Relatives on both sides of my family on both sides have a history of diabetes and, yet, I don’t have it, that is according to the doctors. However, when I was living in the United Kingdom, I regularly experienced periods were my hands shook, I felt agitated and nervous and I craved chocolate. But, by the time I make an appointment to see the doctors, my blood sugar level was normal. I did manage to get my sugar level measured during one of these episodes by the company nurse and, indeed, my sugar levels were very low, low enough for her to tell me to see a doctor.

I have noticed one thing that seems to trigger these periods and that is the consumption of Diet Coke or carbonated water. Is this a plausible theory and how do proceed to prove this?

There are occasions when symptoms attributed to low blood sugar may occur that make people feel bad. The ingestion of a carbohydrate meal will improve symptoms and it is inferred that the symptoms were related to low blood sugars. The fact that you had your blood sugar measured is a good thing in that it gives objectivity to the condition. The harder thing to do is to put it into perspective and decide where to go with it. When a person has a low blood sugar, usually less than 60 mg/dl [3.3 mmol/L], your body compensates for this by decreasing insulin secretion. As the blood sugar falls, more potent intervention on the part of your natural body defenses start to take over. For the most part, these are the secretion of hormones (epinephrine from the adrenal gland and glucagon from the pancreas) that attempt to push the blood sugars back towards a normal set point. Some of the symptoms of low blood sugars, namely the nervousness, palpitations, sweating, and increased pulse rate are the result of those hormones causing systemic symptoms. As you imply, these symptoms have been associated with a potential risk for future diabetes as if there might be dysregulation of insulin secretion occurring. It has also been shown to occur when people have a high carbohydrate diet and there appears to be a sluggish brake by the body on the amount of insulin secreted with a high carbohydrate meal. The link with diabetes is still questionable. However, given your family history, this needs to be a regular screen for you because you are at risk for diabetes.

I am not sure I see a link to the carbonated water or the cola. If the symptoms continue to recur, I would suggest you see your physician. There may be some medications or medical conditions outside a risk of diabetes that may be associated with low blood sugars. Until that time, you need to carry a form of rapid-acting glucose with you at all times until you see your doctor. The doctor will determine if further testing needs to be done after taking a careful history and physical exam.

JTL