Diabetes and Irrational Behaviour

Status
Not open for further replies.

Amity Island

Well-Known Member
Relationship to Diabetes
Type 1
In diabetes, irrational behaviour happens because glucose levels that are too high (hyperglycemia) or, especially, too low (hypoglycemia) impede self-control. When people lack their normal level of self-control, they often:

  • are impulsive
  • disregard long-term consequences of their actions
  • easily give in to temptation
  • make poor decisions even when they’re aware of different choices
Irrational behaviour in diabetes can reduce the quality of life if it happens often or affects major life areas like relationships and work. Mental confusion also has the potential to negatively affect someone’s life. Bouts of confusion, when they’re severe or long-lasting, can limit lifestyle and such things as freedom of movement and ability to work.

Signs of diabetes mental confusion include:

  • forgetfulness, including forgetting what you’re doing while you’re doing it
  • a sensation of brain fog
  • losing important objects
  • difficulty concentrating
  • confusion
  • long pauses during speech, as if you’ve lost your train of thought
  • feeling like you can’t think
  • disorientation
  • sudden agitation ("Diabetic Rage: Can Diabetes Cause Aggressive Behavior?")
  • difficulty doing ordinary tasks
  • incoherent speech

 
I have had a number of epsiodes of severe hypos over the past few years, in an asleep state and once awake.
The experience mentally can be trippy and a struggle to get a grip on reality whilst in the midst of the hypo. My memory of the experience is often gone when my sugar levels are back to normal range. My behaviour can be out of character and I feel very guilty afterwards if anybody has to assist me, I always fear that my behaviour has been upsetting. As a child I was alone with my T1D father once and he became very aggressive during a severe hypo, not towards me but it was frightening.

Becoming a part of this forum and reading through the posts has enabled me to get back on track.

Can anybody share personal experiences of severe hypoglycemia?
 
Have you managed to reduce your hypos @bujanin ? I remember now that you had a thread about them. Apologies for not remembering that when I answered your question about a test for hypo awareness. Are you concerned your awareness has been damaged by running too low?

The most severe hypo I heard about was someone I knew by sight early in diagnosis. Their hypo was so severe they sadly passed away. I understand it was a nighttime hypo. That’s why I get irked when people dismiss hypos as being nothing or simply sorted. Insulin is a potentially dangerous drug and it should always be treated with respect.

Nocturnal hypos are frightening. I do find my Dexcom relieves some of that stress.

I’ve had hypos that caused seizures a couple of times. The awful thing was I could feel the seizure coming but couldn’t stop it. No glucose by mouth can beat an impending hypo seizure. I’ve never been aggressive during a hypo.

I always try to stay above 5 to keep my hypo awareness sharp.
 
Have you managed to reduce your hypos @bujanin ? I remember now that you had a thread about them. Apologies for not remembering that when I answered your question about a test for hypo awareness. Are you concerned your awareness has been damaged by running too low?

The most severe hypo I heard about was someone I knew by sight early in diagnosis. Their hypo was so severe they sadly passed away. I understand it was a nighttime hypo. That’s why I get irked when people dismiss hypos as being nothing or simply sorted. Insulin is a potentially dangerous drug and it should always be treated with respect.

Nocturnal hypos are frightening. I do find my Dexcom relieves some of that stress.

I’ve had hypos that caused seizures a couple of times. The awful thing was I could feel the seizure coming but couldn’t stop it. No glucose by mouth can beat an impending hypo seizure. I’ve never been aggressive during a hypo.

I always try to stay above 5 to keep my hypo awareness sharp.
I have managed to reduce them hugely by raising my low alert to 5.5, finger pricking regularly to calibrate and reacting sooner to declining sugar levels.

My hypo awareness has improved over the past three months by simply trying to stay above 5.5. At 4.6 - 4.9 I feel empty in the stomach, uneasy in the body and a little uncomfortable in the mind. So yes I think I damaged my awareness by running too low but with concerted efforts it's returning.

The most rewarding part of the following from my doc is the time <3.0mmol which previously was 4%. It's a huge improvement but has required a lot of work:

As per his current continuous glucose monitoring data (data from last 30 days reviewed on 22rd
October 2023), his current time spent in target range (3.9-10.0mmol/L) is 66%, time below range (between
3.0-3.9mmol/L) is 3%, and time below range <3.0mmol/L is <1%. As per the International Consensus
Guidance, the recommendations are >70% time in target range (3.9-10.0mmol/L), <4% time below range
(<3.9mmol/L) and <1% time below range (<3.0mmol/L).

Thanks for replying Inka.
 
That’s brilliant @bujanin ! Well done 😎 🙂 You should be very proud of that. Yes, it is hard work to start with but I found it gradually got easier as it became second nature. I hope you find the same.
 
Well done on your efforts to recover your hypo awareness. Great to hear you have been so successful.

Keep doing what you have been doing!
 
Can anybody share personal experiences of severe hypoglycemia?
When I was younger, on a DIY mix of Humilin insulins, and going out more (and drinking alcohol):

I would sometimes think I was dreaming, and gradually come around and realise that in fact I wasn't, and was indeed sat somewhere unexpected, usual because my school friends had delivered me to matron (not normally post-pub trips, though I do recall them telling me that they had had to feed me some toothpaste before delivering me to matron after we popped to the pub after a rubgy match - I only recall waking up sat in the infirmary!)

I've had the unpleasant issue of waking up while very low and only one side of my body wanting to work, which was ok as I managed to drag myself out of bed (not much fun getting to the floor I recall) to my fridge (which I had in my room at school on account of being diabetic for insulin and OJ) and drank some OJ/had something to eat, then everything started working again. Iirc my BG after I'd regained sufficient movement/mental capacity to do anything was in the high 1s mmol/l.

When at uni I vividly recall needing to drag myself across my flat, as my legs were completely "jelly" and I couldn't stand up, I managed to pull myself up to the kitchen counter top and grab the sugar bowl by the kettle (for coffee) and then sit and consume until all was better. Same as above high 1s mmol/l.

I'd sometimes get poor muscle control and drop things (that is perhaps not the right word), often when walking back from having done some grocery shopping when at uni - I should have done something about my BG, and I have learned to do something early now, but then I was younger and always thought I'd be able to make it home, etc. What would happen is I'd be walking along quite happily (though feeling low, but wanting to get home) and would spontaneously open my hand and drop the shopping bag. This was obviously quite annoying, and uncontrollable, even when I concentrated very hard to not do it. I must have looked very odd. I should have taken some hypo treatments with me and eaten them (though this was before mini bags of skittles and dextrose tablets were and still are not all that nice, especially not if they've lived in your pocket for some time, they also have uncomfortable corners).

Last but not least, when low and once I'd realised I needed to deal with it, I would become singular in my goal of doing this. I'm never aggressive, but if someone prevented me from doing this they may see that as aggression or just rudeness. Often this defaulted to going home (from a bar/nightclub while at uni), rather than doing something faster like going to the bar and getting some OJ/Coke (mainly as getting served at a bar that was 8-deep was always a PITA and I knew I could be home in 20 minutes.) This was not actually a very good decision as I'd tend to run lower while walking home and probably should have asked someone to get me a drink, however I'm never really one to rely on other people for anything, and this behaviour certainly comes to the fore when low (when I was younger, I'm perhaps wiser now, or just don't run low very often).

OTOH perhaps this was simply a case of goal fixation, once I had an idea that was it. It takes some serious effort to think of options while low, so this is quite an easy trap to fall into. The same is probably true of my grocery shopping story above, I could have eaten something I'd bought, or stopped at a cafe or shop along the way home, but that would be diverging from the plan and requires extra mental capacity which is often not readily available when low. It is possible to overcome this with some mental discipline, though as I'm also an (decision) optimiser I have to forego this part of my approach to all things and take the first choice (e.g. somewhere selling something that contains sugar.) It's interesting, but once I realised this, it did make life easier once I'd told myself that this is what I would do and made it a habit.

Now that I'm older (and hopefully wiser) and have a CGM I don't tend to run low very often, and if I do I deal with it immediately (or head it off early) rather than hoping I can continue and make it wherever I was going. This is often because I'm on the bike and a long way from home so there is no way I'll make it back if I just keep going rather than treating it and/or because my children are with me so I'm unwilling to just wing it as I would when younger and it was only me I needed to worry about.
 
In diabetes, irrational behaviour happens because glucose levels that are too high (hyperglycemia) or, especially, too low (hypoglycemia) impede self-control. When people lack their normal level of self-control, they often:

  • are impulsive
  • disregard long-term consequences of their actions
  • easily give in to temptation
  • make poor decisions even when they’re aware of different choices

Interesting generalisation. I dated a woman like this once & she wasn’t diabetic.
 
When I was younger, on a DIY mix of Humilin insulins, and going out more (and drinking alcohol):

I would sometimes think I was dreaming, and gradually come around and realise that in fact I wasn't, and was indeed sat somewhere unexpected, usual because my school friends had delivered me to matron (not normally post-pub trips, though I do recall them telling me that they had had to feed me some toothpaste before delivering me to matron after we popped to the pub after a rubgy match - I only recall waking up sat in the infirmary!)

I've had the unpleasant issue of waking up while very low and only one side of my body wanting to work, which was ok as I managed to drag myself out of bed (not much fun getting to the floor I recall) to my fridge (which I had in my room at school on account of being diabetic for insulin and OJ) and drank some OJ/had something to eat, then everything started working again. Iirc my BG after I'd regained sufficient movement/mental capacity to do anything was in the high 1s mmol/l.

When at uni I vividly recall needing to drag myself across my flat, as my legs were completely "jelly" and I couldn't stand up, I managed to pull myself up to the kitchen counter top and grab the sugar bowl by the kettle (for coffee) and then sit and consume until all was better. Same as above high 1s mmol/l.

I'd sometimes get poor muscle control and drop things (that is perhaps not the right word), often when walking back from having done some grocery shopping when at uni - I should have done something about my BG, and I have learned to do something early now, but then I was younger and always thought I'd be able to make it home, etc. What would happen is I'd be walking along quite happily (though feeling low, but wanting to get home) and would spontaneously open my hand and drop the shopping bag. This was obviously quite annoying, and uncontrollable, even when I concentrated very hard to not do it. I must have looked very odd. I should have taken some hypo treatments with me and eaten them (though this was before mini bags of skittles and dextrose tablets were and still are not all that nice, especially not if they've lived in your pocket for some time, they also have uncomfortable corners).

Last but not least, when low and once I'd realised I needed to deal with it, I would become singular in my goal of doing this. I'm never aggressive, but if someone prevented me from doing this they may see that as aggression or just rudeness. Often this defaulted to going home (from a bar/nightclub while at uni), rather than doing something faster like going to the bar and getting some OJ/Coke (mainly as getting served at a bar that was 8-deep was always a PITA and I knew I could be home in 20 minutes.) This was not actually a very good decision as I'd tend to run lower while walking home and probably should have asked someone to get me a drink, however I'm never really one to rely on other people for anything, and this behaviour certainly comes to the fore when low (when I was younger, I'm perhaps wiser now, or just don't run low very often).

OTOH perhaps this was simply a case of goal fixation, once I had an idea that was it. It takes some serious effort to think of options while low, so this is quite an easy trap to fall into. The same is probably true of my grocery shopping story above, I could have eaten something I'd bought, or stopped at a cafe or shop along the way home, but that would be diverging from the plan and requires extra mental capacity which is often not readily available when low. It is possible to overcome this with some mental discipline, though as I'm also an (decision) optimiser I have to forego this part of my approach to all things and take the first choice (e.g. somewhere selling something that contains sugar.) It's interesting, but once I realised this, it did make life easier once I'd told myself that this is what I would do and made it a habit.

Now that I'm older (and hopefully wiser) and have a CGM I don't tend to run low very often, and if I do I deal with it immediately (or head it off early) rather than hoping I can continue and make it wherever I was going. This is often because I'm on the bike and a long way from home so there is no way I'll make it back if I just keep going rather than treating it and/or because my children are with me so I'm unwilling to just wing it as I would when younger and it was only me I needed to worry about.
So much of this resonates. The jelly legs can make the shortest journey take forever.
I could have eaten something I'd bought, or stopped at a cafe or shop along the way home, but that would be diverging from the plan and requires extra mental capacity which is often not readily available when low. It is possible to overcome this with some mental discipline, though as I'm also an (decision) optimiser I have to forego this part of my approach to all things and take the first choice (e.g. somewhere selling something that contains sugar.)
This sense of needing to do what I have planned and bypass shops or other possibilities has led to hypos that so easily could have been avoided.

Thanks SimonP for taking the time to share your experiences.
 
OTOH perhaps this was simply a case of goal fixation, once I had an idea that was it. It takes some serious effort to think of options while low, so this is quite an easy trap to fall into. The same is probably true of my grocery shopping story above, I could have eaten something I'd bought, or stopped at a cafe or shop along the way home, but that would be diverging from the plan and requires extra mental capacity which is often not readily available when low. It is possible to overcome this with some mental discipline, though as I'm also an (decision) optimiser I have to forego this part of my approach to all things and take the first choice (e.g. somewhere selling something that contains sugar.) It's interesting, but once I realised this, it did make life easier once I'd told myself that this is what I would do and made it a habit.

Yes, I recognise that fixation. It’s like the glucose-starved brain can only deal with one thought at a time. Early in diagnosis, I’d push on with what I was doing too, even when common-sense would have said to stop. I remember walking to the shop and getting the jelly legs on the way there, but instead of stopping and having some glucose I carried on walking - like John Cleese in the Ministry of Silly Walks! I also think that with the fixation comes a kind of obstinate determination too.

Also, hypos are unnatural, and especially early on, it’s hard to get your head round the idea that our blood sugar could just keep on dropping. So, I remember recognising what I’d call normal non-diabetic low blood sugar levels, but comprehending the urgency of the need to treat the hypo took me a while to learn. Also, some hypos seemed fiercer and had worse effects even if my blood glucose was slightly higher than previous hypos.
 
Yes, I recognise that fixation. It’s like the glucose-starved brain can only deal with one thought at a time. Early in diagnosis, I’d push on with what I was doing too, even when common-sense would have said to stop. I remember walking to the shop and getting the jelly legs on the way there, but instead of stopping and having some glucose I carried on walking - like John Cleese in the Ministry of Silly Walks! I also think that with the fixation comes a kind of obstinate determination too.
I have had occasions when my sugars are dropping so I put something in the oven or grill thinking twenty minutes that's fine. Sometime later I'm sweating like crazy, foods burnt in the oven and I'm coming out of a hypo that just seemed to appear but of course it had been coming and I'd lost the ability to think simple sugars straight away whilst the food cooks. I've lost a couple of hours through an episode like this before.
 
Which is why the Libre and CGMs are so great. We can spot falling sugars in plenty of time and ward off most hypos, especially if they happen at an unexpected time. I particularly love the arrows because that extra information makes all the difference. Knowing I’m 5.8 and falling alerts me and I usually have a small carb top up and then check again shortly just to keep an eye on things. With finger-pricking, I’d just have seen the 5.8 and carried on.
 
Which is why the Libre and CGMs are so great. We can spot falling sugars in plenty of time and ward off most hypos, especially if they happen at an unexpected time. I particularly love the arrows because that extra information makes all the difference. Knowing I’m 5.8 and falling alerts me and I usually have a small carb top up and then check again shortly just to keep an eye on things. With finger-pricking, I’d just have seen the 5.8 and carried on.
Agreed that CGMs are probably the biggest factor but I'd also say that the move to MDI made life easier as there's much less guessing about how much one needs to eat/ensuring one eats to schedule and the ability to tune dosage to food and activity.
 
I have had occasions when my sugars are dropping so I put something in the oven or grill thinking twenty minutes that's fine. Sometime later I'm sweating like crazy, foods burnt in the oven and I'm coming out of a hypo that just seemed to appear but of course it had been coming and I'd lost the ability to think simple sugars straight away whilst the food cooks. I've lost a couple of hours through an episode like this before.
Yes, indeed, I don't want to eat anything and mess up blood sugar before having supper, though I have realised that eating while hypo (assuming you remember to get the food out of the oven!) isn't very pleasurable and also almost invariably makes me go high as I then do a late bolus and normally not enough. It's tricky as I typically want proper food rather than hypo-treatment food at this point, but I should really treat the hypo, get stable blood sugar, then do normal dosing for supper.

The answer here is to ensure sort out the stability a bit earlier, so I can treat if needed as a late afternoon tea sort of thing. Though with that said it's very dependant on what you're doing in the afternoon - I might take a correction dose then get distracted by feeding the kids/sorting out their homework and only quite late on realise that I'm heading low and have IoB still, I could probably do with some sort of temporary alarm system in XDrip+ (the same thing happens in the morning if I'm stubbornly high so take some stacked corrections, then get distracted by work and when BG finally decides to respond I find that I'm dropping quite quickly so should eat my breakfast as soon as that happens)
 
Status
Not open for further replies.
Back
Top