Ahh… Young Frankenstein. Mel Brooks is a genius and his amazing cast makes it an outstanding comedy that leaves your sides aching from laughter. If you’ve seen the movie, you know what I’m talking about. (Haven’t seen the movie? Please. Do yourself a favor. Rent it.) I was thinking about how hyperglycemia and hypoglycemia wreaks havoc on our brains (Not just diabetics, but everyone!) and Marty Feldman pops into my head with his buggy eyes* and says: “Abby…someone. Abby…Normal.”**
Lots of stuff pop into my head and Marty is not the weirdest one. But truth be told, the long-term impact that out of range blood sugars play in our lives has been bothering me for quite a while. It’s no secret that in the short term, hypoglycemia does a number on our heads. Mental comprehension suffers, motor skills go wonky (That’s the medical term. Look it up.), and verbally? Try having a conversation with someone who is dropping rapidly and get back to me.
Severe hypoglycemia is just downright ugly. The few times that I’ve been in the 20s and 30s found me wrecked for days after, both mentally and physically. Knock on wood, I’ve never fallen unconscious, but I have had glucagon and in one case, a bunch of paramedics hanging around my apartment waiting until I got above 70. Long-term? For those of us who try to maintain between 80 and 120, we can develop hypoglycemic unawareness. Our brain gets desensitized. Want the technical lowdown? À la Wikipedia:
If a person has frequent episodes of hypoglycemia (even mild ones), the brain becomes “used to” the low glucose and no longer signals for epinephrine to be released during such times. More specifically, there are glucose transporters located in the brain cells (neurons). These transporters increase in number in response to repeated hypoglycemia (this permits the brain to receive a steady supply of glucose even during hypoglycemia). As a result, what was once the hypoglycemic threshold for the brain to signal epinephrine release becomes lower. Epinephrine is not released, if at all, until the blood glucose level has dropped to even lower levels. Clinically, the result is hypoglycemic unawareness.
Nighttime hypoglycemia has plagued many of us (using my CGM pinpointed why I was so exhausted in the morning recently… I was going low and not waking up.) and I’ve had to set the hypoglycemic alarm on mine to “air raid siren” level and tweak my basals.
And let’s not forget, there’s that whole permanent brain damage or death thing. This cheery article (Not.) gives you some info on it.
But I’ve always been fuzzy when it comes to hyperglycemia. (Get the joke?) I’d never really investigated what long-term high blood sugars do to the brain. My control was not.good.at.all in my teens and 20s, spending a lot of the time floating through my days with numbers I shudder to think about. I’ve done my time in DKA, but have been very lucky. Long-term, what have I done to myself?
A New England Journal of Medicine article in 2007 kind of sugar coats it. (Another joke? I’m on fire today!) It casually mentions that there are “moderate” declines in motorspeed and psychomotor efficiency, but that’s it. And I’m all like: “Cool by me. Dodged another bullet.”
But, if you’ve figured this out about me by now, I can’t leave well enough alone, so I dig deeper. I found a different conclusion:
Neural Networks, Cognition and Diabetes: What Is The Connection? is a 2012 article from the journal Diabetes. It states plainly that hyperglycemia over the long haul presents us with:
…an increased risk for development of significant disruption in cognitive function in the form of dementia.
Why? Again, but not so plainly:
Hyperglycemia may affect cognitive function by altering synaptic plasticity in the brain, increasing levels of oxidative stress, and/or subtly altering the cerebral microvasculature.
There’s a lot of eye-opening information in this article, and I strongly encourage you to read it.
There are days that I blame my inability to find the right word to describe something (simple stuff, like “water pitcher”) on a lack of caffeine or lack of sleep or just the fact that I’ve been exposed to foreign languages and sometimes words pop into my head that aren’t English. But I wonder… is it my hyperglycemic youth that is making my brain “Abby…Normal”? What do you think?
*Did you know that Marty Feldman’s buggy eyes comes from having Graves’ Disease? Learn something new every day.
**This is the scene from which the title of this post came. Watch the classic snippet here.