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Are Frequent Hypoglycemic Seizures A Life Threat?
Question: Hypoglycemic seizure, a mortal risk?
I was wondering if you could provide some clarification of the potential of death as the result of a hypoglycemic seizure?
My 17 year old son has been Type 1 for 10 years. He has had 2 hypoglycemic seizures in the last 9 months.
My laymen’s analysis of the special set of circumstances that led up to both of his seizures has me very concerned that his livers capacity to adequately impact his blood sugars post seizure might have been compromised. Specifically, I’m worried that the extended period of time that he was low may possibly have resulted in his liver exhausting it’s supply of stored glycogen prior to the seizure, thus compromising his ability to recover from a seizure without immediate mitigation from an outside source.
Here are more details:
-Profile: 17yr old male. Has had Type 1 diabetes for 10 years. Never had a hypoglycemic seizure until this year, and now he’s had two. He wears a insulin pump, and a CGM.
-Prolonged lack of food: He had very little to eat for multiple hours prior to both seizures.
-Bolus over dosage of snack, long before seizure: He bolused a small snack long before the seizures occurred. The first time, it was about 2 hours prior the seizure. In the recent event, it was about 90 minutes prior.
-Prolonged physical activity: Prior to the first event he was swimming all day in a quarry, as well as climbing, and surfing. Prior to the recent event he had jet lag after a long flight, experienced lots of excitement due to being in a new city, and had been on a walking tour while wearing a backpack for hours on end.
-Hypoglycemia unawareness: He showed no awareness that he was going low until 30 seconds before he went into the seizures.
-Prolonged period of low blood glucose level: During the first event, his CGM showed his blood glucose level was 80 or lower for hours prior to his seizure. Given his CGMs accuracy, it could be that he was as low as 50 for an extended period of time. His CGM numbers at the time of his most recent event were similar prior to the seizure, and then showed a rapid drop in the 50 range.
-Glucagon minimally effective: The glucagon shot I provided him after his first seizure appeared to have very minimal impact on his blood glucose level. It was not until he was provided glucose by the EMTs that the blood sugar level XXXXXXX significantly.
-Overweight: He has had problems with dropping weight in the past. In other words, his fat stores appear to resist conversion into energy more than your average person.
-Glycogen depletion?
So my question is: Is it possible that in both of these events his liver was providing glucose to fight his low blood glucose for an extended period of time, and thus eventually depleted it’s store of glycogen resulting in a rapid drop in his blood sugar level? If so, how would it be possible for him to recover from the low without outside help? Is it possible that his liver would not be able to recover in time to compensate for his low BG and the still operating Insulin pump XXXXXXX rate?
Thank You, XXXXXXX
I was wondering if you could provide some clarification of the potential of death as the result of a hypoglycemic seizure?
My 17 year old son has been Type 1 for 10 years. He has had 2 hypoglycemic seizures in the last 9 months.
My laymen’s analysis of the special set of circumstances that led up to both of his seizures has me very concerned that his livers capacity to adequately impact his blood sugars post seizure might have been compromised. Specifically, I’m worried that the extended period of time that he was low may possibly have resulted in his liver exhausting it’s supply of stored glycogen prior to the seizure, thus compromising his ability to recover from a seizure without immediate mitigation from an outside source.
Here are more details:
-Profile: 17yr old male. Has had Type 1 diabetes for 10 years. Never had a hypoglycemic seizure until this year, and now he’s had two. He wears a insulin pump, and a CGM.
-Prolonged lack of food: He had very little to eat for multiple hours prior to both seizures.
-Bolus over dosage of snack, long before seizure: He bolused a small snack long before the seizures occurred. The first time, it was about 2 hours prior the seizure. In the recent event, it was about 90 minutes prior.
-Prolonged physical activity: Prior to the first event he was swimming all day in a quarry, as well as climbing, and surfing. Prior to the recent event he had jet lag after a long flight, experienced lots of excitement due to being in a new city, and had been on a walking tour while wearing a backpack for hours on end.
-Hypoglycemia unawareness: He showed no awareness that he was going low until 30 seconds before he went into the seizures.
-Prolonged period of low blood glucose level: During the first event, his CGM showed his blood glucose level was 80 or lower for hours prior to his seizure. Given his CGMs accuracy, it could be that he was as low as 50 for an extended period of time. His CGM numbers at the time of his most recent event were similar prior to the seizure, and then showed a rapid drop in the 50 range.
-Glucagon minimally effective: The glucagon shot I provided him after his first seizure appeared to have very minimal impact on his blood glucose level. It was not until he was provided glucose by the EMTs that the blood sugar level XXXXXXX significantly.
-Overweight: He has had problems with dropping weight in the past. In other words, his fat stores appear to resist conversion into energy more than your average person.
-Glycogen depletion?
So my question is: Is it possible that in both of these events his liver was providing glucose to fight his low blood glucose for an extended period of time, and thus eventually depleted it’s store of glycogen resulting in a rapid drop in his blood sugar level? If so, how would it be possible for him to recover from the low without outside help? Is it possible that his liver would not be able to recover in time to compensate for his low BG and the still operating Insulin pump XXXXXXX rate?
Thank You, XXXXXXX
Brief Answer:
Hypoglycemia
Detailed Answer:
I follow your question. It is a profound one, probing the fundamentals of the physiology during a hypoglycemic reaction.
The answer is that it is unlikely his liver has lost the capacity to respond to hypoglycemia owing to depleted glycogen reserves, unless he has compromised liver function or 'counter-regulatory hormone failure'.
Let me comment on both these situations.
1 Liver disease
So a major liver problem leading to failure is a known cause of frequent / severe hypoglycemic episodes.
Have his liver function tests done to get this checked.
These include
SGOT
SGPT
Albumin
Bilirubin
Prothrombin time
2 Counter regulatory hormones
like Glucagon, Epinephrine, Cortisol and Growth hormone are vital to recovery from hypoglycemia.
Deficiency of these can make him prone to hyopglycemia.
There are uncommon medical conditions that need to be considered by the endocrine expert.
Some diseases of the pancreas lead to it's inability to mount a prompt glucagon response.
To test for cortisol deficiency, there is a test called 8 am Serum Cortisol.
The last example is multiple pituitary hormone deficits ('panhypopituitarism') that can make him susceptible to such reactions.
There are blood tests to screen for these too.
Even thyroid hormone deficiency makes one vulnerable to hypoglycemia.
A blood test for TSH and Free T4 is helpful in evaluating for this possibility
Hypoglycemia
Detailed Answer:
I follow your question. It is a profound one, probing the fundamentals of the physiology during a hypoglycemic reaction.
The answer is that it is unlikely his liver has lost the capacity to respond to hypoglycemia owing to depleted glycogen reserves, unless he has compromised liver function or 'counter-regulatory hormone failure'.
Let me comment on both these situations.
1 Liver disease
So a major liver problem leading to failure is a known cause of frequent / severe hypoglycemic episodes.
Have his liver function tests done to get this checked.
These include
SGOT
SGPT
Albumin
Bilirubin
Prothrombin time
2 Counter regulatory hormones
like Glucagon, Epinephrine, Cortisol and Growth hormone are vital to recovery from hypoglycemia.
Deficiency of these can make him prone to hyopglycemia.
There are uncommon medical conditions that need to be considered by the endocrine expert.
Some diseases of the pancreas lead to it's inability to mount a prompt glucagon response.
To test for cortisol deficiency, there is a test called 8 am Serum Cortisol.
The last example is multiple pituitary hormone deficits ('panhypopituitarism') that can make him susceptible to such reactions.
There are blood tests to screen for these too.
Even thyroid hormone deficiency makes one vulnerable to hypoglycemia.
A blood test for TSH and Free T4 is helpful in evaluating for this possibility
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr for your thoughtful response.
But I still am not clear on a few topics:
1) My son's BG was low for hours before his seizure. If his liver still had the capacity to provide glucose then why did he crash and have a seizure in the first place?
2) He was unresponsive to glucagon for 10 minutes after we injected it. It was only after being provided intravenous glucose that his blood sugars XXXXXXX and his seizure stopped. If his liver had glycogen available, why would it not respond to the glucagon?
3) Doesn't the liver have a limited amount of glycogen available? I understand it's only about 100grams. Isn't it conceivable that this 100 grams could be used during a prolonged period of low blood sugar.? During both seizures my son had over bolused, and had a basal rate that was too high for his activity. Plus he had not eaten, was exercising, tired, had been low for hours prior to the seizure. How long can the liver provide glucose in these situations, and how quickly can it replenish its glycogen?
4) My understanding is that hypoglycemia can cause seizures, coma and potentially death in Type 1 diabetics. How is this possible if the liver will not deplete it's store of glycogen?
Many thanks, XXXXXXX
But I still am not clear on a few topics:
1) My son's BG was low for hours before his seizure. If his liver still had the capacity to provide glucose then why did he crash and have a seizure in the first place?
2) He was unresponsive to glucagon for 10 minutes after we injected it. It was only after being provided intravenous glucose that his blood sugars XXXXXXX and his seizure stopped. If his liver had glycogen available, why would it not respond to the glucagon?
3) Doesn't the liver have a limited amount of glycogen available? I understand it's only about 100grams. Isn't it conceivable that this 100 grams could be used during a prolonged period of low blood sugar.? During both seizures my son had over bolused, and had a basal rate that was too high for his activity. Plus he had not eaten, was exercising, tired, had been low for hours prior to the seizure. How long can the liver provide glucose in these situations, and how quickly can it replenish its glycogen?
4) My understanding is that hypoglycemia can cause seizures, coma and potentially death in Type 1 diabetics. How is this possible if the liver will not deplete it's store of glycogen?
Many thanks, XXXXXXX
Brief Answer:
Follow up
Detailed Answer:
1 Excessive Insulin in the circulation suppresses the livers capacity to break down glycogen stores.
2 Agreed. If this is absolutely correct, then other causes of hypoglycemia need to be ascertained.
Glucagon cures hypoglycemia due to Insulin or IGF2 only.
Other causes like sepsis, organ failure like heart, liver, lung and kidney failure or hormone deficiencies as enumerated above cause hypoglycemia through other complex mechanisms
So the only conclusion from lack of response to glucagon is that there are likely reasons other than insulin
However, the over exertion can deplete glycogen stores and cause inadequate response to glucagon
I am not aware of published studies addressing exact time duration of glycogen liver stores during exercise.
4 Prolonged suppression of liver glycogen by excess insulin can result in hypoglycemia long enough to cause seizures, coma and death
Follow up
Detailed Answer:
1 Excessive Insulin in the circulation suppresses the livers capacity to break down glycogen stores.
2 Agreed. If this is absolutely correct, then other causes of hypoglycemia need to be ascertained.
Glucagon cures hypoglycemia due to Insulin or IGF2 only.
Other causes like sepsis, organ failure like heart, liver, lung and kidney failure or hormone deficiencies as enumerated above cause hypoglycemia through other complex mechanisms
So the only conclusion from lack of response to glucagon is that there are likely reasons other than insulin
However, the over exertion can deplete glycogen stores and cause inadequate response to glucagon
I am not aware of published studies addressing exact time duration of glycogen liver stores during exercise.
4 Prolonged suppression of liver glycogen by excess insulin can result in hypoglycemia long enough to cause seizures, coma and death
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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