January 13, 2004
Hypoglycemia
Question from Bloomington, Indiana, USA:
I was diagnosed with hypoglycemia when I was 16. I had a fasting blood sugar test which read 64 mg/dl [3.6 mmol/L] at a free clinic to test people for diabetes, high blood pressure, and high cholesterol. The nurse asked me if I was on diabetes medication and I said no. She said that was too low and I should talk to my doctor. She said that people with hypoglycemia have a higher risk of developing diabetes. I am not sure if I have hypoglycemia, but I have tremors in my hands and I have been having a lot of dizzy/fainting spells and severe headaches when I haven’t eaten for a while. I am supposed to take food with me to eat in class, but I’m not allowed to and so then I get sick (especially after one class I have that lasts from 12:15 to 2:30).
I am 18 years old now and I have become worried because a lot of people on my mother’s side of the family are overweight or obese and have type 2 diabetes, high blood pressure, and high cholesterol. My uncle is only 45 and he has already had a stroke. My 72 year old grandmother was recently diagnosed with type 2 diabetes. I don’t know my mom’s medical history because she died when I was 6 months old. All I know was that she was 5′ 1″ and weighed 250 pounds. I also don’t know my dad’s medical history because he is in prison in another state, but I know that he is overweight and there is also a prevalence of type 2 diabetes and heart trouble on his side of the family. I don’t think I am overweight. I am 4′ 11″ and weigh 109 pounds, but it is mostly muscle. I try to exercise but it is very hard to eat healthy food now that I am in college. Almost everything is fried and there are almost no vegetables or fruit. I usually have to go to the grocery store and buy my own food.
I recently had a non-fasting blood sugar test and it was 57 mg/dl [3.2 mmol/L]. I was told again that this was too low and I needed to start eating more. But now that I am back home for break, my grandmother tested my blood sugar for me two hours after I ate a relatively carb-high meal because I got extremely dizzy and almost passed out. It was 93 mg/dl [5.2 mmol/L]. This morning she took it again for me and it was 78 mg/dl [4.3 mmol/L], so I think the higher numbers mean they are under control. Do you think that I really have hypoglycemia and am I at a high risk for developing diabetes?
Answer:
I do not know of which specific test for hypoglycemia you have been tested if any beyond random blood sugar (that actually must be lower than 55 mg/dl and confirmed twice at least in order to be diagnostic of true hypoglycemia that must be further diagnosed with specific tests), but it sounds to me like you might have most of the features of the insulin-resistance metabolic syndrome (high blood pressure, high cholesterol) yielding in your case to compensatory hyperinsulinemia and eventually low blood sugar with all the symptoms you describe that certainly are consistent with hypoglycemia. Family history in both your parental sides is further convincing of the metabolic syndrome trait and all these may indeed predispose you, once the endocrine pancreas won’t meet the increased demand of insulin secondary to insulin-resistance, to insulin deficiency and eventually to diabetes.
But all these can be significantly prevented with proper daily exercise and reduced intake of calories mostly trough a balanced diet. In your case of low blood sugar I would also encourage you to provide small snacks between meals or just before and after exercising. This will allow his blood glucoses to stay closer to normal. We usually suggest that people with this challenge have small snacks between meals — something like crackers and cheese or peanut butter and crackers, or something similar. He can also have some sweets with this snack, but he should not eat sweets (as juices, candy, pop or even a piece of fruit) alone. The added protein and fat of the snack have proven very helpful. Lastly all these must be included in a proper diet.
MS
