Hypo-Glyceima ?

[Smokin Joe]

Guys I need some help here.

My future wife, has been suffering from the following symptoms.
Light headed if she skips a meal
Low blood sugar
Constant thrust
Constant urination

To her credit she has lost 30 lbs in the past 7 months on the weight watchers diet.

She is now 5-5, 137lbs.

She is 25 yrs old.

Diabetis does not run in here family

And today she went for Glucose tolerance test.

Our doctor is thinking hypo-glyceima (sp) or diabetis (sp).

I don't know jack about this sort of stuff so I'm a little nervous.
My guess is that seeing how her hole life she has always been a little over weight and does not excerise, that this drastic life change to a healthy life style has caused her body to freak out for a lack of a better term.

What do you gentlemen think it could be.

Thanks for any input.

Joe

[Smokin Joe]

23 views and no responses?:(

[NousDefionsDoc]

Joe,
Most of us are trauma medicine guys, not clinical guys. I was kind of waiting on DocT.

Is your missus exercising as well as dieting or just dieting?

Sounds to me like her doc is on the right track. To see the results of the test will be interesting.

[Surgicalcric]

Smokin Joe:

It is not that we are ignoring you. It is hard to diagnose endocrine problems via the internet and without lab work. I could tell you what has been my experience but would rather not lead you in the wrong direction with my speculation.

I am sure Doc T or Eagle5US will be around to help you out shortly.

Best of luck to your finacee.

[18C/GS 0602]

Smokin Joe:

Diabetes is a disorder of too much glucose in the blood (hyperglycemia). There are three different types. Type I is seen in young children typically before the age of 12. It is characterized by very little insulin production. Insulin helps move glucose away from the blood and into cells thus lowering the blood glucose level. Given her age and the fact that these symptoms are new this is unlikely. Type II diabetes is seen typically in older overweight people. Type II diabetes is a disorder of insulin resistance. Insulin is made but the cells don’t respond as well so not as much glucose leaves the blood, which results in hyperglycemia. The third type is gestational diabetes, which pregnant women get, but because you did not mention she was pregnant I will leave it out. Regardless of the type of diabetes one will have increased thirst and increased urination, and high blood glucose not low glucose.

She is very young to get type II diabetes, but it is seen in very overweight people sometimes. The glucose tolerance test is a test that is used to help diagnose diabetes. Her increase urination and thirst suggest diabetes but she if very young to get it, and she would have increased blood glucose.

In your post you mentioned that she had low blood glucose. I am assuming that she went into the ER or her doctor and they did a finger stick glucose test and it was low. Hypoglycemia (low blood glucose) can be caused by many things and given by the little you have told me I can’t really narrow it down. Like Surgicalcric said endocrine disorders are complicated and be difficult to diagnose especially without any lab data. I don’t have my medical license yet so take all I have said with a grain of salt.

[Sacamuelas]

Same here Joe. I had a strong hunch but since it was not a "scenario" we are working... I have tried to wait for you to post the test results before I posted. That would have given us more specific info to work with.
Since you are anxious for some help (rightly so since it’s a loved one), I will post anyway.

IMO, it sounds like typical type II diabetes giving her a hypoglycemic spell. The glucose tolerance test, fasting blood glucose and other lab tests can provide confirmation of that opinion.

Generally Type II diabetes is diagnosed based on lab work and signs/symptoms:
1. a fasting glucose level is above 126 milligrams per deciliter (mg/dl) on two occasions.
2. a random glucose level is above 200 milligrams per deciliter with the classic symptoms of increased thirst, urination, and fatigue.
3. a glucose level greater than 200, 2 hours after getting a standardized carbohydrate beverage (Glucose Tolerance Test).

I don't know how much you know about these type situations. So here is a very brief rundown of the two most likely events:
1-She could just be prone to hypoglycemia (low blood sugar levels) spells since beginning her weight loss and increased exercise regime. ( minor "other endocrine disorder")

2-she may have developed adult onset diabetes (type II is what it is called) from being slightly overweight as an adult. When you have diabetes, you usually get the classic symptoms of polyphagia (increased hunger), polyuria (lots of urinating), nocturia (pee at night), and polydipsia (lots of thirst). With this disorder, you are also prone to fluctuations in your blood sugar levels both high and low values. In classic type II, the insulin levels in your blood are usually either normal or actually even high b/c it is not a lack in production of Insulin (like in type I juvenile), but a lack of the effectiveness in the body of the insulin your body produces.

Good thing is if it is either of the above, a lot of times proper diet/exercise alone will control the disorder. Usually if that won't work, then a oral pill can be given to help control the blood sugar by increasing the effectiveness of the insulin you already produce. Shots of insulin are seldom needed for controlling type II diabetes so tell her not to worry about that. She is young . It shouldn't be a major problem for her. The main thing is early ID and prevention of complications that come about from not taking proper care of yourself if you have diabetes. Remember, this is only speculation. Until you get the lab work back, a definitive diagnosis can't really be made. Hope that helps.


Now, you listed lots of "thrust" in your post... that is something you should take up with her yourself without our help if that wasn't a typo for thirst! But that sounds like a GOOD symptom to have if it were my fiancée' LOL ;)

BTW- Post more info when you get it if you want. Good luck Joe..

[Smokin Joe]

Thanks for the help guys. I know you weren't ignoring me I'm just a little freaked out about this right now.

NDD,

The missus was excercising as apart of her weight loss program but stop about 2 months ago.

bdonham,

She did get a finger stick her blood sugar was 43 (first test) and 59 (second test) while fasting. I guess it is supposed to be around 70-100 while fasting?

When she gets the results I will post them.

Gentlemen, I really appericate the help thank you.

Joe

[Smokin Joe]

Originally posted by Sacamuelas

Now, you listed lots of "thrust" in your post... that is something you should take up with her yourself without our help if that wasn't a typo for thirst! But that sounds like a GOOD symptom to have if it were my fiancée' LOL ;)

BTW- Post more info when you get it if you want. Good luck Joe..

Oops, yes I meant thirst.

Forgot to add no she is not pregnant.

Again thanks for the help, I'm new to diabetes and this type of stuff so I'm grasping at straws right now until she gets to see her doctor (which is next week).


Joe

[Sacamuelas]

Joe- until her next appointment, she should eat a healthy/balanced and scheduled diet to help prevent large fluctuations in her blood glucose. She ought to eat a little something- healthy not just high in sugar- every four hours during the daytime. This will help keep her from bottoming out her sugar levels.


Please don't get caught up in hearing the worst case scenario, its just information and she MAY not even have diabetes...but FWIW:
The most common acute (emergency) for diabetics is a very low blood sugar level which can cause shock/coma. Don't worry, it is very rare in type II patients to get to this level, but you prevent this by always having a piece of candy or jelly with her. If she feels the hypoglycemic effects coming on, pop the sugar in her mouth. Better safe than sorry until you find out her real diagnosis... Good luck with her appointment.

[Smokin Joe]

Gentlemen,

I need to make a huge correction!

Diabetes does run in her mom's side of the family. I was mistaken.

Her Grandfather had type II diabetes.

[18C/GS 0602]

Smokin Joe-

The blood glucose levels you listed are pretty low, but not life treating. Just to piggy back on the good advice Sacamuelas gave you, I would say that you should watch her close and look for a few things. When someone’s blood glucose gets low it causes the “fight or flight� system in your body to become stimulated. This causes things such as sweating, nervousness, tremor, and increased heart rate. When the blood glucose goes down farther bizarre behavior and coma can eventually result. So if you or she notices any of these things going on you should give her something with sugar in it and go to the ER. I know it is difficult advice to take right now but I would not worry. Because of her age it is unlikely there is anything major is going on. Was she taking any drugs to help with the weight loss? There are many drugs and supplements available that could cause this hypoglycemia. If there is anything else I can do to help you are more than welcome to PM and I will do what I can.

Sacamuelas-

This just does not sound like DM to me. She seems way too young and her BMI is no where near what I would expect for a 25 y.o. type II. From what I understand the hypoglycemia seen in DM is typically seen in type I patients who take too much relative insulin, and only in type II patients that take too much of their oral hypoglycemia agent. It seems like the story just doesn’t well fit for DM. What do you think?

[Doc T]

As NDD said previously, lots of trauma people on here...not too many medicine ones... I specialize in trauma.

As for your fiancee... this is a mixture of my words and a site online...

People who are pre-diabetic have become so deficient at dealing with carbohydrates (starches and sugars) that they get recurrent incidents of hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar). They suffer fatigue, even after a long sleep, unexplainable hunger and thirst, weakness, tremor, nausea, headaches, giddiness, irritability or anxiety. They risk overt diabetes every day.

By careless nutrition and lifestyle habits, or simply lack of knowledge they are “training� themselves to become diabetic. The mechanisms that maintain their blood sugar at a stable level are being abused to the brink of disorder. They cannot go more than a few hours or so without feeling the need for a pick-me-up snack. Only about 5% of diabetes results from genetic defects, and viral infections. Over 90% of cases do it all to themselves with diet and such!


the best thing she can do is continue a balanced diet that avoids simple carbs... many nutritionalists will recommend a modified atkins kind of diet for patients who suffer from this type of hypoglycemia.

By all means, continue to have her worked up by a physician locally because there are many many causes of hypoglycemia including medications....

hope this helped.

doc t.

[NousDefionsDoc]

Now, if she shoots you in the ass with her BB gun, call me.:D

[Doc T]

should we start a new thread?:D

[Eagle5US]

Sorry for the delay SJ, stuff like this we should all be right on top of...
not to really attempt a diagnosis, but to give you some confidence in the care your bride to be is receiving.
Endocrine disorders are incredibly difficult to diagnose in person let alone over the internet...
but I will say that she has done a wonderful job by losing her weight and beginning an excercise program. 5'5" and 135 is about as close to ideal as any woman may want to be. The "runway waife" that is popularized by many magazines is an overstatement of the minority.
I absolutely agree with what has already been said int that she should continue to eat 4-5 small balanced meals each day. This will help to minimize great highs and lows in her blood sugar levels.
She may also consider keeping a diary of her activities and a running menu of everything she eats and drinks for her next doctor visit.
Another thing to consider...any possibility she is pregnant? (feel free not to answer that publicly, but something to think about)
Her physician is going to be your number 1 resource for information and Q&A. She has the right to ask questions on her condition and care.
Please keep us up to date on her progress...and have confidence in those who are taking care of her. YOUR confidence and support will boost her outlook...regardless of what the final diagnosis is.
My apologies for not answering up sooner...much happenings right now.

Eagle

[Sacamuelas]

Reading Eagle's post made me think my original post might have been misinterpreted or just explained poorly by me.

What I meant in that post about being slightly overweight was referring to the timeframe before her recent 30+ lb weight loss. 5'5" and 135 works for me. :D I didn't want you to think I was criticizing your squeeze Joe.

Does that help clarify what you were asking about as well Bdonham?

The 5'5" and 175+ consistently for several years as a teenager/young adult is more in line with a typical type II/pre type II profile. As far as age, it seems to be a trend that the onset age is getting lower.... that age part is speculation based on my experience-not scientificly proven fact FWIW.

As to hypoglycemia in nonmedicated Type II's, it can and does happen. This is especially true in someone who is exercising, drinking caffeine products, and skipping a meal or two time. I agree though that it is more common in your listed examples.

Again, I wish her the best Joe.

[DoctorDoom]

x

[Smokin Joe]

Thank you all very much.

Your advise has helped put alot of myth and speculation on our part to rest.

She got to see her doctor ealier than expected. He basically said that seeing how she has lost so much weight in 8 to 9 months and that this was not an issue until she lost her weight that he would keep an eye on it but that is should really scare her b/c its just her body adjusting to the weight lose while trying to maintain so sort of routine and stability. Or something to that effect.

Unfortunatley I wasn't there I got a ragging case of the flu and my head still isn't totally straight.

I will post more when I'm more coherent.

Thanks again for everything guys you seriously put a big calm on my nerves

[Smokin Joe]

NDD,

I she shoots me in that ass with a bb gun you will be the first person I call and Roguish Lawyer with be the second person I call.:D

[Smokin Joe]

Okay guys here are the results that I got (from the missus).

Gulcos tolerance test.
she had to fast.
It took about 3 hours.

70 when she walked in the door
drank glucose
she spike at 135
then hit 120
then dropped to 70
then dropped again 55 (which was the last reading) she said when she was at 55 she thought she was going to pass out.

Eagle she is not pregnant, well if she is she hasn't told me yet.

Sacamuelas,

She is not taking any diet pill she lost all of her wait on the weight watchers diet/plan.

[18C/GS 0602]

The American Diabetic Association criteria for diagnosing diabetes include three different ways to make the diagnosis

1. symptoms of diabetes (increased urination, increased thirst, and unexplained weight loss) and a random glucose over 200 mg/dl
2. a fasting glucose (no food intake for over 8 hours) over 126mg/dl
3. a 2-hour glucose above 200 mg/dl during a oral glucose tolerance test (OGTT) using a 75 gm oral glucose load.

Your wife does have symptoms that are seen in diabetes but does not have a random (no relation to meals) glucose test that is above 200 so she does not meet criteria 1. Before OGTT you have to fast, and from your post her glucose value when she walked in the door was 70 which is below the 126mg/dl limit so she does not meet criteria 2. None of the values that you listed after she got the oral glucose load was above 200mg/dl cut off that is listed in criteria 3 so she does not meet that criteria either. So by the ADA guidelines she does not have diabetes.

Common factors that non-specifically deteriorate the OGTT include (1) carbohydrate restriction (150 g for 3 days), (2) bed rest (days) or severe inactivity (weeks), (3) medical or surgical stress, (4) drugs (5) smoking during the test, or (6) anxiety from repeated needlesticks. If any of these factors apply the OGTT she took may not be accurate.

In addition to diagnosing frank diabetes the OGTT can also diagnose something called impaired glucose tolerance which is defined as a fasting glucose less than 126 mg/dL and a 2-hour OGTT level between 140 and 200 mg/dL. Although your wife does not meet these criteria, her high value of 135 does come close to the cut off of 140. Impaired glucose tolerance (IGT) is thought of as a precursor to frank diabetes, but we can not reliably predict which people with IGT will go on to develop diabetes. The treatment for IGT is a good well balanced diet, exercise, and continued surveillance for any signs that things are progressing towards diabetes. Given what you have already said she is already doing these things, so she is ahead of the game so to speak when it comes to preventing diabetes.

Normal blood glucose ranges from 70 to 100 and her last value of 55 is considered hypoglycemic. I don’t really understand why it keeps dropping so I will do some reading and maybe one of the other health professional can enlighten us.

[Smokin Joe]

Thanks bdonham

[18C/GS 0602]

When her glucose was 55 during the OGTT and she felt like she was going to pass out did anyone give her glucose and if they did, did it relieve her symptoms? When she had the other low readings 40 and 55 did her symptoms get better when she was given some glucose?

[Smokin Joe]

She has never recieved any glucose.

When she was at 43 when she first went in for a needle stick, it was a bad read they didn't cover the slide (or whatever you call it) with enough blood.

When she bottomed out at a 55 she said she felt like she was going to pass out she barely made it to her car where she at a fruit granola bar. Then went home and had lunch.

[Smokin Joe]

My personal feeling is that all of the tests that she has gone through have had half-ass'd supervision. Meaning they haven't watched here closely nor did they ask her how she felt when she was at a 55. It pissed me off when she told me she thought she was going to pass out just walking to her car to get her fruit garnola bar. I mean damn she's in a hospital you would think they would ask her how she felt when they saw her glucose level at 55 but they just sent her on her way.

[18C/GS 0602]

Smokin Joe-

Sorry to hear about your bad experience with the hospital. Unfortunately some hospitals are better run than others and you might be well advised to look for a different hospital.

I did some reading a maybe some of this will help. To meet a medical definition of hypoglycemia you must meet 3 criteria. First you must have a symptoms of low blood glucose. Second you must have a low blood glucose reading before any administration of glucose (anything with sugar in it), and third the symptoms of low blood glucose must go away when glucose/sugar are administered. It sounds like your wife might actually meet these criteria if when she had this most recent episode of low blood glucose.

If this is the case there are many different causes of diabetes that your doctor should rule out.

One thing I did find in my reading that does seem to fit the picture is something called postprandial reactive hypoglycemia. This is hypoglycemia that occurs after meals. Essentially what happens is that after a meal your blood glucose levels go up and your body overreacts and releases too much insulin which causes the glucose level to go down below normal. This can be seen in people that have recently lost weight which causes them to become more sensitive to insulin. The treatment for this is a good diet and time to allow your body to adjust. This is only my interpretation of what you have told me and you definitely should talk to and follow your doctor’s advice.

Here is an abstract of a relevant article.


Authors
Brun JF. Fedou C. Mercier J.
Title
Postprandial reactive hypoglycemia. [Review] [148 refs]
Source
Diabetes & Metabolism. 26(5):337-51, 2000 Nov.
Abstract
Postprandial reactive hypoglycemia (PRH) can be diagnosed if sympathetic and neuroglucopenic symptoms develop concurrently with low blood sugar (<3.3 mmol). Neither the oral glucose tolerance test (OGTT) nor mixed meals are suitable for this diagnosis, due to respectively false positive and false negative results. They should be replaced by ambulatory glycemic control or, as recently proposed, an hyperglucidic breakfast test. PRH patients often suffer from an associated adrenergic hormone postprandial syndrome, with potential pathologic consequences such as cardiac arrhythmia. PRH could result from (a) an exaggerated insulin response, either related to insulin resistance or to increased glucagon-like-peptide 1; (b) renal glycosuria; (c) defects in glucagon response; (d) high insulin sensitivity, probably the most frequent cause (50-70%) , which is not adequately compensated by hypoinsulinemia and thus cannot be measured by indices of insulin sensitivity such as the homeostatic model assessment. Such situations are frequent in very lean people, or after massive weight reduction , or in women with moderate lower body overweight. PRH is influenced by patient's alimentary habits (high carbohydrate-low fat diet, alcohol intake). Thus, diet remains the main treatment , although alpha-glucosidase inhibitors and some other drugs may be helpful. [References: 148]

[Smokin Joe]

Thanks bdonham, I will pass this on to her and have her pass it on to her DR.

Thanks again for the help.