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October 17, 2002

Other Illnesses

Question from Franklin, North Carolina, USA:

I am a 22 year old female and during the past few years, I have been experiencing a variety of symptoms that my endocrinologist has been unable to explain and treat. I am on an insulin pump and I carb count. Some days, I will wake up with a good fasting blood glucose, eat, carb count, and everything goes smoothy. The next day I can repeat the exact same routine but my blood sugar will shoot up to as high as 370 mg/dl [20.1 mmol/L]! The insulin is not bad, my site is good, and the ratio for my carbs in the meal was the same as the morning before. What is going on? Also, I have been experiencing abdominal pain, constipation, and episodes of unexplainable sweating. I had my thyroid levels checked, and although my TSH was normal, the other levels (free T4, T3 uptake, etc.) were all low. I did some research and secondary hypothyroidism seemed to be a possibility. However, the sweating episodes did not go along with this hypothesis. Could my unexplainable high blood sugars be caused by gastroparesis from the hypothyroidism and anti-insulin hormones that are also causing me to sweat? I have noticed lately that when I experience these heat episodes, I will have an elevated blood sugar, but the elevated blood sugars are not always accompanied by a heat episode. I am taking any advice you can give because it is really quite frustrating to go to all the effort to carb count and still have a high blood sugar. I seem to have stumped my doctor so please help.

Answer:

It was good to check thyroid functions with such symptoms but unlikely this is thyroid disease with the results you report.

I would also check for celiac disease and for Addison’s disease as well as for gastric emptying or other stomach/intestine motility problems. This is unlikely to be related to insulin antibodies.

SB