Seizures, Vomiting, Fear of Dying: The Threat of Hypoglycemia

As a physician without diabetes, I often fail to understand the experience my patients have of living with diabetes. A real part of the experience of giving insulin is the fear of hypoglycemia.

As a physician, I'm judged on how my patients do with their A1c targets. I always want people to be at less than 7% so that they do not get horrible complications. But day in and day out, patients have to live with the overarching concern of being too low. That can happen anytime, day or night. A patient can go too low if they misjudge insulin by maybe a unit or two, eat too little, or exercise too much.

Increasingly, hypoglycemia is becoming an endpoint. I'm part of a group that consists of the Endocrine Society, the JDRF, and others that is considering including hypoglycemia in clinical trials outcomes and in the ways we monitor our patients.

I asked one of my patients to make a video of four other patients discussing what they feel like when experiencing hypoglycemia. I think their voices are much stronger than anything I can say about hypoglycemia, because it shows you how much they worry about it and how much it impacts their life in real time.

'The Deal With Lows'

Patient 1: I hate feeling low. Feeling low is one of the worst feelings in the world for me. It's scary.

Patient 2: It feels awful. It just feels like the worst thing.

Patient 3: I feel like I'm empty inside. I just want to lie down, curl into a ball, and go to sleep. And I hope that when I wake up, everything is fine and I'll feel better.

Patient 4: I don't feel like myself. I almost feel like I'm having an out-of-body experience.

Patient 2: I don't think clearly. I can't always make good judgments for myself. I get sidetracked. I get confused. I start panicking.

Patient 1: I get angry when I'm low. When I was younger, I'd be in denial. Close friends would tell me I was low based on my symptoms. A couple of times I threw glucose tablets at them, saying that I wasn't.

Patient 3: My brain starts to panic. I shake a lot, and I feel like I'm in the desert trying to crawl to the fridge to get something to survive, I guess.

Patient 4: You don't know what's going to happen once you're going low, and I think that's the scariest part.

Patient 1: I go low during work pretty often, because I'm always on my feet. I can't just go in the back, have sugar, and get right back out on the floor and start serving again. It's embarrassing. No, I need longer. I know I just had three sugar tablets, but I need about 20 minutes before I can get back to work. You almost feel like a liability.

Patient 3: I'll wait the 15 minutes and my blood sugar recuperates, but my body does not at all. That feeling of still not caring and not wanting to do anything can last up to an hour after being low.

Patient 4: Sometimes after you get low and fix yourself, you go high. You correct from going high and then you go low again. I feel like when I go low, I tend to go up and down for the rest of the day.

Patient 2: It's tough for me to say how often I think about how scary and how bad a low can be—how life-threatening it can be.

Patient 3: I got out of the show and almost keeled over. I thought I was going to pass out. I sat on the ground in the middle of the queue and people just walked by me. My friend ran to the concessions and bought like five bottles of orange juice and just kept feeding them to me. It was a panic moment—like, "Oh, my God. I didn't know that this was actually a thing."

Patient 1: I've probably had five seizures in my sleep. I somehow wake up from them. I'll wake up and be able to tell that I just had a seizure. It's so hard. I know what's happening. I know I need juice, but my head is telling me how much easier it would be to close my eyes and just relax.

Patient 4: I had three juice boxes. That's the last thing that I remember. I must have passed out because right when I woke up, I immediately ran to the bathroom and threw up.

Patient 2: I would purposely keep my blood sugar at a higher level before going to bed, even though I knew having those higher blood sugars put me at greater risk for a higher A1c and complications down the road. I didn't care. If I die tomorrow from a low blood sugar, who cares what my A1c is? Having a blood sugar of 200 at bed rather than 100 gave me the peace of mind to think, "Okay, at least I know I'll wake up tomorrow."

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Seizures, Vomiting, Fear of Dying: The Threat of Hypoglycemia - Medscape - Aug 24, 2017.