Lows and long-term neurological damage

[arbequina]

Hello,

Like many of you, we are experiencing quite a few lows due to outdoor activies or heat.

Since Rohan is only 2, we've been told to avoid lows. Normally, I am able to catch a low when it is in the 50-70s.

My husband asked our endo if these types of lows (no convulsions, no obvious effects on Rohan, etc) will have effect on brain development. Our endo answered with a reluctant, "no", which made me think that either he did not know, or did not want to scare us.

Is there any scientific material available where I can read about this? Of course, I want to avoid lows as much as the rest of you, but I would like to take the opportunity to educate myself and come up with a plan to try and avoid even these types of lows, if they are indeed, causing long-term neurological damage.

Thanks!

Nina

[Kaylee's Mommy]

I dont' have any articles.. but from my understanding is the longer the low the worse it is.. if he's headed down and you catch it, correct it and he goes back up.. really not a big deal.. but if he's in the 50s for a while then that is when I would think it would start affecting his brain development.. the other dangerous thing about lows is that a 70 can quickly turn into something much more dangerous.. non-d people go into the 60s and sometimes 50s during fasting/before meals.. but their body can correct that on its own... our kids bodies don't/can't/or to slow to catch that fall and then all of a sudden a low at 70 is no longer ok, because now its in the 40s or 30s.. which has happened to us in a matter of minutes..

sorry Idon't have any articles... hopefully someone else does:)

[D-Dad]

For what it's worth - I did a bunch of searching on this subjust and did not come up with much.

[EmmasMom]

From the research I've read...

There is greater risk of severe and undetected lows in young children, and they are more likely to be damaged by them because it's an "especially critical period for brain development", but severe lows can cause brain damage at any age. A severe low, or "profound hypoglycemia", is defined as lower than 35mg/dl.

Moderate lows in the 40-60 range are unlikely to cause damage, but can be a symptom of "poor metabolic control" if they happen often or for long periods of time, (like during sleep), and may affect your memory and spatial reasoning and cause an overall decline in academic performance.
Overall poor metabolic control, (many highs and lows), is actually the biggest factor in "neurocognitive dysfunction" in people with diabetes.

So... severe lows are to be avoided at all costs, especially in children under 3, but roller coaster blood sugars combined with a high A1C are actually more likely to hurt them in the long run. :rolleyes:

Here's one study I have:
Does moderately severe hypoglycemia cause
cognitive dysfunction in children?

http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1399-543X.2004.00044.x?cookieSet=1


I have some other stuff too, I'll have to find the links so I can post them.:)

[EmmasMom]

Wide Swings in Glucose Levels May Cause More Damage Than Believed

New York, NY, April, 2006 - A new study in France shows that wide swings in glucose levels may damage the body as much as sustained periods of hyperglycemia (high blood glucose).

The finding suggests that diabetes patients should increase their efforts to curb such fluctuations if they want to reduce the risk of complications such as heart disease and damage to the eyes, nerves, and kidneys. It also bolsters the view that continuous glucose monitors and, eventually, an artificial pancreas, could have a tremendous impact on reducing diabetic complications by preventing repeated highs and lows.

The research, led by Louis Monnier, M.D., was conducted at the University of Montpelier and published in the Journal of the American Medical Association (Vol. 295, No. 14, p. 1681, 2006).

The study found that glucose fluctuations trigger "oxidative stress," changes in metabolism that lead to cell damage and cell death and contribute to complications. It was known that hyperglycemia had this effect, but now it appears that repeated highs and lows can be equally damaging.

Previously, chronic hyperglycemia was viewed as the main cause of blood vessel damage. As a result, diabetes care has focused on reducing hemoglobin A1C (HbA1c) levels, which indicate average blood glucose for a two-to-three-month period.

But the Montpelier study underscores that average levels can be misleading. Two people with similar HbA1c levels might have a dramatic difference in the number of glucose "excursions"—when glucose levels depart from normal range and fall too low or rise too high. In recent years, more researchers have concluded that HbA1c readings are not the only measure of good glucose control.

The development of accurate continuous glucose monitors now allows researchers to design experiments that measure glucose fluctuation. The devices can record glucose levels continuously over several days and keep a record of the entire period, making it possible to see how many glucose excursions occur and how drastic they are.

The Montpelier researchers studied 21 patients with diabetes over a three-day period, measuring how often glucose levels went significantly high and low. They found that patients with more glucose fluctuation also had higher levels of a biochemical marker for oxidative stress. Although the study was conducted with type 2 diabetes patients, the findings should apply to type 1 patients as well.

In fact, the correlation between glucose fluctuation and oxidative stress was more direct than the relationship between sustained hyperglycemia and oxidative stress. In other words, glucose fluctuation seems to have a more direct, predictable effect on oxidative stress, and presumably, complications.

"These seminal findings provide a new perspective on the development of diabetes complications," said Antony Horton, JDRF Program Director for Diabetes Complications.

"New technologies, such as continuous glucose sensors, and ultimately a closed-loop system, will allow for significantly better glucose control, including lower A1c's and reduced glucose variability," said Aaron Kowalski, JDRF Strategic Project Director

[arbequina]

Thank you, Amy! These are very helpful. It is quite rare that Rohan goes under 60, but still, I don't like lows and am trying everything to avoid them at his age. I log every day and if there are consistent low readings after 2 days in a row, I make adjustments...still waiting for that CGMS to be approved for us to use!

Cheers,

Nina

[OSUMom]

Thank you for sharing. I have to delicately share this with my son. He doesn't worry so much about the lows I have a feeling - though he is frustrated by them because he tries to be "perfect" with his numbers. He is more frustrated by the highs because they "damage" his A1C number more. I wonder if this isn't a common thought process in older teens. With sometimes a focus on the A1C, one might not worry about so many lows (if you're feeling them like he is) as they help to balance out the highs when coming up with the A1C.

I was concerned that my son didn't realize that maybe the lows could be hurting him long term - again, I know they too frustrate him though because he wants to be right in the target range.

[Ellen]

I think it's vitally important to reduce risk for lows.

Pubmed is a wonderful place to search for abstracts.

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed

There are often links to purchase the full text. If you know anyone enrolled in a university, they can often obtain the full text of the article for you for free. Alternatively, you can respectfully ask the author for a reprint, or simply email and ask questions of the author for clarification.

Be cautious with the information you get from an abstract. Sometimes when you read the full text, you will have questions about the validity of the conclusions drawn based on the methods and data gathered. Also note, rodent studies do not necessarily translate to what would happen in humans. Often you'll find conflicting abstracts too.

Try different search terms: hypoglycemia, neurological impairment, cognitive function...

Here are a few:

Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study Research Group, Jacobson AM, Musen G, Ryan CM, Silvers N, Cleary P, Waberski B, Burwood A, Weinger K, Bayless M, Dahms W, Harth J. (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17476010&ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum) Long-term effect of diabetes and its treatment on cognitive function.
N Engl J Med. 2007 May 3;356(18):1842-52.

Neurocognitive functioning in children with type-1 diabetes with and without episodes of severe hypoglycaemia. (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=12647928&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus) [Dev Med Child Neurol. 2003]

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17404614 Hypoglycemia, functional brain failure, and brain death

[Budapest]

As we are trying to keep him very close to normal levels we were also concerned about this and tried to look into it.

It seems that the bottom line is that they do not really know how low and for how long is a problem but with frequent test or a CGM you can prevent it or catch it and treat it before a few hours and then it is not a permanent problem. Occasionally being in the 40s seems to be better than being in the 140s-150s most of the time. Being in the 40s and 50s most of the time is also a problem though.

The only article we found is the one posted by EmmasMom: Pediatric Diabetes 2004, 5, p. 59-62: "Does moderately severe hypoglycemia cause
cognitive dysfunction in children?"

[OSUMom]

Just had my son's visit with the endo today, and for the too many lows she's going to send a letter and try to get the CGMS approved with our insurance. We'll see if it's a go! My son up to this point has not really wanted to go this route, but he seemed willing today. I know with children BCBS has approved - we'll see if they'll approve someone older! :rolleyes:

[Ellen]

Occasionally being in the 40s seems to be better than being in the 140s-150s most of the time. Being in the 40s and 50s most of the time is also a problem though.



IMHO I think being in the 140s to 150s for a little kid most of the time sounds safer.

[Momof4gr8kids]

Children that are born with hypoglicymia that is uncontrolable have a much higher risk of mental retardation, and other nerological problems. Below is an article on it. If you read it you will notice that the stats are much higher in this group then the normal population. I think the big question is how low is too low? How long? and how often? will hypos have to happen in order to cause these things to happen.


http://pediatrics.aappublications.org/cgi/content/full/107/3/476

[Budapest]

I think the big question is how low is too low? How long? and how often?

This is the million dollar, I mean save-your-child's-heath question. Our biggest challenge is that no one really knows the precise answer so we have rely on our feelings and all the tools at our disposal (pump, cgm etc.)

Good luck to all of us. :cwds:

[Momof4gr8kids]

This is the million dollar, I mean save-your-child's-heath question. Our biggest challenge is that no one really knows the precise answer so we have rely on our feelings and all the tools at our disposal (pump, cgm etc.)

Good luck to all of us. :cwds:

I agree, and yes, Good luck to us all that have to face this reality, and balance.