November 27, 2003
Hypoglycemia
Question from Tennessee, USA:
On October 1st, my 13 year old son experienced an episode of paralysis. From start to finish, it lasted about 4 hours. He got weak in his legs and progressed to complete paralysis within a short period of time. He regained his upper body strength first. The same thing happened again on October 2nd. He has had periods of weakness and/or paralysis all through October, and this month as well (as of Nov. 10). The weakness may last several hours, but the actual paralysis is usually not over 5 or 10 minutes, but sometimes an hour.
He has bee in the hospital, and is being tested for many things. Since October 1st, he has been diagnosed as hypothyroid, insulin resistant, and hyperinsulinemic. He has been on Synthroid since Oct. 3rd, 100 mcg. He will probably be tested for Periodic Paralysis soon, if he continues to have these episodes.
Looking back, we realize he was experiencing these weak spells for about 2 months, and periods of weakness. At first, we just attributed it to adolescent growth spurts and “being 13”, in general (not wanting to do chores and schoolwork).
Now, finally, my question: Could this scenario possibly indicate hypoglycemia? Could being hyperinsulinemic cause hypoglycemia? Is it common for people with hypoglycemia to become paralyzed? If so, is he in grave danger? We are being told not to panic or bring him to the hospital unless he has breathing difficulties and/or unusual heart beat. We are basically being left to our own devices, despite having the “advice” of a neurologist and 2 endocrinologists. I’ve made an appointment with our family doctor for this week, hoping she can fill in the blanks and gaps the specialist are leaving.
He does have slurred speech (due to relaxed facial muscles), emotional outbursts, etc. Episodes seem less likely to happen following meals or snacks that do not include carbohydrates, especially early in the day.
Answer:
Whilst it is certainly true that hypoglycemia can induce transient paralysis, it seems unlikely that this is a simple explanation of your son’s problems because, amongst other factors, he was evidently not shown to be hypoglycemic and, whilst he is hyperinsulinemic, he is also apparently insulin resistant. This very unusual mixture of periodic paralysis, insulin resistance and hyperinsulinemia seems to be a property of a group of syndomes sometimes called ‘channelopathies’ because they are disorders of the channels by which potassium and calcium enter and leave the cell and which also control the entry of glucose into the cell. (See Idiopathic hypokalemic periodic paralysis presenting peculiar insulin secretion.) They are extremely rare and on that account poorly understood in molecular terms and they are likely therefore to be very variable clinically. In the meantime though there are approaches to treatment I hope that this my give you some idea of what the problem might be.
DOB