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July 16, 2003

Diagnosis and Symptoms

Question from Kansas City, Missouri, USA:

My 13 year old daughter is a basketball player and competitive runner in 5 K, 3 K, and 1500 M races. Last summer, she was unable to complete a 3 K race because her arms and legs were like lead (her description). She was very weak and felt nauseated but was completely lucid. She recovered within two hours but felt tired for the next day. We thought this was a one-time exception, but she ran into a similar situation (arms and legs like lead) in cross-country meets later last year. About six months ago, we worked with an adolescent clinic to have her do a treadmill test to determine if periodic paralysis was an issue. It apparently was not, however they did note that her blood sugar was high. Since then she monitored her blood sugar for two weeks before and after meals, and these readings were all within a normal range. We have also tested her blood sugar after races, have found that they are often high (200-240mg/dl [11.1-13.3 mmol/L]) and she may or may not have the heavy arms and legs symptoms. The endocrinologist requested a glucose tolerance test and the results were as follows:    Time       Blood Glucose       Insulin    Fasting 82 mg/dl [4.6 mmol/L] 5.4 0.5 hours 147 mg/dl [8.2 mmol/L] 39.7 1 hour 161 mg/dl [8.9 mmol/L] 44.3 1.5 hours 92 mg/dl [5.1 mmol/L] 18.1 2 hours 113 mg/dl [6.3 mmol/L] 33.1 2.5 hours 109 mg/dl [6.1 mmol/L] 20.7 3 hours 94 mg/dl [5.2 mmol/L] 11.8 3.5 hours 74 mg/dl [4.1 mmol/L] 4.5 4 hours 65 mg/dl [3.6 mmol/L] 4.6 Within a week's time, the endocrinologist has changed from a diagnosis of insulin resistance to reactive hypoglycemia, and now to prediabetes and is suggesting that my daughter may need to do daily insulin injections. He has now requested a first phase insulin test which he feels will tell him whether or not she needs daily insulin, and suggested that though the tests show high blood sugar, she is really experiencing hypoglycemia and is having rebound hyperglycemia, even though we don't have a test yet that shows that. We're rapidly losing confidence in his attention to detail on her case. What are the normal expected glucose/insulin ranges during and after intense exercise? How quickly could a rebound occur from a low to a high of over 200 mg/dl [11.1 mmol/L]?. What short/long term issues are there related to using insulin in someone who perhaps does not have diabetes?. Any other suggestions or thoughts you might have are appreciated.


This does not sound or look like diabetes, insulin resistance, or insulin deficiency to me. I think the single blood glucose of 161 mg/dl [8.9 mmol/L] is borderline. I have not seen or heard of such heavy lead muscle aches, and if periodic paralysis was ruled out, a physical exam, electrolytes, muscle enzymes, as well as and thyroid and adrenal functions are all normal, I do not know what is being described.

In general, if one is not so pleased with a consultation, a second opinion should be sought with all the data from the first group shared with the new consultant so that things do not need to be repeated unnecessarily or expensively. I would be sure that before such heavy exercise, that appropriate food is ingested. Also, be sure she is well hydrated and has appropriate and significant water and electrolytes provided.