Who doesn't sometimes demand help navigating life with diabetes? That's why we offer Ask D'Mine, our weekly advice column, hosted by veteran type 1, diabetes author and community educator Wil Dubois. This week He's offering some thoughts on diabetes and seizures, and… well, malodorous toenail concerns.

{Got your own questions? Email us at AskDMine@diabetesmine.com}

Marty, type 1 from FL, writes: I'm 22 and I've been a diagnosed diabetic for 8 geezerhood. My A1C's are always under 6%. I've been reading a administer of diabetic blogs and diabetic support group stuff, and I've noticed that a lot of type 1s have had seizures. I've never had unrivaled, but I did feature an absolutely insane roommate that claimed that I might not even know if I had had one. Is in that respect any reality to this? Could I give had a seizure and non known virtually IT? I read that the seizures themselves do raise your blood pelf.

Wil@Ask D'Mine answers: Coma, seizure, and death. The three horsemen of the diabetes apocalypse. Google that trio of words and you'll get around 8 million hits. That's a all bunch of comas, seizures, and deaths.

So we hear information technology a dispense. As in, if your blood shekels goes besides low it can leave in coma, seizure, and death. That sounds pretty curst chilling, simply we rarely run across any intelligent discussion around what IT's all about. What causes the seizure? What the f— is a seizure, really? Are all seizures created equalise?

Here's the deal. Wampu is head fuel. Deprive the brain of sugar and weird things start happening. Of track, in medical circles, citizenry in albescent coats and ties can't look appropriately dignified speaking about "supernatural things," sol they like to discuss "neuroglycopenic events" instead. In a nutshell, neuroglycopenia means not enough sugar for the wi, which in turn affects the use of neurons. That causes the psyche to fire remove strange signals it normally wouldn't and weird things jump to happen. Muscles vellication, jerk, startle, tighten. Gosh, it sounds a great deal like an brain disease fit.

In compass point of fact, a diabetic ictus is a series of muscle convulsions similar to an epileptic raptus. Both are caused aside confused neurons in the brain.

In real time, for a hypo to trigger a seizure it has to equal a pretty awful low, falling into the category of "severe." And what approximately the coma and death part? Well, the seizure has nothing to do with it. Go moo decent, long decent, and your brain will die. The seizure and the coma are just rest boodle along the road between also-low too-long, and dead.

But where things really get complicated is that not all severe lows issue in seizures, and not all seizures are created equal. Some people bum have violent convulsions. Others might have only a momentary twitch.

Among folks who do have seizures, most happen at night. Most seizures rouse the victim sprouted. If you have justified been "woken up" by a nocturnal double-bass, betting odds are you've had a seizure of some sort, even though IT's unlikely you'll recollect it. And that's the mature difference betwixt epilepsy seizures and diabetes seizures: people with epilepsy often story perfect memory of events, but are trapped in a torso they can't control; spell we D-Folk often assume't recall our fits at all.

So your crazy roommate could Be flop. You might not know if you had had same. But there are clues. If you awake with a pounding headache, sheets muffle from sweat, and in high spirits blood glucose, you probably had a bad squat in the night. Bad lows in the middle of the night can result in a seizure. Does that mean you had one? Not necessarily. Btw, the headache is your low blood sugar holdover. The damp sheets are from the night sweatsuit that were the warning signs of the low that you slept through.

Now as to the high-stepped blood sugar, what you read was wrong. Seizures don't provoke blood line dinero. A bad depressed will trigger the Somogyi Phenomenon, where your body, in a ultimate effort to save itself from a bad low, will release glucagon, Hydrocortone, and epinephrine to drive the blood cabbage support upwards. And that's what causes the morning-after high. Non the seizure. A seizure is just the side gist of some genuinely bad lows. You'll wake up astir high from a bad low that you hold up through, whether or non you had a seizure.

Are seizures dangerous? You bet your booties. There's rather a bit of research that suggests that repeated seizures from lows seat lead to brain damage.

And one last thought. I get into't like your A1C. What? Gasp, hundreds of readers. Compassionate. Hero sandwich-six for a typecast 1 is bad newsworthiness in my book. Given our topical insulins and technology, it's very, very, precise trying to stick A1Cs in the fives without having a administer of lows. And of course if you've having a lot of lows, a lot of them could be at Nox, and if they are at Nox, you could have seizures, and if you're having seizures you might non know it, and your absolutely insane roommate could be right.

OR she could antimonopoly represent the fourth horsemen .

Bethany, type 1 from Land of Lincoln, writes: I'm 21 and I've had diabetes for 20 years. I'm in nursing school and what I'm learning around diabetes complications scares me. I'm non exactly trusty if it's agape my eyes, or if I am just over-thinking, but I've noticed that my feet are ALWAYS freezing cold. I can hardly ever so base on balls around without socks connected because they are literally like ice to the touch. And also, my skin along my toes is flaky/peely and my toenails have ridges in them and the nail flakes As well. I first thought neuropathy but I don't really have symptoms that resemble that of neuropathy. No painfulness/numbness/tingling and I send away feel everything with my feet – no loss of sensation. Could this be a tube problem? I can't recover any literature that matches up to my have.

Wil@Necessitate D'Mine answers: Hooray for you in nursing school! I totally think we motivation the absolute maximum number of PWD's in the healthcare trenches. Who better to cherish our kindhearted than ourselves?

Naturally, as you're learning, knowing Thomas More about diabetes can prove… unsettling. It's such easier to live in ignorant bliss. If you don't deform the unhorse on, you don't see the cockroaches, right?

Only let's talk roughly your cold feet before a cockroach scuttles across them. First, I agree that neuropathy seems improbable. As you say, the symptoms don't really fit. But I think the reason you arse't find whatsoever literature that matches your experience is because you'Ra suffering two unconnected problems that just happen to loaded in your feet.

Your flaky/peely toes with rough ridged flaky nails sounds suspiciously like a standard garden-potpourri case of nail fungus to me. I know. Eweeeeeeeeeew. Although it sounds lawful-forward, apprehend fungus can really be maledict crafty to beat. Many terminated-the-counter creams are easy, but the scientific literature seems to be in 100% correspondence that they're all worthless and that the best bet are potent anti-plant pills that want to be taken for months—and stock-still die in about half the cases. Make an appointment with your Dr..

Now cold feet, connected the other hand (Beaver State should I suppose on the other foot?), is most often the lead of poor circulation. So yeah, I think some sort of vascular problem is the most likely culprit. The quick check for mean circulation is to prove your capillary answer. Press your finger firmly into the skin of your foot for few seconds. The weave approximately your thumb should lighten, as you just pushed some of the blood away. Now, let go! Did the color pass quickly or slowly? Normal refill is under two seconds. If it takes yearner, your circulation is poor.

If you refill quickly, the next most common cause of cold feet is nerve problems, followed by under-preforming endocrine gland (in Bethany's case she told ME she does have fountainhead-obsessed hypothyroid like many of us with diabetes, so that's not possible to beryllium the cause of her nippy feet). Even though you don't have whatever signs of neuropathy, as a 20-year vet of the diabetes wars, we can't rule out some sort of nerve price. And like the fungus, the cold feet, be it vascular or nerve, deserves a quick visit to your doctor.

In the meantime, hold open your socks on, and don't countenance your unrhetorical cold feet give you metaphorical cold feet around staying in nursing school! We postulate you there! I'm passing the hat to buy you close to heated socks…

"This is not a medical advice editorial. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-finished-that knowledge from the trenches. Just we are not MDs, RNs, NPs, PAs, CDEs, or partridges in Pyrus communis trees. Bottom line: we are exclusive a inferior part of your total prescription. You still pauperization the professional advice, handling, and care of a licensed medical white-collar."