Slow Rot or Quick Fall: A Diabetic's Choice
For those who are not diabetic, a lot of diabetics face a daily internal mental struggle against a common daily event, hypo's (low blood sugar).
Hypoglycaemia
So there I am walking down the local high street just five minute walk from the new school I was attending. I say new as after leaving the juniors this was the ‘big’ school for grown up’s. It was September and I was 12 years old. Turning 13 in a couple of months or so.
The sun was shining down as the last of Summer was still with us. A clear blue sky, children laughing and people going about their everyday business in this North West London suburb.
I had just come out of the local convenience store which was busy, as always, it being lunchtime next to the school. I had purchased a drink and as I walked out, my sugars went. Gone, nada, no glucose in the brain. This was the early 1980s, a world without CGMs.
I do remember falling down, I do remember going in and out of consciousness. I fell to the ground and started convulsing in front of everyone. My strongest memory of this is a woman, dressed in stilettos for footwear standing on the back of my hand, looking down at me with a look of disgust as her words fell from her mouth ‘look at it, drunk, at this time of day!’. Thanks for that memory, whoever you are.
The ambulance was called. The medics gave me a shot of Glucagon. I was escorted back to school by a teacher, and then sent home.
Hypo’s yes, scary as anything and I get the fear. Been there, seen it, done it, do not want to again. Here I am though some four odd decades later still here. Since then I have had hypo’s. Some hypo’s have had to have the emergency services called but still here. Not only here, here, with no long term diabetic complications.
So I get the ‘fear’:-
Risk of Loss of Consciousness or Seizure: Severe hypoglycaemia can lead to confusion, inability to treat oneself, loss of consciousness, or seizures, creating a terrifying feeling of losing control over one’s body and mind.
Hypoglycaemia Unawareness: After repeated low blood sugar events, some individuals develop “hypoglycaemia unawareness,” where the body stops producing the typical warning signs (like shakiness or sweating). This makes it much harder to detect and treat a low before it becomes more severe.
Fear of Public Embarrassment: Many worry about having symptoms or losing control in public, leading to social anxiety, uncooperative behaviour, or needing assistance from strangers. This can significantly impact a person’s quality of life and independence.
Danger of Accidents and Injury: A low blood sugar episode can impair cognitive and motor function (slurred speech, poor coordination, confusion), increasing the risk of falls, injuries, or being involved in a motor vehicle accident.
Potential for Severe Health Consequences: Untreated, severe hypoglycaemia is a life-threatening medical emergency that can lead to coma, permanent brain damage, or, rarely, death.
Impact on Sleep: Nocturnal hypoglycaemia (low blood sugar during sleep) can cause nightmares, sweating, or restless sleep. The fear of not waking up or being unable to treat a low while sleeping is a major source of anxiety for both the person with diabetes and their family members.
The Vicious Cycle of Fear and Management: The overwhelming fear of hypoglycaemia can cause a person to intentionally keep their blood sugar levels higher than recommended to avoid lows. While this reduces the risk of hypoglycaemia, it leads to chronic high blood sugar, increasing the risk of long-term diabetes complications.
Impaired Cognitive Function: Even before consciousness is lost, hypoglycaemia starves the brain of glucose, causing difficulty with concentration, decision-making, and performing routine tasks, which can feel incredibly disorienting and frightening.
Hyperglycaemia
This, is when our bodies are overwhelmed with sugar. On a personal note, hands up, give me a hypo any day. You at least get to eat good things.
At around the same time as above I also experienced glycosuria which is the presence of excess sugar in the urine. Glycosuria occurs when blood glucose exceeds the renal threshold about 180 mg/dL (10 mmol/L). When levels stay above this for a prolonged period (typically several hours), the kidneys can’t reabsorb all glucose, causing it to spill into urine. This is when you are entering into, possibly Diabetic Ketoacidosis (DKA) which is another life-threatening emergency where high acid levels from ketones and severe dehydration can lead to coma or death if untreated.
I remember these times as my parents were none too happy with the sugar residue that was left on the toilet seat, us boys! I also remember that on those occasions when it happened I spent more time getting up and going toilet than I did sleeping. Exhausting times.
Common feelings of being high in sugar or being hyperglycaemic are:-
Initial Physical Discomfort:
Thirst and Frequent Urination: The primary and most disruptive symptoms, leading to constant trips to the toilet and a feeling of unquenchable thirst.
Fatigue and Weakness: Feeling heavy, drained, or intensely tired, as the body’s cells are starved of glucose energy despite having high blood sugar.
Headaches and Blurred Vision: High glucose levels pull fluid from cells, including those in the eyes and brain, causing temporary vision changes and a dull headache.
Irritability and “Fogginess”: Mood swings, lack of concentration, and feeling mentally sluggish or “foggy” are common emotional symptoms.
Emotional and Psychological Strain (If left for several hours):
Frustration and Guilt: The persistent high numbers can cause intense frustration, guilt, and a feeling of failure regarding diabetes management (often referred to as “diabetes distress”).
Anger and Sadness: Prolonged high blood sugar is often associated with a negative mood, including unexplained sadness or anger.
Loss of Function: Difficulty thinking clearly or having low energy can force a halt to daily activities, leading to lost productivity and a sense of being debilitated.
Risk of Acute Life-Threatening Complications (If very high and prolonged):
Diabetic Ketoacidosis (DKA): (Mostly Type 1, but also Type 2) If insulin is severely lacking, the body produces high levels of ketones, causing nausea, vomiting, abdominal pain, rapid breathing, and potentially coma/death.
The Lesser of Two Evils
So, if both are dangerous, why do I fear the slow burn of highs more than the sudden crash of a low? One throws you, potentially into a rapid descent of danger if not treated quickly. The other one that does take some time will still be of a present danger.
Let’s talk about one of my childhood fears and remains so. Long term complications of diabetes, how they happen and what you can do to hopefully live a full and happy life without any long term diabetic complications.
It is all to do with the numbers and I am not one to belittle, moan, sigh, show coldness if your sugar levels are not spot on. You can read my past if you like here.
Long term complications are caused predominately by high blood sugars. Long term complications of diabetes include:-
Microvascular Complications (Damage to Small Vessels)
Diabetic Retinopathy: Damage to the small blood vessels in the retina, leading to impaired vision, floaters, and potentially blindness.
Diabetic Nephropathy: Damage to the small blood vessels in the kidneys, impairing their ability to filter waste. This can progress to chronic kidney disease and eventually kidney failure (requiring dialysis or transplant).
Diabetic Neuropathy: Nerve damage that commonly affects the extremities (feet and legs), causing numbness, tingling, pain, or a complete loss of feeling. This is often associated with the next point.
Macrovascular and Circulatory Complications (Damage to Large Vessels)
Cardiovascular Disease: Accelerated hardening and narrowing of the arteries (atherosclerosis), dramatically increasing the risk of heart attack and stroke.
Peripheral Artery Disease (PAD): Poor blood circulation, especially to the legs and feet, which impairs wound healing and increases the risk of severe infections, ulcers, and ultimately amputation.
Diabetic Foot Problems: A combination of nerve damage (neuropathy) and poor circulation (PAD) leads to unnoticed injuries and slow-healing wounds, which are a major cause of non-traumatic limb amputation.
Other Systemic Issues
Gastroparesis: Nerve damage to the digestive tract that slows or stops the movement of food from the stomach, causing nausea, vomiting, and unpredictable blood sugar levels.
Oral Health Problems: Increased susceptibility to gum disease (periodontitis) and other infections.
Thankfully today we have marvellous gadgets to help diabetics monitor their blood sugar in real time (My first decade or so it was a urine test, I kid you not.). The insulin’s we are prescribed today are also of a far superior than when I started.
By utilising the modern day medical aids that we now have the chances of suffering a dangerous hypo or causing long term complications are dramatically reduced.
One aspect of keeping your blood sugars slightly high is that diabetics think the chances of a hypo are removed, yes, this could be. What though is not a well known fact is that if we run our sugars slightly high over time our bodies get used to this and our bodies will give a ‘false negative’ and make ourselves feel as we are having a hypo and without checking blood sugars we could inject more sugar into the system.
We don’t want sugar at this point we need ‘insulin’.
For me, the lesser of the two evils is being ‘Hypo’. As I have mentioned to many and possibly many more to come my stance is:-
Nobody gets out of this ride, alive. I would rather go quick than slowly rot away because of my inability to convert sugar. No thank you.
How about you, where do you sit? What will be your choice? How do you want to live your life? Let us know in the comments and thanks for reading. After this I fancy a good old coffee.