I am 27 with T1D. Are the sugar spikes causing my seizures?

Question

Hi doctor,

I am a 27-year-old male diagnosed with focal seizures five years ago, currently on Levetiracetam 1,000 mg twice daily. Along with this, I have type 1 diabetes, diagnosed at age 14, and I take 24 units of insulin glargine at night plus insulin aspart before meals.

Over the past month, I have had three seizure episodes, each lasting one to two minutes, followed by confusion and fatigue for several hours. Two of these episodes occurred when my blood sugar was low, once at 54 mg/dL and once at 62 mg/dL. My recent HbA1c was 8.2%, and fasting glucose averages around 160 mg/dL, though I experience hypoglycemia about twice a week. I have also noticed increased irritability and mild memory problems since my last medication dose adjustment three months ago.

My EEG last year showed focal epileptiform discharges in the left temporal region, and the brain MRI was unchanged from prior scans. My BP is 118/76 mmHg, and my BMI is 23.

I am concerned that my fluctuating blood sugars might be triggering seizures and that my current seizure control is inadequate. I would like to know if adjusting my diabetes management or seizure medication could help reduce these episodes and improve my overall stability.

Kindly advise.

Answer 1

Hi,

Welcome to icliniq.com

Your recent seizure episodes, especially those coinciding with low blood sugar, suggest that fluctuations in glucose levels may be contributing to breakthrough seizures in addition to your underlying epilepsy.

Hypoglycemia can lower the brain’s seizure threshold, while hyperglycemia and rapid glucose swings may also affect brain stability. Since your glycated hemoglobin (HbA1c) remains elevated at 8.2 percent and you experience hypoglycemia twice a week, fine-tuning your insulin regimen with the help of your endocrinologist to achieve steadier glucose control could reduce seizure risk.

This may involve:

Adjusting mealtime insulin doses.
Reviewing carbohydrate counting accuracy.
Considering continuous glucose monitoring to detect and prevent lows.

Regarding your epilepsy, the recurrence of focal seizures despite Levetiracetam at 1,000 mg twice daily and the presence of irritability and mild memory problems may indicate the need to reassess your antiseizure therapy.

Your neurologist might consider further dose adjustment, switching to or adding another medication with a more favorable side effect profile, or repeating electroencephalogram (EEG) monitoring to guide changes. Close coordination between your neurology team is important so that treatment adjustments address both seizure control and glucose stability, improving your overall safety and quality of life.

I hope this answers your query.