I don’t remember much about my initial interactions with him, but vaguely I had classified him into a group of young type 1 boys who were not difficult to manage. He was regular with his daily run, his diet was same from one day to the next and so was his carefree temperament. As a result despite my strong reservations for premixed insulin in type 1 diabetes, I let him continue that because his sugars were very well controlled, HbA1c of always less than 7% without ‘symptomatic’ hypoglycemia.
I did warn him that he was trading “convenience” with “the risk of hypoglycemia”. He was however, like most of the boys in 20s, very optimistic, a little too much, to believe in anything bad happening.
Insulin injections are of different types with different duration of actions. Since the food supply to our body is intermittent, the glucose released from food goes up and down. To maintain a normal glucose in blood despite varying delivery from gut, insulin has to match these ups and downs. Hence the need for different insulin time profiles. Premixed insulins are mixtures of short and long acting insulins in fixed proportions. Without explaining the science behind this, it would suffice here to mention that these mixes deliver more than required doses at about 2 am at night, causing low sugar while sleeping. These low sugars can come and go without the usual warning, making the brain more and more comfortable with this enemy.
So one night, his brain unaware of this enemy, fell prey to hypoglycemia and he was rushed to hospital in an unconscious state. Fortunately he recovered completely from it, but the enemy left a small shadow behind- a fear of hypoglycemia. The shadow feeding on his thoughts grew stronger each day, now turning into a monster taking control of his brain.
He is now unable to pursue his studies, take tutions for other students or go for runs or even walks. Even low normal glucose levels precipitate symptoms which he thinks are due to hypoglycemia, but they are panic attacks. Each episode makes him feel he is going to die. We have started negotiating with this enemy from which of course there is no escape, but atleast we need to get his control of his brain back. It is necessary to be aware of the enemy but not obsessed with it. His friends are helping him restart his previous routine, but I wonder if he ever returns to a completely carefree person that he was.

“ Some day we will all die snoopy!
True but on all other days we will not.”