October 15, 2003
Diagnosis and Symptoms
Question from an RN in Newfield, New York, USA:
I am a 42 year old white female (5 feet 6 inches; 157 pounds, who has been on Effexor XR for four years and occasionally Neurotin for sleep (for approximately eight months), and for the last two months, I noticed that I’d get incredibly hungry before lunch, and sweaty, foggy, and sometimes shaky. I would dash back to the break room and grab something to hold me until lunch. I started to check my blood sugar with our glucose meter, and it would read 54-72 mg/dl [3-4 mmol/L]. So I bought an inexpensive meter and started checking my blood sugars.
One morning I couldn’t seem to wake up so I asked one of my kids to get the meter, and was 55 mg/dl [3.1 mmol/L]. After a breakfast of eggs, I climbed to 105 mg/dl [5.8 mmol/L], and it took about an hour and a half to “recover”. These episodes have been increasing.
I have had repeated infections in the last year and a half (yeast, canker sores, bladder/kidney infections, and cellulitis). The cellulitis required a change in antibiotics as the infection went away and flared up after four days of therapy. Right now, I caught what the rest of the family had (a cold/sinus thing) which went to my eyes. I’ve been running a low-grade fever, but my readings have been normal!
My family doctor referred me to an endocrinologist, and I have an appointment in about two weeks which I am going to keep. I just want to know what is going on (stress, hyperinsulinism, whatever). What does your panel of experts think?
Answer:
I am sorry you are having all the problems. Hypoglycemia caused by the inappropriate secretion of insulin is not a common diagnosis. It is thought a lot about, but very few cases turn out to be insulinoma (a tumor that continuously produces insulin). There is a form of hypoglycemia, called reactive hypoglycemia, that occurs following the ingestion of a meal. It has been related to an inappropriate low braking of the post-meal insulin response. This is usually managed by small frequent feedings, although not always in a manner that makes the person symptom-free. Insulin resistance has been associated with reactive hypoglycemia, but it is not a tight association.
The sugars you describe are normal. Even the values in the 50s mg/dl [3.8 mmol/L] may not be abnormal for some people, although the symptoms with the lows suggest there is some connection. I would keep your appointment with the endocrinologist but know that they may use these conservative treatments initially.
JTL
