Questions and Answers
Is There Such a Thing as a Diabetic Seizure?
Q: What exactly is a diabetic seizure? I'm type 1 and have twice gotten so low that I passed out. I don't know if I had a seizure. I do remember that all the muscles in my body were very sore the next day, which would indicate extreme muscle contractions.
If this was a seizure, does this only happen once a person has passed out, or are they still conscious but unable to help themselves?
A: There are all types of "seizures," none of which are particular to diabetes. There are focal seizures in which only one part of the body undergoes repeated contractions or spasms. There are diffuse, or Grand Mal, seizures in which the whole body has spasms. There are also lesser seizures in which there are "spells," or short temporary lapses, like staring into space or daydreaming for a few seconds. There are other varieties that can have sudden losses of strength, sensory disturbances or bizarre behavior. All these are due to a focal or general disturbance in brain function and can occur in people with diabetes.
Generalized seizures are the type you find with hypoglycemia or any severe metabolic disturbance, whereas the focal variety occurs with, for example, hyperosmolar coma (ketoacidosis suppresses seizures), a stroke, or even an injury or malignancy. None are due to the diabetes itself, but, rather a complication of the diabetes. Repeated muscle contractions lead to deprivation of the oxygen and energy that muscles require for contractions, leading to accumulation of lactic acid, hence the pain. If sufficiently long and protracted contractions occur, this can lead to a rise in blood enzymes from muscle, and even the appearance of myoglobin in the urine. It would be exceptional for this to occur without loss of consciousness.
If the seizures are generalized, the best approach is to control the diabetes as well as possible and to avoid hypoglycemia. If they are focal, then one needs to see a neurologist to attempt to find the cause and treat that.
Aaron Vinik, PhD
Director, Diabetes Research Institute
Eastern Virginia Medical School
When Can We Expect a Laser Blood Glucose Meter?
Q: Do you have any information on when a laser blood glucose meter will be on the market? My doctor thought a laser blood glucose meter would be going on the market sometime soon.
Joan M. Richardson
A: The prospects of availability of a laser-based blood glucose meter can be evaluated two ways. The first of these is a laser-based system being developed here at SpectRx in which a low-powered laser is used to produce tiny micropores in the topmost layer of the skin, which is composed of dead skin cells. Interstitial fluid is then drawn through the micropores and the amount of glucose (which studies have shown is the same as in blood) is measured by a sensor in a disposable patch which could potentially be worn on the skin for up to three days.
We believe that this product could be available sometime in the year 2001, but predicting the exact timing is difficult because the U.S. Food and Drug Administration must approve this or any other new method for measuring glucose.
A second approach to using lasers would be to somehow directly measure glucose through unbroken skin. This is very challenging from a technical point of view, and we do not expect availability of this type of technology in the near future.
Mark L. Faupel, Ph.D.Vice
President for Research and Development
How Would Alpha-Lipoic Help People With Diabetes?
Q: I read in Iron Man magazine that they have been using alpha-lipoic acid in Germany for 20 years to treat people with diabetes. Do you have any further information?
A: The following article ran in the August 1999 issue of DIABETES HEALTH:
Lester Packer and colleagues at the University of California, Berkeley, presented research that demonstrates for the first time that free alpha-lipoic acid (ALA) is detectable in nerves, and that its level does not depend on the route of administration, but rather on the treatment dose. The study also shows that blood levels of ALA do not reflect its concentrations in nerve or other tissues. The research was presented at the American Diabetes Association's scientific sessions in June 1999.
In a related story that first appeared in the September 1997 issue of Diabetes Care, daily intravenous treatment with 600 mg. of ALA over a three-week period was discovered to be a safe and effective way to reduce symptoms of diabetic peripheral neuropathy. Also, daily oral treatment with 800 mg. of ALA for four months improved cardiac autonomic dysfunction in people with type 2 diabetes.
Ziegler D. Gries and colleagues at the Diabetes Research Institute at Heinrich Heine University in Dusseldorf, Germany, conducted multicenter, randomized, double-blind trials on patients with type 2 diabetes and peripheral neuropathy. For the Alpha-Lipoic Acid in Diabetic Neuropathy Study, 328 patients were randomly assigned to treatment with intravenous infusion of 1,200, 600 or 100 mg. doses of ALA, or placebo, for three weeks. In patients taking 1,200 and 600 mg. doses of ALA, pain, burning, skin irritation and numbness in the feet decreased significantly after 19 days.
In a separate study, 73 patients with type 2 diabetes and cardiac autonomic neuropathy were randomly assigned to daily treatment with an 800 mg. oral dose of ALA or placebo for four months. Heart rate variability showed significant improvement in the ALA group, compared with the placebo group.
Phillip Low, MD, a neurologist at the Mayo Clinic, says that ALA promotes blood flow to nerves to help repair damage caused by neuropathy. Currently, ALA, a vitamin-like oxidant, is used in Europe to treat and prevent complications associated with diabetic neuropathy, as well as cataracts.
"The therapeutic potential of alpha-lipoic acid is just beginning to be explored," says Packer, a professor of molecular biology at the University of California, Berkeley. "This compound holds great promise."
ALA is found in small amounts in spinach, potatoes and red meat. A bottle of 50 tablets of 50 to 100 mg. can cost from $12 to $20.
How Might Diabetes Cause Me to Lose Concentration?
Q: I'm curious if anybody knows anything about lack of concentration or feeling that you are in a fog if you have diabetes?
I am a business woman and concentration is very important to me. Obviously, when I have this problem, I am not as effective.
What might cause this problem, and how can I treat it?
A: People with diabetes don't have worse concentration than anyone else. However, there are at least three diabetes-related problems that might explain this person's lack of concentration, or of "fogginess."
The most likely culprit is hypoglycemia. Most people know that low blood sugars can lead to obvious symptoms like increased heart rate, excessive sweating or other body changes linked to epinephrine (adrenaline) release. Hypoglycemia can also lead to more subtle changes, known as neuroglycopenic, or "brain sputtering," cues. Many people are struggling with reduced hypoglycemic awareness, but this merely means that the more prominent, epinephrine-related cues have become muted. Neuroglycopenic symptoms are probably still occurring, and may occur even when blood sugars are as high as 60 to 65 mg/dl. And they can, at least initially, be very subtle. For some people, this may mean a slight difficulty with following a conversation, a need to re-read a paragraph several times, or some additional difficulty with getting one's key in the door. So if you're occasionally having trouble with concentration, the first thing you should do is check your blood sugar at that time.
A second possibility is fatigue and/or poor sleep. If you are not getting sufficient, restful sleep, concentration is likely to suffer throughout the next day. Of course, there are lots of reasons why people do not get sufficient sleep or may feel chronically fatigued, and this is not necessarily linked to diabetes (after all, this is an active businesswoman). But diabetes can certainly contribute to this problem. Chronically high blood sugars may lead to fatigue, as do wildly fluctuating blood sugars, or frequent hypoglycemia. Some people even have frequent, mild hypoglycemia while sleeping. Even though they may not notice this occurring, this may lead to problems with sleep quality and, thus, problems with fatigue and concentration throughout the next day.
Finally, there is the possibility of depression. Recent evidence suggests that 30 percent or more of people with diabetes may be significantly depressed. Some people may not notice feeling particularly sad, but there are plenty of other symptoms like concentration problems, chronic fatigue and a loss of pleasure in daily activities that clearly indicate the presence of a depressive disorder.
So a problem with concentration may indeed be linked to diabetes. It is certainly worth talking with your doctor about this problem.
William H. Polonsky, PhD, CDE
Assistant Clinical Professor
Department of Psychiatry
University of California, San Diego