January 1, 2001
Hypoglycemia
Question from Longwood, Florida, USA:
I am a 37 year old female who has not been diagnosed with diabetes or hypoglycemia. I have had seizures since I was 14 years old without any determined cause through testing by EEG’s, MRI’s or CT Scan’s. I had one five-hour glucose tolerance test (GTT) when I was about 15 that was normal, but I was asymptomatic at the time. In the last 23 years, I have had approximately six grand mal seizures, and I have taken a variety of anti-convulsants.
I have always wondered if there is a different underlying cause to explain these seizures. Over the past year, I have been experiencing dizzy spells, fatigue, shakiness, headaches, a fuzzy-headed feeling and have had problems with a poor memory. My doctor suggested that I may am experiencing bouts of hypoglycemia and wanted me to start paying closer attention to my diet. I will admit that I was doing a poor job with my diet prior to this, eating primarily carbohydrates. I eat meat occasionally preferring to substitute nuts, beans, cheese, yogurt and other dairy products, but crave carbohydrates. I was inadvertently eating my first meal around noon-2 pm, causing bouts of dizziness and cravings. Since I began better balancing my dietary intake, the severity of my dizzy spells have decreased, but I am continuing to have them. These can occur whether I am driving or laying still on the couch.
There is a history of diabetes in my family. Other than the one GTT, I have never done glucose testing during any of these symptoms. I am scheduled to see a neurologist in two months and am wondering if I should approach the idea of hypoglycemia. In the past, any mention of dietary intervention was met with skepticism, and I was told it was an overly diagnosed problem. I would like to stop taking my seizure medication, but don’t want to risk a seizure if I don’t know what is causing or triggering my seizures. I haven’t had one in over eight years and would prefer not to! Is there a chance that hypoglycemia might be triggering my seizures? I’m tired of being told there is no explanation for the seizures and that “in 50% of cases, you’ll never know the cause”. I don’t like having these dizzy episodes and sensations of walking or leaning to one side sometimes.
Answer:
It is important for you to know that I am not a neurologist. Rather, my area of expertise is in endocrinology. However, in order to understand your symptoms, some attempt needs to be made to establish cause and effect. I would suggest that intermittent hypoglycemia, or rebound hyperglycemia, is still an unlikely explanation for your seizure disorder. It may be a cause for your symptoms of dizziness which are not true seizures. An oral glucose tolerance test with a low blood sugar is neither necessary or specific for diagnosing a functional problem with hypoglycemia. Rather, you probably need to speak with your doctor about more specific ways of approaching the problem. One way is to monitor blood sugars and see if low values correspond with symptoms. An additional issue is to eat small frequent feedings throughout the day and see if the symptoms decrease. I would caution you very strongly against stopping your anti-seizure medications without the input of your physician and before you see your neurologist.
Although it would be nice to have a simple problem which ties everything together, it is probably an unlikely explanation for you. It is very true that there are no specific abnormalities noted with seizure disorders in a large number of patients.
JTL