| HYPOGLYCEMIA (Low Blood Sugar)
Definitions
Hypoglycemia literally means low blood sugar (glucose). There are two
types: fasting and reactive (postprandial) hypoglycemia. The former
refers to the development of low blood glucose concentrations during
periods of food deprivation, while the latter occurs 2 - 4 hours after
eating (postprandially). The normal range for blood sugar is 60 - 100
mg./dl. Levels below 60 mg./dl. are considered to be in the
hypoglycemic range.
Signs & Symptoms
When the blood sugar falls, the body's glands react by secreting a
number of hormones, especially adrenalin. The symptoms result as much
or more from this surge of adrenalin and other hormones as they do from
the lack of glucose. They include nervousness, sweating, blurred
vision, irritability, fatigue, hunger, palpitations, and numbness.
Because the brain is acutely sensitive to low blood sugar levels,
confusion, seizures, blackouts, and even coma may occur. While minor
symptoms are rapidly relieved (within 5 - 20 minutes) by eating, severe
cases may require hospitalization.
Fasting Hypoglycemia
Accidental or intentional overdose of insulin or blood sugar-lowering
pills by diabetics and other individuals is the most common cause of
fasting hypoglycemia in adults. All the other causes are rare. Among
them are insulin-producing tumors, severe liver disease, Reye's
syndrome, kidney disease, alcohol ingestion, pituitary and adrenal
gland underactivity, cancers, medications, extreme malnutrition, and
inherited enzyme deficiencies.
Insulinoma deserves special mention. This tumor of the pancreas
secretes excessive amounts of insulin even though there may be a
dangerous effect on blood glucose levels. The diagnosis can be a
tricky one to make, and the condition can be difficult to differentiate
from surreptitious insulin injection. Special blood tests and dye X-
rays of the pancreatic arteries are necessary to confirm the presence
and location of this rare tumor.
Reactive Hypoglycemia
Reactive hypoglycemia is due to an oversecretion of insulin from the
pancreas in reaction to meals. Although it is known to develop in
persons who have had previous stomach or intestinal surgery, in
children with certain enzyme deficiencies (galactosemia, fructose
intolerance), and perhaps in individuals in the early stages of
diabetes, this condition is rare in otherwise healthy adults. In fact,
many hormonal disease experts question whether reactive hypoglycemia
even exists outside of the above- mentioned situations. Claims in
popular media that hypoglycemia is exceedingly common and often
responsible for such health complaints as headaches, fatigue,
nervousness, personality changes, depression, and an inabiltity to
concentrate are simply unfounded. High protein, low carbohydrate, low
fat diets - to decrease insulin secretion - are often prescribed for
persons with these complaints when the diagnosis is unjustified.
Part of the problem seems to be the reliance upon the glucose tolerance
test (GTT) as a method of diagnosis. In this test blood sugar levels
are determined at set time intervals following the ingestion of a
standard amount of liquid glucose. While falls in the blood sugar as
low to as 45 mg/dl. are not uncommon, they are seen in healthy persons
about as often as those people who have meal-related symptoms.
Furthermore, a drop in blood sugar on the GTT is not enough: the
symptoms must occur concomitantly with the low sugar levels.
Frequently, there is no correlation. Tests using standardized meals
instead of glucose, and measuring hormone as well as sugar levels, are
more reliable.
Treatment
When a hypoglycemic attack does comes on, the treatment is eating or
intravenous glucose administration. Ideally, the diagnosis should be
confirmed and the underlying cause treated specifically, e.g. removing
the insulinoma, stopping the implicated medication, treating adrenal
insufficiency, etc. When true reactive hypoglycemia is unrelated to
previous intestinal surgery or incipient diabetes, small, frequent low-
carbohydrate meals may be of benefit. Other touted therapies are
unproven.
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| The diet you're on should be something that will keep your blood sugar
level the most constant as possible, at all times.
What this means is several small meals, instead of 3 large ones. A
friend of mine who's hypoglycemic eats 5 smaller meals/day, and NEVER
EVER goes more than 2 hrs without eating. In the evening, a protein
snack is helpful right before bed as protein takes longer to digest, so
you will be constantly dumping some amount of sugar into your body all
night.
Chromium is supposed to be very helpful in stabalizing insulin levels
in non-diabetics, and CAN be helpful in diabetics. (not your problem, I
know), and a major deficiency of chromium can also be a cause of
diabetes, so I would NOT ignore the link between chromium and insulin.
Avoid sugars whenever possible.
And you should see an internist, hopefully one with some speciality in
hypoglycemia. They should in turn send you to a nutrionist/dietician
who can help you work up a diet that's acceptable to you AND meets your
medical needs.
A lot of people still don't believe that hypoglycemia is real. Your
first battle will be in finding someone who does.
good luck!
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| Re weight: It makes sense to me that being overweight would make this problem
worse. It also works the other way: hypoglycemia tends to make you gain weight
because you need to eat more often and that often translates into more calories
per day.
Hypoglycemia is usually not curable, but it is manageable, and the principal
means of management is diet, as several replies have said.
There is no medical specialty specific to hypoglycemia, as far as I know.
Finding a doctor who has expertise in it is mainly a matter of trial and error
and networking.
Re dieticians: You will probably encounter the same problem you have with
doctors, that is, some dieticians don't know beans about hypoglycemia and
what would do is mainly act on the doctor's instructions on timing of meals
and avoiding sugar. Many people would do just as well by acting on the
doctors instructions directly without consulting a dietician.
I second the statement about the difficulty of avoiding sugar. I have hypo-
glycemia and avoiding sugar has been a major challenge. For starters, you can
rule about 80% of the cereals on the market. It gets boring limiting yourself
to a few brands, but that is what you need to do.
For me, one of the biggest problems is attending conferences, whether work-
related or not. They ASSUME that everyone can go for 5 hours without eating
meal food. And in my experience, eating a sugary snack when I am starving
often is worse than nothing. I have formed the habit of carrying food with
me whenever I travel.
Another issue is getting thru the afternoon at work. At most Digital
plants, the caf closes at 3:00 and all you can get afterwards is sugar-
and salt-laden snacks from vending machines. Very few people who have
hypoglycemia and work past 4:30 can handle this situation. I carry a bag lunch
with me and eat it around 4:00.
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