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October 6, 2004

Diagnosis and Symptoms

Question from Burnaby, British Columbia, Canada:

After numerous blood tests, both at the laboratory and with a glucose monitor, no one seems to be able to figure out what is wrong with me. I am 29 and have been treated on and off for depression and anxiety for about eight years now with little or no improvement. In that time, I was also diagnosed with Irritable Bowel Syndrome (IBS) due to severe cramping with alternating mucousy diarrhea and constipation. Other symptoms include cold sweats, night sweats, grinding of teeth, yelling kicking and thrashing nightmares, constant tense neck and shoulders, intermittent shakiness, foggy thinking with memory lapses (but I score in the 140s on IQ tests), mood swings, frequent urination, extreme thirst, headaches and extreme sleepiness in mid-to-late afternoon (I'm not a coffee drinker). I have also been told all my life that I'm not living up to my potential. These symptoms have been present for years, many since childhood. This past summer, I went tree planting, which is extremely strenuous work without breaks and little eating and the symptoms began to get worse. Then, three months later, while sitting and writing, my main employment, I began to experience severe shakes (possibly seizures, but I have to wait six months to see a neurologist) and light-headedness upon standing and black outs. Home glucose tests were: Time Blood Glucose prior to ingesting Hagen Das ice cream bar 6.3 mmol/L [113 mg/dl] 0.5 hour 8.0 mmol/L [144 mg/dl] 1.0 hour 5.4 mmol/L [97 mg/dl] 2.0 hours 5.3 mmol/L [95 mg/dl] 3.5 hours 4.2 mmol/L [76 mg/dl] (with two "lo" readings before getting the result) 4.25 hours 1.2 mmol/L [22 mg/dl] (with one 'lo' reading before getting result) To me, this would seem to indicate hypoglycemia, but all blood tests from the laboratory fall between 4.0 and 6.0 mmol/L [72 and 108 mg/dl] and the doctor tells me that I do not have hypoglycemia nor diabetes. However, the physical symptoms are interfering with my life and employment to a significant degree. I am already being treated for anxiety and depression at 225 mg of Effexor XR daily. Any help you could give would be greatly appreciated since I'm about at the end of my rope here.

Answer:

Problems with a condition known as reactive hypoglycemia are not uncommon in the general population. You may have symptoms that are worse than usual. The main point behind the genesis of the symptoms is that your body has a difficult time putting the brakes on insulin secretion following stimulation with a meal. The usual way to address this is to have you meet with a dietitian and review the symptoms in relation to the food you eat. The dietitian will have you avoid foods that make the symptoms worse and try substituting foods that do not have a problem. I am not sure what all the other symptoms mean. You will have to speak with your doctor to make sure other things are not a problem.

JTL