The hypoglycemia link

[ginger]

Hi all--

I just searched old threads and found one specific to low blood sugar (hypoglycemia) a year ago and few others where blood sugar is mentioned... but wanted to know how often dysautonomia patients also have low blood sugar or blood sugar regulatory issues?

I did a 4-hour glucose test 7-8 years ago and was postivie for hypoglycemia, even stopped test early. And until this past year, I knew the warning signs, tried to do smaller, more frequent meals, exercised, etc. I usually feel/felt symptoms starting about 70 and could catch it and stop it.

Just the other day--and this has now happened a number of times the last several months--out of the blue, I'm low and didn't even know it was coming. Takes me by surprise. Bam! Instant severe shakes, weakness, agitated, etc. I have a tester and checked it the other day and it was 56! How could I not feel this coming? And that was after a vegetarian lunch with variety veggies and beans, not many carbs. I don't get it.

Any thoughts? Suggestions for more reading?

Ginger

[MightyMouse]

My blood sugar has always tested within the normal range. My cat, however, has been an insulin dependent diabetic for almost 6 years not kidding. 2 injections a day, currently at 3 units each of humulin, 12 hours apart. You may think that the cat thing is a bit off topic, but...

I can tell you that when her blood sugar is too low, she sleeps a LOT and is whiny (sits at the top of the stairs and cries...yes, cats can cry)... and cranky (doensn't want to be petted, when she's normally very sociable).

She also will run away from me if I try to give her a shot and her sugar is too low---don't laugh---she some how knows not to let me give her insulin when she's already low. The first few times, I chased her down and gave her the shot anyway, thinking she was just being a "noodge." I regretted it as she went into seizures within the hour each time. I've come to trust her judgement on that one. Most of the time, she doesn't move away from her food dish or even stop chowing down when I give her the shot.

When her sugar is too high, she's agitated, can't seem to stay in one place, drinks like a fish and pees like river. I could tell you HOW I test her blood sugar, but it's a long story about how to get a cat's urine! ...no fun...

ps. btw, if you ever do a search on dysautonomia, you will realize that both cats and dogs are known to develop it, just like humans. Other than me, a dog is the only other recipient of florinef at my local pharmacy. The dog also takes proamatine! I sometimes wonder if my cat feels as icky as I do some days.

[opus88]

Ginger,

You may have had a very healthy meal in some ways, but where was the protein and/or fat? You didn't mention either of those (beans have protein but also carbs), but maybe they were there. You may be more of a protein person and therefore need a higher level of such.

You might want to consider increasing either or both of those things (healthy fats, only!) to help your body deal with the blood sugar plunges. I lived in that space way too long and now don't usually have that trouble as long as I have the protein and fat first, followed by the carb, or a higher level of protein & fat if the carbs will be eaten at the same time.

Good luck with your experimenting on these ratios!

[yogini]

My blood sugar has shown up as low sometimes, and normal other times. I actually just noticed something on this topic today on Chris Calder's site (http://home.att.net/~potsweb/POTS.html):

Reactive hypoglycemia is a common symptom of both POTS and CFS, and occurs through a complex series of neural and hormonal interactions which are not yet fully understood. Researchers have discovered that people with orthostatic hypotension (low standing blood pressure) often get a drop in blood pressure after eating carbohydrate rich foods. This may be caused by a direct vasodilation effect (increase in internal size of blood vessels) of suddenly higher blood glucose levels. The traditional definition of hypoglycemia is an abnormal lowering of blood sugar levels after the body overreacts to carbohydrates with excessive insulin production. Researchers now believe that this lowering of blood sugar levels is not the only cause of symptoms. Recent studies suggest glucose aggravated aberrations of the production levels of adrenaline, norepinephrine, serotonin, dopamine, and lactic acid may be associated with reactive hypoglycemia.

[MightyMouse]

just an FYI, I know that this topic has come up more than once on NDRF's forum. You may want to search their archives for info under:

hypoglycemia

reactive hypoglycemia

and

glycemic index

Nina

[Laura]

Hi Ginger! I thought I would add that with hypogycemia it often helps alot to really increase your fiber intake. This slows down the breakdown of carbs (sugar) so that your body won't release too much insulin too quickly. You can get those fiber pills OTC at the drug store ( find it with the Metamucil products) and take 1-2 pills 1/2 hour before each meal and it should help to regulate your sugar levels! My sister has reactive hypoglycemia and this has really helped! Laura!

[kristinp29]

When I first got sick, I was tested for diabetes, but everything was normal. Over the years, I have had symptoms of hypoglycemia and still do on occassion. Generally, I need to eat every few hours or so otherwise I get tired, warm, and... kind of cranky . But, once I eat again, I'm good to go!

--Kristin

[ginger]

Thanks for the tips all! I have tried some of your suggestions and found them helpful in the past, but this recent thing is just weird. As is a POTsy body! You're right about the ratio thing. Maybe I'm going to have to readjust again?

rqt9191-- that's interesting. I'll have to share this with my family doctor. He'd find that helpful since he first did the 4-hour glucose on me. Boy, he's just getting a load of new information from me this year! Maybe that's why we were meant to have dysautonomia's--to inform and open the eyes of our medical practitioners!

MightyMouse-- Hey, I love my kitty cat, so I'm laughing, but with you. What we wouldn't do for our beloved pets! No, correction, our furry, four-legged family members. What made me laugh was the Florinef for you and the dog. btw, my name, Ginger, has been number one or at least top in the list of favorite dog names for many years running! I will check NDRF, thanks. Oh, and I'll say a little prayer for your kitty.

Thanks again

Ginger

[ramakentesh]

I often get these kind of hypoglycemic feelings in the morning when i havent eaten for a while - i get shaky, out of it and feel unwell until i eat. My blood sugar was tested and most of the time - once during this symptom, it was found to be inside the 'normal' levels despite my symptoms.

I have read the information on that site above, but its unfortunate that no doctor i have spoken to has read this anywhere or even acknowledges that this is the way that research is going in this field. I would love to see a study that indicated that.

[opus88]

Ramakentesh,

These tests are not nearly as accurate as we are led to believe. You may have caught your reading at a normal level, but was it on the way up or on the way down? It could be that a crash is happening very quickly, bringing the symptoms on by the speed of change rather than the momentary reading. Or your glucose could be quickly shooting up, causing the ill feeling, and again you just happened to catch it while it was in that normal range. Researchers or engineers or whoever designs these things need to find a way to do a continual glucose monitor to watch the flow of activity rather than just relying on a snapshot approach. You could try doing a stick every 60 seconds or so, but OUCH!! (I haven't gotten desperate enough to put myself through that.)

[ramakentesh]

your right - ive read that before. I think its probably yet another problem that adds on to my pots - high adrenaline system means bigger reactions to glucose according to my doctor.

[JLB]

Just a thought: The pancreas is part of the ANS, isn't it?

How much might this have to do with Dysautonomia?

[bluegirl]

Its very interesting reading through all of this, I went to see a dietician last week and was diagnosed as hypoglyceamic (cant spell it) and have to eat high fibre snack/cereal bars between meals; does this problem o hand in hand with POTS?

Any assistance gratefully received please!

[avais1]

I used to faint when I was little, and I was told it was hypoglycemia. I too have had the fasting 4 hour GTT test. I passed the test, but was sicker than a dog during the test. I think Opus had a point - for me, it is the SPEED of the change. And since the ANS does control this function, and none of ours works properly (or we wouldn't be here) it is feasible that we may struggle with blood sugar issues. I basically follow a diabetic diet, and it does help. There is definitely no harm in it. Good luck to you!

[dream02]

My four hour test was a nightmare for me. I got so sick I ended up in the ER and my family doc said that it showed that I rollar coaster. I'm not diabetic per se but have to really pay attention to when I need to eat. I've had quite a few doctors immediatly ask me if I was diabetic when told I have dysautonomia so I always assumed it went hand in hand. I still feel like I know so little about the disease I'm dealing with. Hopefully I'll get more knowledgable since there are so few doctors who really know about it.

Denise

[opus88]

I just did a self-administered GTT for the Metabolic Typing testing. I was very surprised that one of my readings was 160 - I've never caught it above 120! I went from 90 jsut before drinking the solution to 160 30 minutes later, then 134 45 minutes later, 109 20 minutes after that, and finally 103 20 minutes later. I felt ok at the highest reading, but then felt worse as the levels came back down.

I'm going to look for my previous 2 tests to see the speed of change and what my reactions were at those times. Will be interesting to see if I can find any kind of pattern.

[vemee]

I had a week last spring where I had hypoglycemia. I went to work feeling weird and took my blood sugar with a monitor we had on the fire engine and it was 38. I got the same reading with another monitor. From Tuesday to Saturday my sugar was off but not as low as 38. After that week I have not had any trouble since. I may have had hypoglycemic events a few months earlier because I felt the way I did when the sugar was low but I did not use the glucometer. I would't be surprised if a misfunctioning autonomic system would be responsible .

[Melanie]

I don't know what to say. I've been telling my doctors since they told me I have Diabetic Autonomic Neuropathy that it just doesn't make sense. I have had hypoglycemic incidents and heart arrythmia (SVT, now inapproprite tach) since I was 14 and I'm 41 now, diagnosed with diabetes 2 years ago! I haven't been able to find anything that had the 2 together and here are all of you have had experiences just like me! I could just cry. I have so many questions, but I'm new to your site tonight. So I will have to explore and learn lots! I would be so glad of encouragement and suggestions! None of my doctors understand dysautonomia (including my cardio). Started with a new cardio last month who suggested POTS or chiariX (sp?), so I'm still new with this info (could tell you almost anything about D.A.N.!). Here I feel like I have come home. I have just applied for Social Security Disability benefits; but most of all, my concerns lie with my 12 year old son who is showing the same symptoms I had near that age. I feel like I'm dieing (thought I was wih the Diabetic A.N. diagnosis) and do not want him to have to go through all this!

Thanks! Thank God for all of you and this forum! (I'm sorry to gush and I am not a religious fanatic - I am just overwhelmed with finding your forum and the timing of finding this most unexpected connection that explains so much!! Like I said, words just cannot fit my emotions right now.) Melanie

[BuddyLeesWife]

http://www.medscape.com/viewarticle/473205_1

I just read this article last night on Diabetic Autonomic Neuropathy, I've copied the introduction and the table of symptoms. Hopefully you can get to the article using the above link.

Table 1. Clinical Manifestations of Autonomic Neuropathy

Cardiovascular

Tachycardia, exercise intolerance

Cardiac denervation

Orthostatic hypotension

Gastrointestinal

Esophageal dysfunction

Gastroparesis diabeticorum

Diarrhea

Constipation

Fecal incontinence

Genitourinary

Erectile dysfunction

Retrograde ejaculation

Cystopathy

Neurogenic bladder

Neurovascular

Impaired skin blood flow

Heat intolerance

Gustatory sweating

Dry skin

Metabolic

Hypoglycemia unawareness

Hypoglycemia unresponsiveness

Hypoglycemia-associated autonomic failure

Pupillary

Decreased diameter of dark adapted pupil

Argyll-Robertson type pupil

--------------------------------------------------------------------------------

Introduction

Diabetic neuropathy is a heterogeneous disorder that encompasses a wide range of abnormalities affecting both proximal and distal peripheral sensory and motor nerves, as well as the autonomic nervous system (ANS). Diabetic autonomic neuropathy is among the least recognized and understood complications of diabetes despite its significant negative impact on survival and quality of life in people with diabetes.[1-3] Many organs are dually innervated, receiving fibers from the parasympathetic and sympathetic divisions of the ANS. Diabetic autonomic neuropathy typically occurs as a systemwide disorder affecting all parts of the ANS. Diabetic autonomic neuropathy manifests first in longer nerves. The vagus nerve (the longest of the ANS nerves) accounts for ~75% of all parasympathetic activity; as such, even early affects of diabetic autonomic neuropathy are widespread. The organ systems that most often exhibit prominent clinical autonomic signs and symptoms in diabetes include the pupil, sweat glands, genitourinary system, gastrointestinal tract system, adrenal medullary system, and the cardiovascular system (Table 1).[4] The availability of sensitive, specific, and reproducible noninvasive tests of autonomic function has enhanced our understanding of the prevalence, pathophysiology, and clinical manifestations of this disorder.[1,5-6] Clinical symptoms of autonomic neuropathy generally do not occur until long after the onset of diabetes. Subclinical autonomic dysfunction, however, can occur within a year of diagnosis in type 2 diabetic patients and within 2 years in type 1 diabetic patients.[7]

[Melanie]

Hi Buddy Lee's Wife, Thank you so much for your concern. I have been reading for >1 year now about Diabetic Autonomic Neuropathy (DAN). Maybe I am in denial. But there are 2 facts that make me question that diagnosis: 1. as the article said, one usually has diabetes for a long while before developing DAN symptoms (that would place me at about age 9 with Type 2 diabetes, which was never found in years of blood tests, though no one ever did the multi hour test with me until 2 years ago, so maybe it's possible?); and 2. It is often said that the eyes are the first to have symptoms, but that has not been the case with me. everything else first.

And with my 12 year old having fainting spells (none in the last year, thank God!), low blood sugar; I think this sounds more like there has been POTS all along and no one ever picked up on it.

This is so hard. Do you think this does not sound like POTS? Can you tell me why? I was reading last night that there is a very large overlap with those who have POTS also having Chronic fatigue Syndrome. That seemed to describe my present and account for my past pretty well; but like I said, maybe I am in denial.

Well, thank you very much for your thoughts.

Melanie

[BuddyLeesWife]

I wish I had answers to your questions because it would mean I knew what I was talking about - I don't. I came across the article on DAN while searching for something that explained all of my husband's symptoms, not just some or most of them. Your post came up the next time I signed on so I thought I would include the article I read. My husband is diagnosed with NCS (he's a fainter) and his identical twin also faints but his diagnosis is "non-epileptic seizures", meaning they don't know what is wrong. So, I too keep searching and reading and taking stuff to the doctor, hoping that they will find something that responds more consistently to treatment but so far no luck here.

[Melanie]

Hi Buddy Lee's Wife, I'm so sorry to hear you're in the same boat. thanks for sharing what you had come across. Is you husband diabetic? If you haven't already, you might want to look up vaso vagal syncope. I wish you and Buddy and his twin a Happy valentine's Day and renewed health - and answers! Keep loving, you'll find answers :-) Melanie