Seizures due to hypoglycemia (low blood sugar)

Seizures in the setting of hypoglycemia are well described. The brain needs sugar to function and when the blood sugar falls “too low”, one of the things that can happen is that the patient may have a seizure (this is usually a generalized convulsion-a tonic-clonic or Grand Mal seizure). There is no one level of blood sugar below which one has a seizure (rather the¬†level varies from person to person). Let me explain that with an example. Lets assume you are a diabetic and you take your insulin shot but for once forget to take a meal (maybe you are a hard working executive on the run). You have a convulsion while at work and are taken to the nearest ER. There your blood sugar at the time of presentation is recorded to be 60 mg/dl. There might be another similar patient whose blood sugar falls to 52mg/dl yet he does not have a convulsion. So there is no set limit below which the brain shall have a seizure but speaking in broader terms usually the brain does not tolerate blood sugar below 60mg/dl and below 40 mg/dl most patients shall be symptomatic (either have a convulsion or be confused and obtunded. The term used for this constellation of neurological signs and symptoms as a result of hypoglycemia is NEUROHYPOGLYCEMIA).

The good news though is that seizures due to hypoglycemia are readily treatable. In the ER we load the patient with glucose (usually this is given via an intravenous drip as the patient is obtunded and confused and cannot accept anything from the mouth). The blood sugar quickly rises and the seizures stop. Patients who suffer from hypoglycemic seizures do not need to be on an anti-epileptic drug. These patients do not have epilepsy. If their blood sugar does not fall down again, they will not have another seizure.

Rather a meticulous search should be conducted to find out the cause of hypoglycemia:

-is the patient a diabetic who took too much insulin by mistake?

 -did he miss his meal but took his insulin?

-is there any other cause of hypoglycemia such an insulin secreting tumor?

-is the patient septic?

Hypoglycemic seizures are most commonly seen in diabetics. This emphasizes the importance of good glycemic control in this vulnerable population.

Nitin Sethi, MD

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73 thoughts on “Seizures due to hypoglycemia (low blood sugar)

  1. Hi,

    May I ask the folowing question. I Have type I diabetes and have found that when my blood sugar is running a little low, I can becme photosesntive- experiecing mild ‘shocks’ or seizures throughout my body when exposed to flickering lights. Can these two events be correlated in any way?

    Thank-you for your time.

    Tim

  2. Dear Tim,
    what is most likely happening is that you are experiencing systemic signs and symptoms of hypoglycemia. These include feeling nervous, agitated, irritable,tremulous (feeling minor tremors in the body)and palpitations.
    Seizures with hypoglycemia are not common and they only occur when your blood sugar falls real low.
    Personal Regards,
    Nitin Sethi, MD

  3. Dr Sethi,

    I am very interested in this subject. My 16 yr old daughter is a long time kidney /transplant patient with every complication under the sun. She has had two sets of nephrectomies, maiden and graft, PTLD cancer in the liver, battled diabetes last year, recent encephalitis, and is currently on hemodialysis again waiting for her second kidney transplant.
    My daughter’s dialysis unit has recently instituted a policy restricting food and drink during treatment and this is beginning to exasperate her headaches, nausea, and blood sugar swings while on dialysis. Although not currently diabetic, we have been monitoring her blood sugar levels throughout her treatments because she has had one seizure and two that were averted with fluid returns. Her bg’s were as low as 60 with the seizure, but the other two times I noticed it wasn’t the actual blood sugar level, but the fact that she dropped 20-25 points in a 15-30 minute time frame. Is this because of her not eating? Is that safe? Could that be causing undo harm to her neurologically or bringing back the diabetes?

    Thank you for you help!

    L

  4. Dear Liz,
    you do raise a very valid point. You are right, it is not the absolute number to which the blood sugar drops to, but the rate of fall which at times determines if a patient becomes symptomatic because of hypoglycemia (low blood sugar). The same holds true for other electrolytes like sodium. Let me explain with the aid of an example. A person is more likely to be symptomatic if his/her blood sugar drops acutely (rapidly) from 120 to 70, rather than one whose blood sugar drops from 120 to lets say 60 over a period of time. This is because a slower fall gives the body and the brain time to get adjusted to the low sugar and draw on other reserves.
    Your daughter likely has a very brittle control of her blood sugar, this is because during dialysis there are rapid shifts in the body’s fluid and electrolytes (sodium, potassium, calcium). Neurohypoglyemia can prove to be dangerous-as I stated in my post, patients can have seizures if the blood sugar falls down too low.
    She should have close blood sugar monitoring and an attempt made to avoid rapid and wide fluctuations in the blood sugar levels.
    Personal Regards,
    Nitin Sethi, MD

  5. Dr Sethi,

    How would your experience suggest the attempt at preventing the wide/rapid fluctuations in blood sugar levels?
    Do you reccomend the withholding of nuttrition and fluid during dialysis treatment?

    Thanks,
    Liz

  6. Hmm Liz, that is indeed a tough one to answer. Fluid and electrolyte balance is a delicate one and sometimes needs very fine tuning–you do not want fluid overload or increased electrolytes (blood sugar included) as well as fluid depletion and low electrolytes (hyponatremia, hypoglycemia etc). Usually the nephrologists are the best to manage this.

    Personal Regards,

    Nitin Sethi, MD

  7. Hi,
    I seem to be having a problem with my blood sugar. Sometimes for no particular reason my body starts to shake, i get confused and disoriented. It feels like I am going to lose consciousness. It takes a great deal of sugar to bring me back to normal. i eat sugar on a daily basis, because when I stop this issue seems to occur. If I stop eating the sugar on a daily basis, it seems to occur more offten. Any idea what is going on or where to look for answers. I get sent for a blood test and nothing shows up. My younger brother does have type 1 diabetis. I have been tested for diabetis all my life and comes back negative, however I continue to struggle with diving blood sugar issues, and it can be very scary. Any idea what is going on?
    thanks
    Liza

    • Understand exactly what you are going through!
      What type of seizures do you have? If you do not have catamennial seizures maybe get test for this type of seizure. Have your basal body temperature measured, have your serum hormone level checked each month..its very possible your meds are affecting your pancreas and will in turn affect your glucose secretion…when they take your level all things are normal when you very well know something is wrong

      Hope this helps!

  8. My best friend had been battling hypoglycemia for the last 10 years. She had her first grand mal seizure 10 years ago it was then found that her blood sugar was 39. She frequently monitors her blood sugars levels and carries juice with her all of the time. She recently began having seizures (grand mal) on a regular basis in the early morning hours despite waking frequently throughout the night to have a snack of peanut butter and crackers. Her blood sugar levels run on average in the 40’s, it is very rare that she can go over 60 and if she gets that high it will not remain for longer than 30 minutes at a time. She has had many tests and was even told by a specialist that this was all in her head and was prescribed an anti anxiety medication. She always feels tired and lethargic. Her Dr.s have inquired about alcoholism and she does not consume any alcohol at all as she fears for her life. What is the next step?

    • Dear April,
      thank you for writing in. I am not sure what plagues your friend. The best approach shall of course be to first determine what is the cause of her recurrent bouts of hypoglycemia and secondly are her seizures related to hypoglycemic attacks.
      If she indeed has seizures due to hypoglycemia, the treatment shall involve correcting the underlying etiology of hypoglycemia.

      Personal Regards,
      Nitin Sethi, MD

  9. Respected Doctor…On 12th Decmber while in sleep my wife observed that with big sounds from my mouth and beating the bed with my legs and hands for some time.(5 to 10 mts).. after that she gone outside my house and asked for help…one doctor came and given Glucon-D.. immidietly after that i recognised everbody there and immdietly gone to hospital for treatment…yesterday only i was discharged from hospital after all tests ..the tests are MRI.CT scan.and EEG…all are normal…kindly advise me what precautions i have to take from now..

    • Dear Mr. Muddu,
      it seems you had a seizure in your sleep but what was the etiology? You say you made a rapid recovery after receiving glucose. Are you a diabetic? I ask all these questions because one needs to determine the underlying cause of your recent seizure. Only then you can get answers to important questions like: will this ever recurr? and what to do if I have another seizure? So first and foremost my advise to you is to see a doctor and bring this recent episode to his attention.
      Now comes the question of seizure safety. For this I shall refer you to my website http://braindiseases.info. Under the category of seizures, you shall find important information about seizure safety/ precautions.
      I wish you my very best.

      Personal Regards,
      Nitin Sethi, MD

  10. hi
    im not here to ask a question sorry, just to ponder your mind a little,
    ive had type 1 diabetes since the age of 4 (16 years) and i am now 20. when i was 7 i had my 1st seizure. time went on and since ive been 15 ive had around 20 + full on seizures ive had 2 in the street both ive recovered from, but the rest was in my sleep, with no warning atall. i go ridged and ALWAYS bite my tounge and injure myself, suck as banged my head off the cooker, the floor, raidiator etc. after this happens i get sugar rubbed in my gums by my family or friends till i come round, (no paramedic or hospital service involed) but the confusing thing was when i had them in the street and i came around WITHOUT sugar or anything. witch was also confusing for the hospital and my gp. witch also brings me to my next thing.
    ive been to my local gp and also im back attending the hospital on a weekly basis.
    as ive now been to see my gp today, and gave him details etc. of each seizure. hes now under the idea of sending me to a neurologist as he dosent beleive that my seizures are in anyway linked to my diabetes.
    also ive just had my insulin changed from human mixtard 30 (twice daily) to lantus(morning) & novo rapid(breakfast, lunch, dinner).

    what i was wondering was, what your thoughts would be on this ?

    Stephen

    • Dear Stephen,
      thank you for writing in. This is what I feel. I think it shall be worth your time to see a neurologist and get a thorough evaluation for your seizure disorder. Some of your seizures likely can be accounted for by hypoglycemia (the ones in which you make a rapid recovery when sugar is rubbed onto your gums). It is also possible that you have underlying epilepsy/ seizure disorder. This may result in convulsions which are unrelated to hypoglycemic episodes. Also why should you be having hypoglycemia induced seizures if your diabetes is well controlled? As you can understand there are bits in your history which do not “gel”.
      So I feel you need a good work-up. A neuroimaging study of the brain (ideally a MRI scan of the brain) and an electroencephalogram (EEG study) may be warranted. Your doctor may then decide to treat you with an anti-convulsant medication.

      Personal Regards,
      Nitin Sethi, MD

  11. Dear Kevin,
    thank you for writing in. You ask a good question. There can be many causes of hypoglycemia, diabetes mellitus is one of the more common causes. In diabetes mellitus hypoglycemia commonly occurs in the setting of a missed meal (by that I mean, a diabetic patient takes his anti-diabetic medication/ insulin but forgets to take his meal). Another setting may be if one has what is called brittle diabetes. This is a condition in which the blood sugar varies quite a lot. Such patients need fine control of their blood sugar level to prevent episodes of hypoglycemia or hyperglycemia.
    Seizures occur due to hypoglycemia per se (low blood sugar), not because of hypoglycemia due to diabetes. What I mean to say is that hypoglycemia due to any cause can cause a seizure provided the blood sugar falls below a critical level (usually less than 50 mg/dl).
    Personal Regards,
    Nitin Sethi, MD

  12. Dear Mr. Kearns,
    thank you for writing in to me and I apologize for the delay in my reply. Recovery from a generalized convulsion at times is protracted. Think of it like this–your brain had a major malfunction (a big short circuit), add to that the insult that it was deprived of blood sugar (hypoglycemia).
    It takes at times a week to two, before a patient feels that he is himself again (back to baseline). I wish you my very best.

    Personal Regards,
    Nitin Sethi, MD

  13. My son is diabetic type 1, since his 5th year. And he had several seizures in the last 5 years. Mostly once a year, every time he had a hypoglycaemia.
    The last time he had a epileptic seizure, with a fracture of thoracic vertebra 2. I have made a MRI scan of the brains, but everything seems normal.
    Are there other investigations necessary to be sure it is an epileptic insult due to hypoglycaemia, instead of real epilepsy.

    H.W.
    Radiologist, Antonius Hospital Utrecht, The Netherlands.

    • Dear Dr. Kooiman,
      thank you for writing in to me. If I get you right you are saying that all of your son’s seizures have occured in the setting of hypoglycemia. Do you by any chance recall what was his blood sugar during these ictal episodes. For a seizure to occur due to hypoglycemia, the blood sugar has to usually fall down to an extremely low level (we call this neurohypoglycemia). As you are aware the brain needs sugar for energy and its metabolism so when blood sugar falls down to the range of 60 mg/dl or less, that is when a seizure occurs. The seizure in the setting of hypoglycemia is usually a generalized convulsion. That said I and many other physicians have seen patients presenting to the ER with focal findings suggestive of a stroke only to find them completely reverse once the blood sugar was corrected.
      I do have a few practical suggestions for you:
      –have a home blood glucose meter and check your son’s blood sugar at various times during the day such as in the early morning when he wakes up (fasting blood sugar), prior and after lunch (post prandial blood sugar) and finally before he heads to bed during the night. Do this for about 2 weeks and keep a record of the values in a notebook. This shall prove to be tremendously helpful to you as a parent and his physician to see how his blood sugar fluctuates during the day. Are there times when his blood sugar falls down/ bottoms out unexpectedly.
      –a seizure due to hypoglycemia is rapidly reversible and in fact can be aborted with intravenous dextrose solution. Now it may be hard to administer intravenous dextrose at home.
      –another very important point which comes to mind is why is he having so frequent hypoglycemic episodes. This shall require a thorough review by his endocrinologist. His insulin dose may need to be adjusted and/or he may warrant frequent small meals during the day to prevent his sugar from suddenly dropping.
      –now to your final question: does your son actually have underlying epilepsy per-se. The answer to that depends upon this:
      -has he ever had a seizure in the setting of normal glucose level?
      -an EEG study shall be extremely useful. If the electroencephalogram shows inter-ictal epileptiform activity then likely your son does suffer from epilepsy. Remember in patients with seizures due to hypoglycemia per-se, the EEG between the seizures should be normal.
      -a routine EEG (30 minutes study) can fail to reveal an answer. In that case a long term EEG monitoring study (24-72 hours either in the hospital or in an outpatient setting) may aid in characterization of his typical events.
      -as you may have guessed right, patients with seizures due to hypoglycemia per se do not need to be on anti-convulsant therapy. In these patients what we need to ensure that they do not become hypoglycemic. No hypoglycemia means no seizures. On the other hand if your son does have underlying epilepsy, he shall warrant anti-convulsant therapy.
      -also a neuroimaging study (ideally MRI of the brain) may he helpful to rule out any intracerebral structural cause of seizure.

      I hope you find this information helpful. Please feel free to contact me again.

      Personal Regards,
      Nitin Sethi, MD

      • This is exactly my question! I’m so glad I found this. My son just had his second focal seizure. When he had his first one, I had no idea what it was. He is a type 1 since age 2. I believe his first seizure was around age 3 and he just had another at age 4. I am frustrated because medical personnel just assumed it was due to low bg. I can’t find my notes from his first seizure, but I don’t think bg was a player in that. I have a daughter who has had 2 seizures in the last 9 years, full tonicclonic and I know hers were hypoglycemia related. They were completely different and only lasted a few minutes. I just can’t shake this feeling that my son’s seizures don’t have anything to do with bg. With this last seizure, he started by waking with weeping sounds. Then his left side of face showed weakness and his bg was117. My husband apparently didn’t think anything was wrong at the time and layed him back down. a few minutes later, his eyes were rolling to the side, he seemed to be in and out of it, his left side of his body seemed tense and weak at the same time. His arm went out to the side with his hand making a weird shape, his leg bent and foot flexed. He seemed semi-concious. We tried to have him sit up and stand which he couldn’t do. his head and body just kept falling to the left. We tested him again and bg was 58. We treated low with honey to the gums. He continued to get worse. We really thought this was a mini stroke. My husband just sat and held him while we waited for the ambulance. He just sat there leaning to left slobbering out his mouth, eyes rolling to the side, left arm out, left leg bent, foot flexed. His bg was 78. He seemed to come out of it while we were on the way to the hospital, but he still was having trouble controlling his left arm. he didn’t get control of his hand back for a few hours. The dr said it was a focal seizure due to hypoglycemia. Also, another note to mention, he has fairly controlled bg, but obviously his sugar spikes and drops. He has had lows in the 30’s and 40’s and just showed some confusion with those.
        It seemed to last for such a long period of time. Was this a series of seizures?
        Could there be permanent damage? How can we tell if these were bg related or not? What if the first one was not and the second one was? Who do I see? What tests do I ask for?
        Thanks for any advice.

  14. i am 25 year old, i had seizure on 14 feb 2008.my toungue was beeten,i am unconcious for about five to ten minute. presently i am prescribed with Divalproex sodium 500. i dont have history of diabetus but before seizure i suffered weekness problem. may i know 1) how long i have to go through this treatment.2)what are the chances of having another seizure 3)what care shoud be taken.
    i am now doing ph.d. in life science stream and healthy enough.Thank you….

    • Dear Rajesh,
      thank you for writing in to me. You ask some very specific questions and I shall attempt to answer them for you:

      –How long do you have to be on the anti-convulsant (Divalproex sodium): well this one is tough to answer. The duration of anti-convulsant therapy is predominantly determined by the risk of you suffering another seizure in the near furture. Let me explain this better. If your physician feels that he risk of you having another seizure is very remote then the duration of therapy may be quite short (for example if your seizure was triggered by lack of sleep and excessive alcohol use). On the other hand patients who have epilepsy frequently warrant prolonged anti-convulsant treatment. At times they may have to be on medication for their entire life. So to answer your question, it is your doctor who shall be the best person to answer this question. Based on your history (the circumstances under which the seizure occurred, any precipitating factors and so forth), the results of your EEG and MRI scan, he shall be able to tell you how long he wants you to continue taking the medication. A word of caution here: UNDER NO CIRCUMSTANCES STOP THE ANTI-CONVULSANT WITHOUT CONSULTING YOUR DOCTOR FIRST.

      I am written about seizure safety on my blog and on my website (http://braindiseases.info). Please feel free to browse through the same.

      Personal Regards,

      Nitin Sethi, MD

  15. Dear Lilly,
    thank you for writing in to me. It is high uncontrolled blood sugar which leads to diabetes mellitus or rather diabetes mellitus is characterized by high blood sugar. Depending upon the type of diabetes (type 1 Vs type 2), the treatment is either insulin injections or oral hypoglycemic drugs (medications which bring down blood sugar).
    You must follow up with your doctor. I am sure everything shall work out fine.

    Personal Regards,

    Nitin Sethi, MD

  16. Thank you for this article. I would love to pick your brain a little if you would let me.

    I had a 3 grand mal seizures at around 3am (consistently) for the past 3-4 months (they are about one month apart). I am a 34 year old mother of two, weaning my youngest still, nursing at night. I do not have diabetes. I have NEVER previously had a seizure.
    I do drink occasionally, consume caffeine, and have reduced meat intake quite a lot in the past year.
    To say the least my family is very concerned.
    I have been to a neurologist, have had an EEG and an MRI, and numerous blood tests all of which have revealed that there are no serious issues.
    At this point the neurologist just wants to put me on anti-seizure medications, all of which cause some kind of damaging side effects. I do not like that idea, so I have been researching what possibly might be going on with my poor brain in order to manage my health, and stumbled upon your article.
    At this point I have been disgusted with the doctor’s attitudes of: “Well, we can’t find a problem, so just take this medication”. It has been upsetting to say the least to someone that wants to manage their health (not just the symptoms).

    I think I may have nighttime hypoglycemia. Can you tell me what can I do to manage it or maybe refer me to more resources?

    Thank you so much!

    • Hi, I’m having pretty much the same situation. I’ve had a few seizures over the last few years and the DMV is trying to suspend my license because of it. My neurologist ordered an EEG that came out normal but still decided to put me on an anti-seizure medication, levetiracetam (keppra), that I started taking a few days ago. It makes me feel strange and very moody which I don’t like. My seizures have been so spaced apart so I’m not sure why she put me on a medication so soon. Mind you that I’ve had low blood sugar many times before (69) and had pancreatitis when I was 10 or 11. If you found any answers to your predicament please e-mail me. PLEASE….

      • Dear Savannah,
        thank you for writing in to me. I can understand your anxiety and distress at this. You are upset that you may suffer loss of your driving privileges. But the question which needs to be answered is whether you have underlying epilepsy/ seizure disorder and thus remain at risk for suffering another seizure or whether all your seizures were induced/provoked (you mention a few possible causes: medication use (Tramadol) and possible low sugar). This is an important distinction to make since if you have underlying epilepsy you warrant to be on an anticonvulsant medication. You do not want to suffer a seizure at the wrong place or the wrong time. Imagine what would happen if you were to suffer a seizure while behind the wheel of a car. There is no way you shall be able to control the car. You can have a serious accident injuring yourself or others sharing the road with you. The laws regarding epilepsy and driving are pretty straight forward. The state allows you to drive provided they are satisfied that the seizures are well controlled. For example in NY you cannot drive till you are seizure free for one year on medication. You should be aware of the law of your state. You can find this by either going to the DMV website or the American Epilepsy Society website.
        As regarding how long you should take levetiracetam and the side-effects you are experiencing, all these questions shall be best answered by your current neurologist.

        Personal Regards,
        Nitin Sethi, MD

    • Erin, I would love to hear how things are going and what you have learned. My wife is having nocturnal seizures and I think it could be related to hypoglycemia. Hope you and your family are well.

  17. Hi,
    My boyfriend has type-1 diabetes. He is 20 years old. He had a seizure due to hypoglycemia a few days ago while we were travelling in a foreign country. I have a question, now that we are back in our own country, shall I inform his parents about his seizure? He refused to tell his parents about the seizure. I know the age of consent is 16/18 years old. Do I have to respect his decision and not inform his parents about his seizure? thank you

  18. Dr. Sethi,

    My son is 14. He had his first seizure on June 25, 2010 and has had 3 since. We have seen an integrative medicine specialist at Greenwich Hospital who feels our son’s seizures are due to hypoglycemia. In fact, we believe this is true since we have been able to stop a few from happening by giving him 100% fruit juice followed by a protein when he begins to feel one coming on. With that said, the last seizure continued regardless of food intake — maybe we were too late in trying to get the food into him?

    The onset for our son is a “de ja vu” feeling followed by mental confusion. Each seizure has happened either when he has not eaten regularly, or our scheduled has been crazy and food was not readily available. Yet there other times when he may go longer thatn ususal before eating and he is fine. It seems to be more critical of late.

    We have a sleep deprived EEG and MRI scheduled within the next 2 weeks, and a follow up w/a pediatric neurologist. My concern is that the ped neurologist does not believe that seizures can be caused by food, blood sugar levels, or lack thereof — but I have read extensive reports that indicate they can be. Since we live just outside NYC, can you recommend a neurologist that may be more knowledgable about blood sugar and seizures? This Dr actually told me that sugar/food cannot stop a seizure, and although I explained that we have been able to stop them a few times, he disagreed and told me that sometimes the brain simply does not cycle through to a complete seizure.

    Our son’s situation is complicated by the fact that he is allergic to gluten, and has Hasimoto’s Thyroiditis. The Integrative medicine M.D. has recommended no sugar (only natural fruit, small amounts of honey, or Stevia) and a no gluten diet. This has created a huge challenge w/keeping our son’s blood sugar level, simply because it can be difficult to find foods or always have the proper foods on hand.

    Any insight you can provide is greatly appreciated. Our son is not diabetic, but the Integrative med specialist (M.D.) feels he is pre-diabetic. I will definitely purchase a blood glucose machine to begin monitoring his blood sugar levels. How often do you recommend that we do this throughout the day?

    For now, I’m trying to make sure that he eats every 1.5 to 2 hours. At the moment, if he goes much beyond that, he seems to begin feeling light headed and shaky.

    Thank you,
    Kate

  19. Dear Dr. Sethi,

    Your article was very informative ….I had my first Grand mal at 14 -15 years. Thereafter saw a neurologist and was put on Carbamazepine . I was ok after that but when 18 yrs old, my doctor thought it was uinnecessary and took me off it…I had a seizure and was back on meds.But throughout I have moments of sudden feeling of scare as I feel confused and lose feeling in my left hand. I have called this ‘hand problem’ This occurs for a few seconds and goes off and comes again and off.and thus repeatedly.Until it tapers off after a while sometimes lasting 30 minutes or more or just 15 minutes.II have been sufferingf this for last 35 years. I am now 51. This happens even tho I am on Carbamazepine 2 or 3 a day. I usually take a 1/2 valium at this time or another dose of meds. Also this occurs only if I have not eaten for long hours, have not slept properly am stressed out.
    Of late after I hit menopause, I find when I have not eaten for a long time I feel a seizure coming on! That is why your article was informative. Of course it is controlled due to the meds…but it is a very scary feeling and also traumatizes my family. Is there any solution for me…what is it that I have?
    My sodium level is also low and I have high blood pressure. Thank you doctor for your insight.

    • Dear Pat,
      Thank you for writing in to me. I am glad you found the article helpful. Well first things first, the reason you have low sodium is likely on account of the drug carbamazepine. The drug causes hyponatremia and if that indeed is the case then you do not have anything to worry about. Likely you have partial epilepsy but some seizures do generalize. Your doctor with the aid of an EEG study or a long term EEG study shall be able to determine if the funny feeling you get are small seizures/auras. Based on that he shall be able to adjust your medication accordingly.
      Personal Regards,
      Nitin Sethi,MD

  20. I am 44 and not diabetic, although I had gestasional diabetes when pg with my son 10 years ago. My parents have both also recently been diagnosed with diabetes.

    Since I was 19 or 20 I’ve had ‘episodes’ of shaking, anxiety, disorientation. In college I would treat it with a can of soda and eventually it would go away, then it would be followed by a headache and a need to sleep.
    I suffer from severe PMS/PMDD, in an attempt to control it I cut almost all sugar out of my life…but I still have these episodes, and I now realize they usually occur during my PMS/PMDD time.
    I also take B12 injectsions as I am missing intrinsic factor (which I know is very rare but I’ve had it confirmed mulitple times)

    I have asked to be tested for diabetes multiple times, dr’s check my urine and say I’m fine…no one seems interested in doing the 4 hour blood sugar test.
    Can I have hypoglycemic episodes even if I’m not diabetic?
    Is there any documented relationship between hypoglycemia and PMS/PMDD?
    I’ve thought this was a blood sugar issue for years, my new dr now thinks I’ve been having seizures this whole time.
    Thank you!

    • Dear Tracy,
      Thank you for writing in to me. Your history is complicated but I have a few thoughts. People can have impaired glucose tolerance and not frank diabetes mellitus. The way the diagnosis of diabetes mellitus is secured is by checking fasting glucose and post prandial glucose (2hours after a meal). Then if needed a glucose tolerance test can be carried out. Your doctor shall be the best person to guide this workup forward. Whether your typical events are due to hypoglycemia or are seizures can be best determined by capturing one of these events on a EEG and simultaneously checking your blood sugar at the same time. Hope I have been able to help you out.
      Personal Regards,
      Nitin Sethi, MD

    • Tracy, Your story sounds so similar to mine. I thought that I was hypoglycemic since high school, because I would seem to come around after being forced to drink a glass or two of juice, but A1C always came back normal. Now I am being told by doctors that it looks as though I am having a complex partial seizure when I am like this. My spells seem to be around the time of my menstrual cycle more. I almost always get anxious, and confused, then really frustrated and mean prior to spell. (That is my warning now…and I just get the jitters, weak.) Then I my lose ability to talk and I stare and my eyes dance around the room. I pick at my clothing, or just fidget with my hands. Sometimes my lip twitches towards the end of the spell. I am really tired and cold after my spell. Seizure monitoring came out clear, but dr said I was “suspicious enough” to start seizure meds. Not wanting to take the meds if I am not experiencing epilepsy, but some other underlying problem.

  21. Hi, I’m 46 and have had type I diabetes since age 12. I have had several hypoglycemic episodes over the years but never one as bad as 3 days ago. Usually I can feel it coming, especially if i’m busy and forget to eat supper. All I can remember now is that at about midnight I was looking at my computer screen and confused at what I was seeing, then, about 5am I woke on the floor. I was totally drenched *not the usual damp from sweating” I had chewed my tongue up pretty well, I think I was hitting my arms/legs, and head on the desk because i’m all bruised up and bumps on the back of my head. well, my question is: it’s 2 days later and I still feel not quite up to par as far as my thinking goes. Is it possible I may have cause some permanent damage to my brain or should I just give myself a few days to recover.

    PS: I now realize why this happened, the pharmacy recently changed the brand of my humolog pen and I’m pretty sure I dose 25 units of humolg instead of Lantus. *( I won’t do that again)
    Thanks,
    Greg

  22. Dr. Sethi,
    My girlfriend expieriences regular seizures {they last approximately 20 to 30 minutes of on and off twitching before she falls asleep at night, also she seizes in response to loud sounds}. She has Borderline Personality Disorder so I had attibuted the seizures to stress and scheduled an EEG for her. However, she is also underweight and we are both college students so eating regularly is rather difficult. Could it be possible that the seizures are due to low blood sugar? Or even a combination of stress and low blood sugar?

    • Dear Elysia,
      thank you for writing in to me. Your girlfriend warrants a good seizure work-up which shall include tests such as an EEG study (and if further needed a video-EEG study to capture these events on a camera so that they can be characterized: are they seizures? if there are seizures–where in the brain are they coming from? what kind of seizures are they and so forth). The doctor may further order a MRI of the brain. Seizures can occur due to stress and sleep deprivation and also in the setting of low blood sugar (hypoglycemia).

      That said what we need to do first and foremost is to diagnose her. Just what are these nocturnal events (could they be some sort of sleep disorder and not seizures?). My advice is that she should be evaluated by a doctor as soon as possible.

      Personal Regards,

      Nitin Sethi, MD

  23. I have been dealing with hypoglycemic “episodes” since last novemeber. I have gone to plenty of doctors and had plenty of blood work and all that I have really found out is that I have hypoglycemia, insulin resistant cells and a “lazy pancrease”. Does this mean that I have diabetes? Does it mean that I will be getting diabetes sometimes soon? I have tried januvia and still experienced low sugars. I have been taking byetta for a couple months but sometimes, rarely, but still, I will get really low blood sugar readings like in teh 50s and low 60s and feel like im going to pass out. I am not really sure what the problem is because its usually like right after a meal.

  24. my new born baby after 02 days of birth he had having hypoglycemia with seizures. after that he was having meninjities. he was in NICU for 22 days with continuous in antibiotics and mother milk. after discharge from NICU i took him to ENT and Eye doctors. both are saying there is no problems. i have also done head ultrasound and found every thing is ok. can you advice me whether any problems may occur in future due to this diseases? your reply can very much understand me. Thanks.

  25. Dr. Sethi,
    My husband has been experiencing seizures for about 2 years now. When they first started we saw a neurologist, had blood tests and a MRI. The doctor could not find anything wrong. When the seizures continued I did some research and concluded it was most likely hypoglycemia, which I have since found out his mother has, but not nearly as severe. My husband is a personal trainer and in very good shape so I am doubtful that this could be linked to diabetes. Since all the seizures occur very early in the morning my husband has started consuming glucose tabs before bed. This has seemed to work very well, for the most part. My question is how do I administer glucose during a seizure? I currently wait for him to become somewhat coherent and force him to consume more glucose tabs. We do not have insurance and multiple neurology visits puts a pretty hard financial strain on our family.

  26. I have the same issue(s) as above. I have had blood tests, CT-Scan, MRI, Spinal tap(s) and nothing can be found.

    Once again yesterday I messed up and had a less than good breakfast, no lunch and then supper not until after 9pm. This morning I had a siezure, this is the 3rd time in a year and each time it is becuase I did not eat right. Would glucose tablets help?

    As we too have no insurance and neurologist visits are financially a severe burden.

  27. Absolutely Kiran, an old infarct can act as a a seizure focus in diabetic patients. In fact old infarcts are the most common causes of seizures/epilepsy in people above the age of 60.

    Nitin Sethi, MD

  28. Dr. Sethi,

    My mother has been having seizures off and on for just over a year now. When we take her to the Emergency room, they run all the standard tests and can never find anything wrong with her brain. She is considered pre-diabetic right now, not officially diagnosed as being diabetic.

    Yesterday, my mom had been alone most of the day and was supposed to come to my house for Thanksgiving dinner but never showed. She lives across the street from me and I sent one of my children over to see if she was okay and he came back crying and said his grandma had fallen out of her chair. When I came over she was lying on the floor and I got her to sit up.

    She always does and says strange things after these seizures. For instance, when I sat her back at her computer desk yesterday, she grabbed a spoon that was on the desk and tried to use it as a mouse. Here is the timetable of the day for her and this is why I suspect that her seizures may be related to blood sugar:

    5:30 p.m. — I discovered she’d had a seizure, I rushed to her house to help her, my husband and I got her up to her desk chair and I gave her some orange juice to drink.

    6:00 p.m. — She had her second seizure that I knew of that day. My husband and I took her across the street to our house to watch her as my father wound not be home until about 10:30 p.m.

    7:00 p.m. — Her third seizure.

    7 – 8:00 p.m. — She took a nap. (She was not passed out this whole time because she responded to what we were saying. Even though a lot of it didn’t make much sense.)

    8:00 p.m. — She woke up from her nap and I fed her a banana.

    8:30 p.m. — Her fourth seizure.

    9:00 p.m. — I gave her a very full plate from our Thanksgiving dinner, complete with turkey, mashed potatoes, a roll, deviled eggs, corn and stuffing.

    9:30 p.m. — She got about half way done with her plate when she had fifth seizure. Much more mild than the others. There was an intense frown on her face, it looked like tears were in her eyes, she was staring off into space, only barley shaking this time, although she was gripping her fork so hard her knuckles were white. I could tell her muscles were tense and she looked like she was terrified. When I asked her if she was okay, she could shake her head “yes.”

    11:00 p.m. — Mom had basically licked her plate CLEAN and drank all of the sweet tea I’d given her. My father came home from work and came over to see her. They both had a piece of pumpkin pie and my dad went outside for a smoke and then had to go home to get something.

    11:30 p.m. — She had her sixth seizure, milder still than the fifth one and about 2 hours from her last seizure. I took her home not long after that and as far as I know, she had no other seizures that night.

    NOTE: I had asked my mom what she had eaten that day and she told me “nothing.” My dad confirmed this as far as he knew. He left for work around 1:30 p.m. and my mom didn’t ask him to make anything for her so he didn’t. My mom has a lot of trouble sleeping due to arthritis pain so she’s up at all hours of the day and night and it’s not unusual for her to nap until 1 or 2 p.m. I did not check her blood sugar but if I know of any other seizures it is the first thing I will do!

    My mom does not remember much from yesterday. She remembers being at my house, but does not remember most of our conversations or that she ate. She remembers being home after coming to my house but does not remember how she got to and from my house. This is normal for her. After she has a seizure, she doesn’t remember having one and does not remember much of what happens afterwords. The last time she had problems, she remembers being at home, then being in the waiting room in the ER talking to my brother, then she woke up in the hospital bed, and that’s all she remembered from that day.

    Does these symptoms sound typical of a person with hypoglycemia induced seizures? How do we check this problem to figure out if this is true?

    Thank you for your time.

    Sincerely,

    Dianna

  29. Hi. I am a 24 year old mother of two. I have had the four hour blood sugar tests while pregnant and not pregnant and both have resulted in normal results (Non diabetic) however I have had the strangest problem. if I do not eat well in a day, or have not eaten enough sugar, I become confused, dissoriented, suffer Vertigo and when I stand from a reclining position I will lose the control to stand as I tunnel vision and am unable to think as I fall to the ground feeling really flushed and fuzzy as I am aware of trembling. After an attack like this (which only lasts for a few seconds to a full minute) I sit back up, feeling a little shaky and I am dissoriented about what I had been doing, though I know I’ve had one of my falling over spells. I have talked to doctors about this and they either tell me it’s vertigo or that I have low blood sugar. They never give me medication they just tell me to eat regulary and to breathe in when standing and to do it slowly. I seem to be able to manage it fine but what hte heck is it called? it’s not a seizure as near as I can tell, it’s not very long but I can have several in a day and then none for months after.
    Thank you for your time.

  30. Dear Dr,

    I am 35 Years and have had diabetes type II for maybe 10 years. I was taking metformin 500mg, although my doc wanted me to take 1000mg i found it drpped my sugar level too low. I had gastric bypass surgery a year ago and recently experienced a seizure, this was the first after ten years, around the time i was diagnosed with diabetes, i was having reaccuring seizures which was diagnosed as epilepsy. once i started to take care of my sugar levels, it went away.
    Now i am off the meds cuz of the surgery figuered since i am bypassing my pancras, there is no need, but the seizures are back.

    I am planning to get pregnant and was prescribed seizure meds the other day Keppra i think its called, i am afraid to take them, but also i am just drained, foggy, and sometimes out of it. i havent been able to be productive for a weak now since my fall last weak which was a seizure leaving me unconcious for a few seconds. Also my levels are frantic, 190 after eating immediately to 80 2 hrs after eating. often i measure and it is in 70s a rate that pregastric bypass had me in shakes and sweats. could the surgery be masking some of my syptoms?
    i would value your advise please.
    Shoule i take my seizure meds?
    should i get back on metphormine, will it regulate gulocose level?

  31. Dear Dr. Sethi:

    I have a family member who has experienced symptoms of seizures during sleep, Only two such events over the last several months. Symptoms were waking up with a fat lip and bleeding (recently), 2nd day back from middle east with 7 hr. time difference – recuperating from Jet Lag. Falling out of bed and sleepwalking to another bed in the room (several months ago). This was after extreme athletic output, and subsequent realization that they did not consume enough calories during the day, during that day (collegiate sportsman). While we are going to be following up with neurological exam, and blood work, do you have an comments in regards to your own experience on this type of scenario? It has been suggested by a nutritionist that individual experiences hypoglycemia from day’s activities which sets the stage for the seizures during sleep. Person has never had symptoms when awake and is otherwise extremely healthy.

    Thanks,
    Marc

  32. Alright I’m desperate so I might as well ask you. I recently had a seizure at a party after drinking and I know that already doesn’t sound good but I went to the ER the next morning and checked. In the morning I still felt funny which was probably from the alcohol. Since it wasn’t my first time having a seizure they notified the DMV. They did a CT scan and blood tests and everthing came out fine so the ER doctor blamed the seizure on the fact that I was prescribed Tramadol, which I would take for the tendonitis pain in my hip every week or so it wasn’t often AT ALL. I decided it would be smart to make an appointment with my physician to discuss the whole thing since it wasn’t my first seizure.

    So let me go back for a second and tell you some of my medical history. When I was 11 I had pancratitis with no real explanation why, they said it couldve been caused by the flu I had gotten. There was a new strain of a stomach flu goin around at the time. I was in the hospital for a week and the doctors told me that I had to watch my sugar intake from then on. Ever since then I’ve had random little things come up. I’ve gotten heart palpatations, passed out at random times (my mom tested my blood sugar when that happened and it was 60, she has type 1 diabetes fyi). I’ve had constant nosebleeds all my life and headaches often, kind of irrelevant but yea. I’ve had anxiety attacks for the past few years and I’ve had a few seizures in my sleep, where I’ve urinated in my sleep. I’ve only had a few seizures in my life and I only remember the beginning of it and when I’m coming out of it. I’ve had stomach porblems for years and I get mood swings often, which is probably because I’m a moody 18 year old. Right at the end of December of 2011 I started having a pain in my throat and when I got it checked it turned out to be a cyst on my thyroid. When i went to get it biopsied, it had already shrunk down to almost nothing.

    When I went to see my physician, she sent me to see a neurologist. The neurologist prescribed me Keppra for the seizures which I’m not too comfortable with taking because I don’t think I have a seizure disorder. But if I don’t take it, the DMV will suspend my license on the 18th of March. I had an EEG and all it did was make me twitch a little during the test but it came out completely clear and I’m about to have an MRI on March 6th. I’ve been tested for diabetes multiple times and it’s always come out negative.

    I don’t want to take the medication because it makes me feel, well not normal and it makes me get nosebleeds. I just went out and bought a blood sugar tester and it seems to be reading 69 often. I don’t feel sick but I’m tired of being told that there’s another random thing wrong. Please help.

    Thanks.

  33. Hello Everyone, I am glad to meet you. I am new here.

    I noticed that a lot of you are having seizures, as well as your diabetes. Seizures are a complication of diabetes. I am going to give you a link:

    I also have epilepsy, diabetes and Alzheimer’s. When I was diagnosed with diabetes, I stuck to my diet. My seizures are under control now.

    When you have hypoglyclemia, you can have seizures, coma and death. The same is true of hyperglycemia..When your blood glucose goes to low, you need to have a small snack. i never let my BG goes below 90 or higher than 140.

    Take care of your diabetes diet and you should not have any problems.

    The reason your hypoglycemia seizure does not show up on the EEG, is because it is a Diabetic Seizure. Only epileptic seizures will show up on an EEG.

    Your Friend, Ruth

    • Dear Ruth,
      thank you for writing in. I am glad you are taking such good control of your blood sugar. You say only an epileptic seizure shall show up on an EEG and not a diabetic seizure–that is not quite true. A seizure is a seizure and if you happen to have one while the EEG is running, it shall be recorded on the EEG.
      What you are mentioning Ruth is what we neurologists refer to as interictal epileptiform discharges. Think of them as abnormal blips which show up on the EEG when the EEG study is done inbetween the seizures (inbetween means the patient has an EEG study when he or she is not having a seizure at that very moment). Patients who have underlying epilepsy may show interical epileptiform discharges. On the other hand those who have seizures provoked by metabolic factors (low blood sugar–hypoglycemia, low sodium–hyponatremia, low calcium or magnesium) or toxic factors (excessive intake of alcohol or use of a recreational drug such as cocaine) usually do not show interictal epileptiform features and the EEG is frequently reported as normal.
      Here I want to emphasize a point. The diagnosis of a seizure disorder/ epilepsy is not made simply based on an abnormal EEG. Put in another way, a normal EEG does not rule out or rule in epilepsy. Many epileptics may have normal EEGs even when the test is repeated many times. Conversely there are people who have abnormal EEGs but no epilepsy. Hence the diagnosis of a seizure disorder (epilepsy) is made based on a thorough history of the patient event (convulsion): what led to the event, what happened during the event, the clinical semiology of the event, whether there were any provoking factors and so forth. The past medical history is explored (any history of significant head trauma, any history of meningitis or encephalitis). The medications the patient was taking at that time are reviewed. Even the birth history is reviewed–was the patient born full term, were there any complications during child birth such as lack of oxygen.

      Nitin Sethi, MD

  34. Hello Doctor,

    A family member is diabetic for last 15 years, since he was 19. He is admired by his physician, he has maintained excellent control. He was diagnosed with celiac disease since last 6 years. He has healthy regime, exercises a lot, self disciplined. He does not smoke, has alcohol occassionally, no drug history. no siezure history.

    Recently he went for mountain trip. Bit of alcohol, bit of less sleep, quite a lot of exertion on hills. After 5 days, he went for trekking and was exhausted beyond capacity on downhill path. Next day, the cook betrayed and cooked a dish with wheat, he had severe diarhoea (running tap, 3 times), in foggy state he perhaps took 4 doses of insulin, compared to the 2 he otherwise takes. At 3am, he had his first siezure, lasted 30-90 seconds, stopped for a few seconds and then again occured for a shorter time. he bit his tongue, bleeded. he was admitted in hospital within 30 minutes, he was given 2 injections(i dont know which) and then dextrose drip. at 4am, his blood sugar was 53. he was given 5 dextrose IV and kept under observation for 16 hours. at hospital, he vomited once, had diarhoea twice, and slept mostly. he complained of severe headache and loved the massage. he barely has any recollection of the day, conversations, event. he was being very aggressive and resisting every single suggestion from doctor/us (initially he refused going to hospital, then from getting ecg done, then refused getting mri, eating soft food, demanded more anti-diarhoea medicine, insisted he is fine and refused to get any tests done in the next 4 days).

    after 2 days he told us he had a similar bitten tongue episode in the past, and he was not aware it was siezure. doctor didnt diagnose it at that time.

    I am worried.

    my questions:
    1) at what blood sugar level would he get siezure? je is 5.6, 55-60kg, physically fit.
    2) lets say it was 40 when he had siezure, then can it increase on its own in next few minutes/hours?
    3) epilepsy siezures are not generally emergency, but are all hypoglycemia siezures FATAL, if not treated on time?
    4) home emergency – safe to give sugar in any form if patient is conscious post siezure? if patient is unconscious what needs to be done at home till ambulance arrives?
    5) can sugar tablet be placed below his tongue while he is having siezure?
    6) can sugar (fruit juice, candy, etc) be given if he is semi-conscious, confused?
    7) should we turn the patient left or right when he is having siezure to avoid fluid from entering his wind pipe?
    8) he is being very difficult. how do we convince him to get his tests done? what tests should he undergo? is spinal tap required? is the test to check the stage of his celiac disease necessary?
    9) we dont know how many times in the past he has had this episode, since he does not live with us – but he told us only once and that also he realised now, after this incident where his tongue was bitten
    10) is there is any good book / guide for family members so that we educate ourselves.
    11) what are the chances of recurrence of siezure? what preventive care does the patient and family members need to take care of?
    12) are there any siezure besides hypoglycmic and epilepsy??
    13) i have heard of some glucose meter, which warns patient in the night. what is it called, is it advisable to wear it so that he does not have siezure again in sleep?
    14) if we did not reach him to hospital in 30 minutes, this time, what could have possibly happened? he was conscious after the siezure, he wore his own shoes, and walked to ambulance, however he was disorieted and aggressively denying all treatment. primarily because he trusts himself and has excellent care regime and believes doctors cannot do anything, its all about self-reliance.
    15) he is more prone to other diseases due to diabetes + celiac. what high nutrition food do u advise?

    would be hugely thankful for your response,
    thanks,
    amelia

  35. Hi there. I am hoping someone can help me. My boyfriend is a type 2 diabetic. He suffers from very high sugar. However, when his sugar drops to low he has seizures. Now is the seizures due to low sugar or high sugar. Test showed high sugar. Can a high sugar also cause seizures. I don’t want to treat him with the wrong treatment ie glucose if it is actually a high sugar seizure and not low like we think it is? Very confused as the treatment for high and low is so different? Pls can someone shed some light. Blessings!!

    • Hello Marie,

      In general, Hyperglycemia does not result in seizure – at least, not without very severe spikes. For example a lot of people who do not know they are actually diabetic can have very, very, very high blood glucose levels for a very long time without even knowing it – especially if they are asymptomatic, and without seizures too. Severe or very sudden-onset Hypoglycemia on the other hand almost always results in seizure (and at what level is highly independent, different people have different tolerances) because the brain relies on a continuous supply of blood glucose to function (it does not store very much Glucose for itself locally due to space constraints) and without it, it ‘starves’ and causes misfires of the Neurotransmitters (seizure – and not always grand mal or that is to say with convulsion, some simply “stare off into space”, others remain partially cognitive) and eventually, without intervention, will cause coma or even cease to function (die).

      However again, high blood Glucose readings after a seizure brought on by Hypoglycemia may be and usually is in fact be due to what is called Glycogenolysis or a breakdown of Glycogen into Glucose from the Liver (Glycogenesis preceding this, or that is to say the conversion of Glucose to Glycogen when blood Glucose exceeds the demand). This is the body’s natural response to Hypoglycemia (and it is also our source of energy when our bodies are fasting in-between meals), especially when sugars drop off very suddenly or severely and where the brain panics and tells the Pancreas to release a LOT of a hormone called Glucagon in a very rapid time, which therefore forces the liver to begin breaking down the Glycogen into Glucose in order to correct the Hypoglycemia by itself, eventually (this takes some time).

      Sadly, this particular mechanism or natural defense of the body can be and is typically impaired or delayed in Diabetics (how much depends on how bad or unmanaged their Diabetes is), and which is why it is such an emergency in their case especially because in these Diabetics, the risk of coma or even death is greatly increased without timely medical intervention.

      But if you’re ever unsure, you should test his blood with his glucose meter during or right after the attack (hard as this might be, especially if he’s confused, agitated or even combative – and if combative, you’d be best to leave it to Paramedics who are trained to handle and assess those situations). That will tell you for certain and allow you to administer the proper medication. But be advised, meters are not accurate (below) <40 mg/dL.

      I'm not a Physician, however I had to learn about all of this recently myself (HMO's suck, you have to do your own legwork before getting anywhere close to a diagnosis with them these days). I suffered a Hypoglycemic attack with complex partial seizure and hallucination on the 17th and 16 hours after (just wanted to go to sleep after, and I did for 13 hours) the attack. When I finally got into Urgent Care (Nurse's orders), the meter read 104 mg/dL (16 hours after attack) and then two hours later (18 hours after attack) on labs, it fell to 100mg/dL (just to give you an idea of how very much Glucose can be released into the blood stream from Glycogenesis, effects linger on and on). I'm not Diabetic and with previously normal blood sugars below 100 (though I do suffer from Hyperinsulinema or excess blood Insulin, unknown cause), my body was able to handle the drop itself through Glycogenesis, though not before the seizure (evidently without loss of motor control).

      Anyway, I hope your boyfriend's condition improves and gets under better control. God Bless.

      • Thank you so much for the reply. I will have to read your reply properly as it does not make much sense to me. All I know is he gets a seizure every 2 months or so. Usually was because he drank to much the previous night – but this thank God is now ended or because he did not eat. So I am hoping this will now be sorted. I believe God has taken control and hoping it will not happen again. “Should” it ever happen again I will take his level for sure to see what it reads. I am just not sure if I should be calling a paramedic every time it happens? As it worries me to know there could be permanent damage or he could loos control of his body permanently?? Or there could be brain damage? Gosh this is scary!!

  36. Hi,

    I was very glad to find this and have some of my own questions. When I was a child I ate alot of sugar/caffeine . Chocolate,mountain dew, and way more. To top that off I hardly ever ate anything that might stabilize my blood sugar. When I was 9 I started experiencing small seizures- my eyes would flutter inthe sun light. I didn’t affect me much I could continue doing whatever I was doing. I had gone for an EEG and put on medication that gave me terrible headaches and made me very sick-so I refused to take them. When I was 12 I was at a friends Halloween party and their were strobe lights-which caused my first grand mal siezure. So I then went for another EEG. It was later discovered that I was hypoglycemic and had to cut back on my caffeine intake. But still didn’t eat well and continued having grand mal siezure along with the petite siezures. I was on meds that didn’t work . But no one believed they didn’t work because I didn’t take them regularly. Since I have been old enough to understand hypoglycemia I have worked at eating well and keeping my blood sugar stable the right way. 14 yrs I had my last grand mal siezure. I have not had one since but I do still have the petite siezure and do not take medication. I do see that when my sugars are low I experience more clusters of siezures. They also cluster when I am angry or very stressed. Is there anything you suggest I do to help with these siezures? I am pregnant now and it has come time for me to take their glucose test but I am afraid to mess with my sugars like that because I am afraid that I might have a grand mal siezure…? I don’t no if this matters but I am very violent when coming out of a grand mal siezure. Please any suggestions would be appreciated! Thanks, kristan

    • I forgot to mention that when I do eat or drink caffeine I feel as if someone ran me over again and again! I feel so exhausted that I literally dose off while walking and my heart races to that extent that I am afraid what might happen to me. I hope this info will help you to give me some insight on what is going on. I have never been told I have diabetes just that I am hypoglycemic! Thx again! Kristan

  37. Can you comment on seizures as a result of hypoglycemia caused by dumping syndrome. This is in a patient who underwent gastric bypass surgery 10 years ago. There are two recorded instances of this occurring about 18 months apart. In both cases he had very sugary food in a short space of time, experienced sweatiness, faintness, increased heart rate then lost consciousness. Emergency response team was called who recorded blood sugar at 2.1 and administered glucose liquid My understanding of how it works is that prior to surgery he was insulin resistant but the surgery can make you the opposite – very sensitive to changes in insulin level. When the sweets were eaten the blood sugar increases, body releases insulin in response, but because the bypass makes everything go through the system very quickly the blood sugar can then plummet causing loss of consciousness or even seizure if the drop is very fast. Seems to be well controlled in this case by following a sensible diet and avoiding intake of highly sugary foods, but would be interested in your thoughts.

    • Dear Sara,
      thank you for writing in. As I have explained in my post, seizures can occur if the blood sugar drops down too low too fast. There is no one cut off number below which a seizure shall occur. It is usually the rate of fall of glucose which determines it. That said neurohypoglycemic symptoms usually occur when the blood sugar falls below 60 mg/dl. So seizures can occur in a patient with dumping syndrome and the explanation which you have given is quite logical. The pancreas secretes insulin in response to food intake. In a healthy individual the amount of insulin secreted by the pancreas in response to the food challenge is highly regulated. No over or under secretion of insulin occurs and the blood sugar does not fluctuate much. In a patient with dumping syndrome this highly regulated mechanism may fall apart. The pancreas may release X amount of insulin in response to Y amount of food. But due to the gastric bypass “Y” amount of food rapidly traverses through the gut so that when the insulin actually reaches the gut, food is either already gone or there is less food and more insulin leading to hypoglycemia.
      Hope that simple explanation helps to answer your question.

      Nitin K Sethi, MD

    • I hadn’t seen this before posting below, apologies.

      Sara, I suffer from these seizures as a result of gastric bypass as well. I hit my ten-year mark in December, but began having seizures about seven years ago. You are actually the only other person I’ve known who suffered from this. Pre-surgery, I was prediabetic, which lapsed eventually. I was not yet glucose resistant, but I was headed there.

      I am curious – was glucose liquid administered in both cases? I only ask, as I have received glucose liquid twice, but have not required it in five other cases–it appears to resolve without intervention.

  38. This can also be caused as a result of weight-loss surgery. I was a very large young man and had a laparoscopic roux-en-y proximal gastric bypass. A side effect of gastric bypass is something called Dumping Syndrome. Dumping Syndrome gets its name from the process of too much sugar being dumped into the bloodstream. Because the “pouch” created by gastric bypass is essentially time-released, it dumps this sugar sometimes in a massive wave.

    This can result in severe drowsiness, a feeling of overheatedness and, as with all gastric bypass surgeries, discomfort.

    After losing approximately 80% of my target weight, I turned 21, and as is wont by the young, began experimenting with alcohol. Nothing too severe. The day after my 21st birthday, I had dinner with my father and consumed a great deal of sugar and two drinks. I felt the effects of Dumping and, as is often the case, laid down. I awoke nine hours later with stitches above my eyebrow and in my eyelid, having knocked down a pair of toenail clippers in the process – and as occurs with seizures, essentially stabbed myself on them repeatedly. I asked my sister-in-law the time and she reminded me that I had promised to stop asking. It was only when I touched her hand to tell her I was “back in,” that she realized I was now actually conscious.

    This was the first of seven total seizures. I was tested repeatedly for epilepsy, I underwent EEGs, EKGs, MRIs, as well as a number of other ad-hoc tests that could not detect what was occurring. It was only after visiting an endocrinologist and three more seizures, that it was determined that the gastric bypass was the chief cause of the seizures.

    Too much sugar was sending me into Dumping Syndrome. When my blood sugar normalized after such a massive amount of sugar, it went too far to the other extreme, dropping me to as low as 13 on a Glucometer. My normal level was between 85 and 90. This information was found at the end of what I can only describe as a horrific punishment for possibly killing a puppy, known as a Glucose Resistance Test.

    The subject consumes a heavily concentrated sugar-heavy solution and over the next eight hours, every hour, a vial of blood is taken. Hour five is where your arm hurts. At the seventh, you can barely lift it.

    For me, it resulted in essentially being incapacitated for three hours, lying on a medical cot, because I was going to pass out. I did not seize, which was highly unexpected.

    The internal warning signs –

    – Inability to focus
    – Confusion
    – Shaking hands
    – Paranoia
    – Cognitive impairment

    I am an anosmiac (a complete lack of smell), so I tend to focus on vision and hearing during this time. Vision becomes gradually washed out, from a color palette-perspective. Reading words repeatedly–for me, it was a political science textbook–and being unable to synthesize the information is a major sign.

    For aural, inability to understand words begins to set in, and at that point, the timetable is dramatically shortened. If I get here, I am preparing to drop to the ground to avoid an uncontrolled fall.

    For verbal, I do recall being able to form words in one specific instance, but required someone to instruct me on the method of opening a box of crackers. It took approximately an hour. By all rights, I should’ve had a seizure.

    For touch, muscle constriction is common, inadvertent body tremors begin to take over. Specifically, I begin snapping my head, hard to the left, reset and repeat. I have never averted a seizure at this stage, due to inability to physically act.

    External signs –

    – If walking together, an increasingly slower pace.
    – The person in question is non-responsive to name being called.
    – Clear, inadvertent muscle contractions.

    I have had a total of seven of these seizures, suffering a total of four concussions in the process. I have had two events in a public setting, which does make self-diagnosis much more difficult. In order to test myself in public, I tend to force myself to do a series of complex mathematical problems. This is my key determining factor if my vision begins to trouble me. Perhaps I am tired, perhaps I simply have something in my eyes, the math will help me figure it out.

    Once tremors begin in my hands, I know that action is required to avert an episode. I do not always have the foresight to notice this–during a movie, or on a date, or a situation where I am otherwise distracted.

    In any location other than public transportation, I have memorized those items with the highest concentration of sugar, with emphasis on speed of getting to those items.

    I personally experience full recovery very, very rapidly. The seizure tends to last under 30 seconds; barring a concussion, I regain consciousness within two minutes and my blood sugar begins to trend back toward acceptable levels within seconds of the seizure ending. I had an EMT group in the same department store I was in, and a Glucometer test taken during the seizure placed me at 14 – a test two minutes later had me back at 54.

    I do not believe for an instant that most patients suffer from this type of issue and experience that speed of recovery, but mostly due to the fact that this type of seizure is caused due to mitigating factors of a unique case of endocrinology and digestive/circulatory system. The signs listed above, however, should apply to many of those who suffer a seizure due to hypoglycemia.

  39. I have been a Type 1 Diabetic for 12 yrs. it’s only been in the last 5-6 yrs that I’ve experienced seizures with hypoglycaemia. It’s an extremely frightening experience when it happens. I’ve just had over 6mths off work due to an injury I sustained during a seizure last year, as my legs are the first thing to give way if i’m standing. Even checking ur BSL 6 times a day it can still happen. I feel for anyone else who suffers from this extreme symptom.

  40. Greetings and thank you for your informative site.
    I have a 17 yr old son, diabetic since he was 12. Over the last year we’ve had a particularly difficult time helping him regulate blood sugar levels. In this last year he’s had numerous lows, lately resulting in seizure more drastically. Interestingly, we’re seeing some patterns develop.
    1. Lows are in the early morning hours, somehow connected to sleep?. 2. Seizures are directly connected/related to lows. 3. The seizure activity seems to be progressively getting worse, even AFTER we’ve been able to bring his blood sugar level to a “normal” level. Let me explain: Two days ago his mom checked him around 6:30 a.m. and he was pretty low but not having a seizure (able to drink, eat, look around and acknowledge her, etc. but acting kinda silly). We got him up, walking around, peeled himself an orange, conversed with his brother, then decided to go back to bed. About 20 minutes later, his brother found him in bed having a seizure. What was extremely alarming to us was the fact that we couldn’t wake him up. Ended up taking him to ER. His seizure lasted at least an hour-and-a-half, probably closer to two hours. We do have an MRI and an EEG scheduled soon. In the initial neurology consult, the Dr definitely ruled out “epileptic” related because I showed him a video clip of the seizure taking place. I am very curious what your thoughts would be and additional questions you might ask that the neurologist didn’t. Incidentally, this neurologist seemed more interested in asking our son about the seizures than us. He doesn’t remember them whatsoever. Your comments would be appreciated.

    • Oh, I forgot to mention in my previous post that when his brother found him in that seizure, his brother checked his blood sugar level and it was at 120. Additionally, he has no recollection of anything that took place the night before the seizure all the way till some time after he woke up in the hospital.
      Hope this helps. Thanks.

  41. Can you offer me some insight on Hypoglycemia and Seizure Disorders occurring concurrently? I was diagnosed with a seizure disorder about two years ago. An MRI revealed that the hippocampus on the right side of my brain is underdeveloped causing abnormal neurological signals, creating focal or tonic-clonic seizures. HOWEVER, I strongly suspect that I am suffering from reactive hypoglycemia. Every blood test I have ever had always comes back normal. However, I experience the classic symptoms of low blood sugar if I miss a meal or go too long without a meal or snack. I also tend to wake up lethargic, tired, and irritable. I have had sleep studies to rule out sleep disorders and seizures while sleeping. But, about 90% of the seizures I have had, have been when I was extremely tired, after a few alcoholic drinks, falling asleep, or just waking up (which could be indicative of hypoglycemia). I also find that when I am feeling low on blood sugar that eating will subside most of my symptoms. If I go too long before eating, I need a few sugar tablets, a meal, lots of fluids, and a quick nap to get going again. Also, after an episode like this, I feel lethargic and nauseated for the rest of the day and sometimes into the next day. The nausea is accompanied by diarrhea; my stomach violently turns and churns for the rest of the day. I continue to feel a little shaky and weak. It usually takes a good nights sleep to make me feel 100% better.

    I’ve also considered that I may have an underlying diabetic issue. However, no tests have confirmed this; regardless of how many times I’ve had a blood tests. It’s honestly quite frustrating.

    Your thoughts? Could you possibly shed some light on how I can get these issues resolved?

    Thank you.

  42. Dr.Sethi.
    I have a son of the age of 4 and he is having hypoglycemia problem since the last seven months along with seizures.Iam from Nepal and the doctors suggested me to take my son to Sir Gangaram Hospital of delhi india for further diagnosis for the reason of hypoglycemia.According to his EEG report,he is epileptic.What i dont understand is can seizures cause hypoglycemia?
    He had this condition a third time yesterday since seen first before about seven months.What happens is : if he is having fever during the day he will not eat well especially the dinner and the next day when he awakes he will feel very weak and soon he will have seizures.when he had seizures in the second time the doctors prescribed a medicine called M-toin 50mg which was to be taken after dinner one and a half tablet every day and we were continuing the same for the last four months and it seemed it was working too but yesterdays condition has made me very weak and i dont know what to do.Please advice me on futher treatment and what to do and what not to.

    • Dear Aaman,
      thank you for writing in to me. I agree that you should get your son evaluated at a good hospital. Sir Ganga Ram Hospital is a big hospital in the heart of New Delhi and I know they have excellent pediatric and neurology departments. The reason I know this is because I trained there after completing my medical school. I am not sure what ails your son. It is possible that he has a seizure disorder and hypoglycemia has nothing to do with it. He needs to be evaluated to determine the cause of his seizures. As I have stated in my posts in the past a good quality EEG and a neuroimaging study such as a CT scan or MRI scan shall be very helpful in this regard.
      I assume M-toin is what is more commonly known as phenytoin. It is a commonly prescribed anticonvulsant medication. It seems it has helped reduce the frequency of your son’s seizures though not completely stopped them. Your son’s doctor can help adjust the dose of the medication and guide you further. I wish you my best.

      Nitin K Sethi, MD

  43. Hello Doctor,

    I am curious, My dad just passed away a few weeks ago.
    He is a Type II diabetic non-insulin dependent. He only takes oral hypoglycemics, He is diabetic for more than 10 years but still he is on oral meds. Last year, he began to experience edema all around his legs and stomach we had his creatinine level checked and it was above normal which indicates kidney damage. From then on, he was always on diet eating only fish and chicken meat with vegetables and plenty of fruits.

    After months and months of diet, his edema did not improve at all, we rushed him to the hospital just this April of 2013 because his sugar was running very low, he would get disoriented and almost lethargic. In the ER they gave him fluid containing glucose (D 50/50) and he was able to regain a few strength. After 5 days of confinement he began to experience oliguria so the doctor ordered to remove all his infusions and IV fluids (Blood transfusions, albumin and furosemide). Overnight, I noticed he was having difficulty of breathing but was able to cope, they said it was due to congestion and the only way to solve it is through a dialysis. We were still convincing him that time to agree to a dialysis procedure, but he never consented for the procedure so the morning (7:30 AM) after all of his infusions were removed he had a sudden cardiac arrest.

    It still bothers me, because to me it looks like seizure from hypoglycemia because they removed that glucose containing fluid from my dad overnight without giving advise on feeding him during the dawn. His chief complaint was hypoglycemia when he was admitted and his sugar was not even tested when the attack happened. You mentioned that seizure from low blood sugar is reversible if attended correctly. Instead what they did was give him cardiac compressions and epinephrine.

    Is it possible that if they gave glucagon or anything to address his blood sugar level he might have been revived? or was it all really impossible to do so? because after the seizure/attack his blood pressure dropped from 120/80 to 90/60?

    Your comments might help me remove all this doubts from my head and give me my peace of mind. Thank you.

  44. Dr. Sethi,

    In search of information I happened to come across your blog and thought I would perhaps find an answer here. My name is Lori, I am 38 years old. In November 2003, I had RNY surgery. Over the course of the last 10 years I have not had any major complications or issues due to having this kind of surgery. Occasionally, I eat the wrong thing or too much of something high in sugar and or carbs and I feel kinda crappy for a half hour or so but that is usually the extent of it. This past Saturday I was on a trip with my kids and stopped for a coffee and a bagel along the way. I can’t eat a bagel like most non wls patients can, it takes me some time to finish the whole thing. Our trip was approximately 3 hours long. After we arrived at our destination (amusement park) I was waiting with a friend of mine for our kids to get off a ride when I started feeling lightheaded, shaky, etc. I told my friend that I felt funny and that this time it was different. I then collapsed and had a grand mal seizure. When I woke I was already in the ambulance on the way to the ER. At the ER routine things seemed to have been done, blood pressure, hooked up to IV but no EEG or scan of my brain. After a few hours I was discharged. Upon my return home I saw my primary care doctor who referred me to a neurologist. The neurologist did not seem to concerned that I had had a seizure and orderd an MRI and EEG to be done in approx. 3 weeks from now. I find this disturbing that the tests aren’t for 3 weeks! I am not diabetic and have never previously had a seizure but have seen a lot of info about people who have had gastric bypass surgery who have also had seizures. My thoughts are this was (or at least I’m hoping) due to reactive hypoglycemia and that it won’t happen again as long as I’m careful about what I am taking in! I had been taking Wellbutrin since 2012 but have since stopped when I found out that it can lower a persons seizure threshhold. I also have Hashimoto’s Thyroiditus and my TSH at ER came back with a value of 15.74 so my Levothyroxine dose was changed. Can I please have your thoughts on this? Thank you in advance for your time!

    Lori

  45. Hi dr seth,
    I have heard that seizures can cause hypoglycemia. Is that true? Or is it only hypoglycemia causing seizure?

  46. I recently experienced a seizure resulting from high stress, lack of sleep, and now diagnosed hypoglycemia. All brain scans were normal and I have no history of seizures. I have been making the appropriate life and diet changes to address the hypoglycemia as well as the reason causing stress and lack of sleep. My question is this: what are the % chance of a repeat seizure if I continue to make the changes I have described. My neurologist told me 1% after 6 months but I have read other articles on the internet stating 24% for up to two years. Thanks.

  47. My son will be 3 in october he is hypoglycemic and is on steroids predisoline and has alittle fever he is eating normal drinking normal jus cranky will a fever cause him to have a seizure?

  48. Dear Dr. Sethi,

    Appreciate your concern in heping people all around the world.

    My son (15yrs now) have been experience non conclusive status of epilepsy with occational recurrent seizures in his age of 4. Doctors had treated him with Clonazapam for three years and then tailed off. there was a one seizure while tail off then continued with Clonazapam for another 1 year and then tailed off.

    No signs of seizurs for for three continues years.

    Suddenly there were few serious seizuer attackes (In 2012 September) and we took him to neuroglosit. he has been treated with Encorate 400g BD + Frisium 5mg morning & 10mg night.

    Then he was complaining about a developing pain under his right chest & we did single line ECG & found all OK.

    Then he was fainted on last 5th for about 45mnts & he could not repond to us, even if his eyes were open. He was taken to hospital & found his RBS was 70. He recovered after Dextrox & RBS chart was maintained (2am in morning for five days). The count came down to 58 & then gradually increased 82, 86, 93 & 100.

    Now he is being suspected for hypoglycamie and retroperitional tumor.

    My question is that is there a posibillity to cause hypoglycamia for his seizurs in recent past. If then will there be any side efects of Clonozapam, Encorate & Fresiam in the long run.

    Your kind reply wold be greatly apprecaited.

    Niroshan.

    • Thank you for your question Mr. Niroshan. Medications like clonazepam, clobazam and valproic acid do have some side-effects in the long term (liver dysfunction, neurocognitive side-effects among others). The cause of your son’s seizures needs to be determined and whether he warrants long term anticonvulsant therapy can then be determined. You should remain in follow up with his doctor.

      Nitin K Sethi, MD

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