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December 5, 2006

Diagnosis and Symptoms, Hypoglycemia

Question from Istambul, Turkey:

I know it is not possible to diagnose over the Internet, but I would REALLY appreciate some help to my problem. I am a 24 year old female, 160 cm (5 feet, 2.5 inches) tall and weigh 43 kg (95 pounds). I have always been very thin and active. I had a Glucose Tolerance Test (GTT) run since after eating, many times I get sick, shaky, nauseous, and light headed. I have even passed out quite a few times and needed glucose IVs to regain consciousness. Here are the results to my GTT: basal glucose 74 mg/dl mg/dl [4.1 mmol/L], basal insulin level 7.93 mcU/mL. After 60 minutes of drinking 100 g of glucose: blood glucose 163 mg/dl, insulin level 305 mcU/mL [9.1 mmol/L]. After 120 minutes: blood glucose 26 mg/dl [1.4 mmol/L] (here I started feeling sick again, had to lie down as I had trouble seeing), insulin level 25.10 mcU/mL After 180 minutes: blood glucose 59 mg/dl [3.3 mmol/L], insulin level 7.78 mcU/dL At this point, they did a urine test which showed positive for glucose (250 mg/dL [13.9 mmol/L]) and negative for ketones. The doctor told me that I have reactive hypoglycemia and I will end up becoming a type 2 diabetic. He prescribed a sugar free diet with small meals which is killing me because of hunger. What is your opinion of this, please? How can I avoid becoming diabetic? Why is it that I had sugar in my urine? My doctor didn't tell me why.

Answer:

Reactive hypoglycemia is very common. It is not clear that diabetes is the end-result of this condition. I would suggest to you that you need an effective means of avoiding the symptoms. A small, frequent feeding diet throughout the day can do this. The natural history of such a condition is not clear. For some, it becomes less of a problem later on. For some, with very high insulin levels, this may predispose to type 2 diabetes. The predisposition to diabetes comes from the idea that insulin levels rise with increasing insulin resistance and then result in the lows you experience when your body cannot turn off the high insulin levels. Whether that is the natural history or not is not clear. Your best bet is to live a healthy lifestyle. Exercise to remain healthy. Make good food choices. Keep regular doctor appointments. If you have a family history of diabetes, and if you develop pre-diabetes based on your blood sugar measurements, you can discuss with your physician the potential of using some medications that have been used to help prevent or delay the onset of diabetes. However, you do not have diabetes based on your test results. Do not starve yourself to the point of weight loss. If possible, work with a dietician who can coach you regarding your food intake. The reason for glucose in your urine is that after the large glucose load, the blood sugars get high enough to spill into your urine. It was probably transient. Nevertheless, it did spill into your urine and was measured there.

JTL