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July 26, 2005

Hypoglycemia

Question from Concord, Massachusetts, USA:

My 20 year old daughter is having episodes that last for about one and a half hours. In order, she feels that the room is spinning, her heart is pounding, and she has mental disturbances (not good judgment, anger). At the end, when she starts to feel better, she gets a low level headache. At a recent appointment, when she was not having any symptoms, she had a blood sugar of 60 mg/dl [3.3 mmol/L]. Over the past 18 months, she has also had a low potassium level as well on at least two occasions. One doctor has said she has reactive hypoglycemia and told her to be religious about having small meals. He also said that, if the problems continued, she should have a CAT scan and an EKG. The problems have continued until she ended up in the Emergency Room (ER) this past weekend. Both a CAT scan and an EKG were done and both were negative. They tested her blood sugar at the ER and it was 112 mg/dl [6.2 mmol/L} after drinking three glasses of juice (she drank juice about one and a half hours before, when the symptoms started) because she thought it was hypoglycemia. The ER doctor said that he did not think she had hypoglycemia, that he felt it was migraines and wants her to see a neurologist. My daughter has been very healthy up until this point with no real medical problems. She has been a vegetarian for about four years and eats only whole grains, organic foods, etc. She has never liked sweets and does not eat any candy, pie, cake, etc. that would be raising and then lowering her blood sugars quickly. We are really confused as to what is going on as she had been very good about making sure she ate small meals about six times a day and some snacks in between, yet her symptoms continue. There is a family history of diabetes, both types 1 and 2 on both sides of the family. What do you think she could have?

Answer:

If glucose does not make the symptoms better, you can’t give her a diagnosis of reactive hypoglycemia. I would suggest you make the appointment with the neurologist as some form of neurological problems (migraine headaches or atypical seizures) may mimic low blood sugars. The neurologist will help to explain how they can perform studies to look for these problems.

JTL