Two Aint Beas and Two Opies - blood sugar related?

[bluemax]

So I was about 30 miles into a 45 mile easy ride today and started noticing double images of things on the horizon. When I looked closely, it was even evident with things like a single rock on the pavement. A rock would appear as two rocks 8" apart when "they" came into view and merge into one as I got close. I'm taking insulin and had been eating at regular intervals but BS could have been on the low side. I did some chores outside when I got home. Came in, plunked down in front of the tube watching Andy Griffith and was still seeing double. Two Gomers was cause for concern. BS was 56 at that point. I've had lots lower numbers without noticing double vision. Am wondering if the double vision was likely due to low BS or whether there's something else going on.

[ultraman6970]

Water?

[mtb_frk]

I'm diabetic and have been much lower than 56 without double vision, but a former co-worker, also diabetic, had a bad low one day and couldn't read the sign behind the counter at Wendy's. Seems like he had a similar experience. When your blood sugar gets low, your body does strange things. Sometimes my mouth/tounge will go numb when I get low, other times it doesn't.

[Wolfman]

I wouldn't be surprised if your double vision were related to low blood sugar. Patients with insulinomas (insulin-secreting tumors) have been known to have diplopia and a lot of the "neuroglycopenic" (not enough glucose for the central nervous system) symptoms (irritability, confusion, headache, difficulty speaking) are said to occur at around a blood sugar of 50.

It goes without saying that this is not medical advice, but if it were me and it resolved and I felt well, I'd stay the course but make sure to monitor myself closely and make an appointment soon. If it's happened again without exertion, or happens again even when I was all topped up, I need to make an urgent appointment.

[NateM]

Double vision is common for diabetics with low blood sugar.Its one of the signals your body is giving you before something really nasty happens. Be careful with your exercise and insulin as your blood sugar can drop really fast.Being on a bike with double vision can be a bit dangerous. I've been an insulin dependent Type 1 Diabetic for 35 yrs.Any questions pm me.Nate Merrill

[malcolm]

True double vision as in seeing two images is a complicated from a medical perspective. Not many things produce actual double vision, disconjugate gaze is one. Most times when people describe double vision they are actually describing blurry vision that can seem like two images one usually smudged or distorted.

I suspect in your case it was not true double vision but possibly sugar related.
Did it clear once you rested and replenished your blood glucose?
Diabetics are more prone to ocular motor nerve palsies and that will produce disconjugate gaze and double vision but doesn't clear with correction of sugar.
If it's better I wouldn't worry about it unless it's recurrent if it didn't clear you need medical attention sooner rather than later.
Good luck

[DfCas]

I've had weird vision/grey outs with low blood sugar. Type 1/insulin dependent 35 years. I'm old now, 62.5.

[bluemax]

The double images didn't seem blurry at all. I saw two of everything I focussed on, but clearly. Seems that it was BS related, but I didn't have any of the other usual symptoms: fatigue, sweating, mouth numbness, shakiness. I did find myself wandering toward and into the left lane if I didn't pay close attention, as if the bike was being pulled that direction. At any rate, not much I could do but ride on as I was out of food.

[malcolm]

Originally Posted by bluemax

The double images didn't seem blurry at all. I saw two of everything I focussed on, but clearly. Seems that it was BS related, but I didn't have any of the other usual symptoms: fatigue, sweating, mouth numbness, shakiness. I did find myself wandering toward and into the left lane if I didn't pay close attention, as if the bike was being pulled that direction. At any rate, not much I could do but ride on as I was out of food.

Just a suggestion but that have glucose past that is available and comes in a fairly small size. I would imagine most pharmacies have it or could get it. Not sure of the shelf life but it might be worth carrying. It's much more effective and predictable than candy etc.
Low blood sugar can be problematic as I'm sure you know, particularly while exerting ones self. Serious injury or worse is not an infrequent outcome. Hypoglycemic seizure would not be good while riding a bike.

[DfCas]

You really need to carry enough stuff that running out of food is impossible, and always carry some money so you can buy food if your stash gets low. I use an insulin pump so I can shut off insulin if I'm havibg a low day.

If you are on injections of long acting, you are stuck with what you took and it may be hard to elevate your BS.

[malcolm]

Originally Posted by DfCas

You really need to carry enough stuff that running out of food is impossible, and always carry some money so you can buy food if your stash gets low. I use an insulin pump so I can shut off insulin if I'm havibg a low day.

If you are on injections of long acting, you are stuck with what you took and it may be hard to elevate your BS.

This is a great point. Not to beat a dead horse but we tend to take diabetes for granted. Low blood sugar can be a life threatening problem exponentially magnified with the longer acting insulins and oral agents which also have very long half lives.

[numbskull]

Originally Posted by bluemax

I did find myself wandering toward and into the left lane if I didn't pay close attention, as if the bike was being pulled that direction.

This bothers me.

Although double vision is disorienting and may well have caused you to mis-steer, the sensation of falling or moving to one side usually suggests either vestibular/inner ear dysfunction (which may have visual effects but not typically stable diplopia) or cerebellar dysfunction which is usually the result of posterior circulation ischemia (lack of blood flow to the back of the brain).

Likewise your observation that the pattern of symptoms did not fit your typical hypoglycemic attacks is also important. If low BS was the issue it should have.

As Malcom points out, diabetics can have isolated cranial nerve palsies that might cause diplopia, but this usually happens in poorly controlled diabetics (as far as I am aware) and is typically related to high sugars over time causing nerve swelling.

Given your story I think you would be prudent to request an MRA (or CTA) of your posterior cerebral circulation and an appointment with a decent neurologist. While waiting for this you might do well to put yourself on an aspirin a day.

There is another possibility. The circulation to the back of the brain is partially supplied by the two vertebral arteries that run up the back of the spine. They can be kinked by neck extension (such as we all do while cycling) particularly as people get older and arthritis sets in. Such an event might conceivably cause cerebellar dysfunction (i.e., imbalance/gait deviation) and brainstem dysfunction (i.e., diplopia) although I can't say I've ever seen it.

[Wolfman]

Interesting... definitely put "cerebellar ischemia 2/2 posterior cervical artery structural compression" on the differential, but given that the OP still had symptoms at home sitting on the couch and after standing upright doing yard work, it's a long shot. It does fit with the balance disturbance and the different presentation, though.