February 4, 2003
Diagnosis and Symptoms, Hypoglycemia
Question from Washington, DC, USA:
For a year and a half, I have been plagued with hypoglycemic episodes. They come at me from out of the blue, and at various times throughout the day. I’ve had an oral glucose tolerance test during which I had hypoglycemia (45 mg/dl [2.5 mmol/L] by the third hour so the test was stopped. I was examined at the National Institutes of Health for four days where I underwent a 48 hour fast, and my blood glucoses remained steady in the 70s mg/dl [3.9 mmol/L]. I also showed no signs of insulinoma.
Sometimes my blood glucoses will read as high as 300 mg/dl [16.7 mmol/L] (not lately); and the lowest I have recorded is 27 mg/dl [1.5 mmol/L] (was taken to the ER). All lab work comes back normal for TSH, insulin, epinephrine, C-peptide, and testosterone (low-normal). I’ve not had an antibody tests to date but think maybe I should.
Just last evening, I had one of my monthly episodes and twice recorded blood glucoses 50-55 mg/dl [2.8-3.1 mmol/L]. my mother and older sister share the same symptoms and problems. I’m also thinking about celiac disease. Could this be the issue? I’m at a loss. What should I ask my doctors to consider looking at?
Answer:
I agree that celiac disease is a possibility. However, without diagnosed diabetes, it is still uncommon.
It is hard to say what the best course of action would be after all the testing you have had. If you have symptoms of post-meal fullness or nausea, you might consider having your stomach motility checked. I would make sure you check with a dietitian about a diet of small frequent feedings throughout the day. This will sometimes decrease the symptoms. I would assume that people have checked your medications. You need to be screened for liver problems. It sounds like you have had an extensive work-up for insulinoma and that you do not have it. Your case will take time and patience on behalf of yourself and your physician.
JTL
