're not alone.

If he's having problems like this, he NEEDS to see an endo- the family GP is NOT going to be able to treat him properly. If you don't have one already, call the GP and get a prescription for one of the little mini-meters and the testing supplies that he needs to go with so that he can get back on track with his testing and chart what's going on with his levels. I'm sure you can find a Walgreens or CVS or Riteaide in the area that will fill it. In the meantime, also ask them about changing the dosage of his metformin if he's consistently low and having episodes.

And from my understanding, since he's not under control of his sugars, he actually should be testing at least 6 times a day- before meals and then two hours afterwards. With that much testing, he'll know exactly where he is, and there should be no rapid dropping into acting out.

I'm type 2, on meds and insulin, and the heat here does me in like crazy (well, any heat really)... Part of the problem is that you both may be dehydrated, especially if you're not used to the heat and sun. Be sure to drink a lot of water....

I also have a really hard time telling when I get too low until it's too late, so I have to be extra careful- I can buzz along on adrenaline or caffeine for hours at a time, and then hit a quiet pocket and crash hard. I've learned the hard way to test first, then exercise (even if it's walking), and if the sugars are within the normal/low range have a small carb snack like cheese and crackers, or cheese and fruit. I also have glucose tabs around just in case, and those who know me know that if there's something really wrong to go get juice or normal soda ASAP. Anything to bring that sugar up. Then I figure out why I crashed and work on fixing it.

There is NO excuse for his actions, however, especially if he's nasty with you and fine with other people- doesn't matter if he's had anger management issues in the past. And you can't let him drive in that condition, he can kill you and everyone else around him. If he's not "well" enough to figure it out for himself, you're going to have to put your foot down and insist he test and fix it before going one step further.

 

[Michelle67]

You've already gotten some really good advice, I'm just going to weigh in on the "been there done that" side of things. Or rather, I should say, my family has been there and done that. I am not diabetic, just hypoglycemic, and I become a nasty cranky person when my blood sugar drops. It seems to happen to me most often while traveling---when my body is in unfamiliar climates and the activity level and routine are not normal, etc. My poor husband is pretty good about recognizing the symptoms, and usually says something like "Oh, I see it's feeding time at the zoo." Yeah, kinda sarcastic, but since I'm usually being a lot nastier than that at the time it's not like I have a lot of room to talk about sarcasm. My usual response is to grouse about how whatever little petty thing I'm going off about is the problem, not me...and his usual response is to get us to a restaurant.