Study on Hypoglycemia and Dementia in Elderly

The “results” of yet another study assessing hypoglycemia (low blood sugar) were published last week. This particular study focused on the elderly and dementia. The local television station even spent a few seconds mentioning the study. Unfortunately, the “press” on this television station and the truncated versions published on many websites neglected to mention a few things of utter importance. Thus, the “press” the study got came across as nothing but a scare tactic against tight blood sugar control.

The television reporter said the study concluded hypoglycemia in the elderly causes dementia. The television station neglected to mention the word “severe.” Therefore, they also neglected to mention what the definition of severe relative to hypoglycemia means. "Severe hypoglycemia" means requiring assistance such as from losing consciousness or having a seizure. It does not mean simply being inconvenienced or feeling shaky.

The reporter also neglected to mention that the severe hypoglycemia incidences they studied lasted a substantial amount of time, which most low blood sugar reactions do not. Most low blood sugar incidents are nothing but inconvenient ten or fifteen minute periods of time - providing the diabetic has not so substantially overdosed on insulin (or other) that the incident lasts a good portion of the duration of the particular injection or medication.

In addition, what group of elderly were they studying? Why did these incidences happen in the first place?

Did they study the group of diabetics told they only need one large dose of long acting insulin (Lantus, NPH, or Levemir) to extend the duration, instead of breaking the insulin into smaller doses with fewer peaks and valleys? Were they the patients instructed to take large doses of long acting insulin in order to cover meals instead of taking both long acting and rapid acting (mealtime) insulin in smaller, less risky doses?

Did the study include those patients in nursing homes overfed carbohydrates in conjunction with large doses of insulin? Was it those patients told they only need to test once or twice a day? Or, was it those patients, such as nursing home patients or those receiving minimal at home care and thus, again, very little glucose testing and the impossibility of level control.

Did the study include those patients told to use a high risk, inaccurate sliding scale for adjusting their insulin doses? Was it those patients told NOT to adjust insulin requirements regardless of food intake or activity level? Did the study include those patients told to eat a high carbohydrate, low protein, low-fat meal plans that require very high doses of insulin and result in the “russian roulette game” of high and low blood sugar?

Did these scientists study what blood sugar range these patients target? Did these scientists study the average deviation of blood sugar these patients experience on a regular basis? Did these scientists study the activity level of these patients?

Did the scientists consider the fact that anyone (regardless of age) who reaches a blood sugar level that causes them to lose consciousness or have a seizure is in jeopardy of a variety of problems including dementia or dementia like symptoms?

This study, as do others that claim to assess the effects of targeting tight blood sugar, seems to be conducted without consideration to the previously mentioned factors and many not mentioned. Those conducting the study appear to have a goal of scaring people who do not know any better or are at such a point in their lives they have no control over their own diabetes care (such as those in nursing homes or receiving in home care). They appear to have a goal of proving that targeting non-diabetic blood sugar levels is dangerous.

There are many diabetics targeting non-diabetic blood sugar levels properly who reap nothing but positive benefits. The issue is not that hypoglycemia does or does not cause dementia in a very helpless group of patients who are likely at risk (for dementia) in the first place. It is that the majority of caregivers do not take the time or do not have the technical aptitude to assist their patients properly attaining healthy, non-diabetic blood sugar levels. It is much easier to put the fear of God into people, so that they target high blood sugar and pay the consequences of those complications.

One of my physicians tried that approach a few years ago when I began targeting normalized blood sugar; it did not work. I continue to strive daily for normalized blood sugar levels without passing out or having seizures. The physician was concerned he/she would be called to bail me out of jail from a car accident or walking naked on a highway medium strip!

What the physician(s) and these studies neglect to consider is that there are safe ways to target and attain non-diabetic blood sugar levels. Tight control of non-diabetic levels does not mean passing out or seizures. The safe methods include, among other things, less russian roulette, smaller (spaced apart) doses of insulin and high frequency glucose testing and adjustment.

They also neglect to consider the fact that patients deserve and are entitled to education of the tools, techniques, and methods available in targeting non-diabetic blood sugar levels. They do not deserve threats and fear of non-diabetic blood sugar levels. Diabetics simply deserve “better.” So please stop scaring people and start listening to those of us who have figured out “better,” so you can share it with your diabetic patients.

The “results” of yet another study assessing hypoglycemia (low blood sugar) were published last week. This particular study focused on the elderly and dementia. The local television station even spent a few seconds mentioning the study. Unfortunately, the “press” on this television station and the truncated versions published on many websites neglected to mention a few things of utter importance. Thus, the “press” the study got came across as nothing but a scare tactic against tight blood sugar control.

The television reporter said the study concluded hypoglycemia in the elderly causes dementia. The television station neglected to mention the word “severe.” Therefore, they neglected to mention what the definition of severe relative to hypoglycemia means. "Severe hypoglycemia" means requiring assistance such as from losing consciousness or having a seizure. It does not mean simply being inconvenienced or feeling shaky.

The reporter also neglected to mention that the severe hypoglycemia incidences they studied lasted a substantial amount of time, which most low blood sugar reactions do not. Most low blood sugar incidents are nothing but inconvenient ten or fifteen minute periods of time - providing the diabetic has not so substantially overdosed on insulin (or other) that the incident lasts a good portion of the duration of the particular injection or medication.

In addition, what group of elderly were they studying? Why did these incidences happen in the first place?

Did they study the group of diabetics told they only need one large dose of long acting insulin (Lantus, NPH, or Levemir) to extend the duration, instead of breaking the insulin into smaller doses with fewer peaks and valleys? Were they the patients instructed to take large doses of long acting insulin in order to cover meals instead of taking both long acting and rapid acting (mealtime) insulin in smaller, less risky doses?

Did the study include those patients in nursing homes overfed carbohydrates in conjunction with large doses of insulin? Was it those patients told they only need to test once or twice a day? Or, was it those patients, such as nursing home patients or those receiving minimal at home care and thus, again, very little glucose testing and the impossibility of level control.

Did the study include those patients told to use a high risk, inaccurate sliding scale for adjusting their insulin doses? Was it those patients told NOT to adjust insulin requirements regardless of food intake or activity level? Did the study include those patients told to eat a high carbohydrate, low protein, low-fat meal plans that require very high doses of insulin and result in the “russian roulette game” of high and low blood sugar?

Did these scientists study what blood sugar range these patients target? Did these scientists study the average deviation of blood sugar these patients experience on a regular basis? Did these scientists study the activity level of these patients?

Did the scientists consider the fact that anyone (regardless of age) who reaches a blood sugar level that causes them to lose consciousness or have a seizure is in jeopardy of a variety of problems including dementia or dementia like symptoms?

This study, as do others that claim to assess the effects of targeting tight blood sugar, seems to be conducted without consideration to the previously mentioned factors and many not mentioned. Those conducting the study appear to have a goal of scaring people who do not know any better or are at such a point in their lives they have no control over their own diabetes care (such as those in nursing homes or receiving in home care). They appear to have a goal of proving that targeting non-diabetic blood sugar levels is dangerous.

There are many diabetics targeting non-diabetic blood sugar levels properly who reap nothing but positive benefits. The issue is not that hypoglycemia does or does not cause dementia in a very helpless group of patients who are likely at risk (for dementia) in the first place. It is that the majority of caregivers do not take the time or do not have the technical aptitude to assist their patients properly attaining healthy, non-diabetic blood sugar levels. It is much easier to put the fear of God into people, so that they target high blood sugar and pay the consequences of those complications.

One of my physicians tried that approach a few years ago when I began targeting normalized blood sugar; it did not work. I continue to strive daily for normalized blood sugar levels without passing out or having seizures. The physician was concerned he/she would be called to bail me out of jail from a car accident or walking naked on a highway medium strip!

What the physician(s) and these studies neglect to consider is that there are safe ways to target and attain non-diabetic blood sugar levels. Tight control of non-diabetic levels does not mean passing out or seizures. The safe methods include, among other things, less russian roulette, smaller (spaced apart) doses of insulin and high frequency glucose testing and adjustment.

They also neglect to consider the fact that patients deserve and are entitled to education of the tools, techniques, and methods available in targeting non-diabetic blood sugar levels. They do not deserve threats and fear of non-diabetic blood sugar levels. Diabetics simply deserve “better.” So please stop scaring people and start listening to those of us who have figured out “better,” so you can share it with your diabetic patients.