Can Low Blood Sugar Cause Syncope? Dysautonomia Related?

[MikeO]

Over the last few years i have been struggling with a unknown cause of syncope. while i have made great progress in understanding my orthostatics and adjusting to it along with everything else i have found that i have health wise the syncope cause has been elusive.

I have been haltered numerous times, had a ILR put in, two tilt tables tests, stress tests, echo's and tracked my blood pressure to no end and nothing popped out as a cause to the episodes.

Last year a smart university dietician suspected hypoglycemia and had a OGTT test ordered which showed a atypical glucose response which got me a diagnoses for diabetes.

so the DM diagnose open up the door for support. right off the bat i had a CGM put on so we could see what was going on and it did clearly show periods of low blood sugars (was dismissed by the DM trainers sigh) but at least i was able to recognize symptoms that came with the lows (suspect i am a bit hypo unaware) but feeling anxiety and walking like i am drunk is consistent. The CGM also showed that if i eat the same foods i can either go low or go high which is confusing. Blood sugars are about as liable as my HR and blood pressures.

Not sure how much a dysfunctional functional autonomic system (has been suggested) affects my blood sugars but it seems to me that my system either pumps out a ton of insulin or at times none at all.

So i have trended my blood sugars (1219 sticks so far) and have seen the highs and low but earlier this week i caught a really low reading (23 mg/dl) started feeling anxiety and drunk so i immediately went for corrective measures and by chance had purchased some glucose packs. so took the pack and followed it up with a half sandwich and my blood sugars recovered 106 mg/dl.

This is kinda scary and i get a feeling when i have gone full syncope it was BG related. I feel i was working on automatic during the low. i don't even remember where or what i was doing prior (which is consistent when i flat out pass out) 

Not sure if other folks have seen or have to deal low blood sugars or have any tips      

[MikeO]

well more to add to this. can't wait to see endo in a week.

 

[Pistol]

@MikeO I have neuro-cardiogenic syncope from sudden drop in BP and HR ( following a period of tachycardia and hypertension ) as caught on TTT and ILR. I also have glucose intolerance causing periods of severe hypog;ycemia, meaning eating something rich in sugar will spike insulin and then -, once the food is digested, usually 1 1/2 hour after eating - my sugar bottoms out, causing severe hypoglycemia. I have passed out from both scenarios, although I can tell the difference and also see that the sugar-low comes on slower than the syncope. 

The biggest difference I see between the two symptoms is that when my BS drops I get clammy ( especially on my upper lip ), very weak , shaky and hungry. juice and a protein rich snack helps fast. When I get the circulation-related presyncope it comes on fast, my hands and feet get ice cold and I begin to have tremors ( but entire different than the low sugar shakes ). 

I barely ever experience hypoglycemia anymore since i have adjusted my diet and follow a six-feedings-a-day regimen. So - in your case I can see it will be difficult to determine what is causing your syncope unless you can tell the difference between the two based on how you FEEL. And it is crucial to respond quickly when you feel unbalanced or in any way symptomatic. As always - we can be our best advocates and healers if we learn to LISTEN to our bodies. Our symptoms are usually a warning sign that something is wrong. 

[MikeO]

6 hours ago, Pistol said:

I can see it will be difficult to determine what is causing your syncope unless you can tell the difference between the two based on how you FEEL.

This one is tuff. I have fight left in me. I have the presyncope down and even can tell you the BP's when this happens (low diastolics ) despite a normal systolic is a indicator. sure when i feel a low my bp's are not what i record but then i do not want to faceplant trying to get the numbers. get into the 60's diastolic wise is consistent. sample event is a 123/62. upside i have learned how to recover from this.

[Pistol]

@MikeO try to get away from numbers and go by how you experience your body ( how you FEEL ). Numbers - in our case - are simply data collected before and after, not WHILE it happens. The symptoms before we have an episode are only apparent to US, therefore it is US that need to respond ASAP. 

I hope you know what I am trying to convey ..?

[MikeO]

12 hours ago, Pistol said:

@MikeO try to get away from numbers and go by how you experience your body ( how you FEEL ). Numbers - in our case - are simply data collected before and after, not WHILE it happens. The symptoms before we have an episode are only apparent to US, therefore it is US that need to respond ASAP. 

I hope you know what I am trying to convey ..?

So yes i know what you are trying to convey but the BP data has been helpful when dealing with providers especially ferreting out the postprandial hypo and drug treatments albeit i don't need vitals to know when i am feeling orthostatic (have this down for sure). Blood sugars i need to track. i do know when they are high cuz i become symptomatic but the lows i get a feeling i lost my ability to adequate recognize them. excessive high BG's i need to keep a eye on as well while elevated.    

[bumpkin]

On 9/17/2023 at 1:44 PM, MikeO said:

This one is tuff. I have fight left in me. I have the presyncope down and even can tell you the BP's when this happens (low diastolics ) despite a normal systolic is a indicator. sure when i feel a low my bp's are not what i record but then i do not want to faceplant trying to get the numbers. get into the 60's diastolic wise is consistent. sample event is a 123/62. upside i have learned how to recover from this.

It cracks me up how many times I land on your posts Mike, it's like wandering around the dysautonomia woods and finding all the trees you've etched into, like we're on the same dang journey 😂

I feel like I've also more-or-less figured out how to recover from those numbers, but I don't have it down to a science, it's more like I'll recognize the presyncope, realize I feel like death, take my bp with the wrist cuff and then I get back up on my feet and fight through it with maple syrup, salt water and snacks.

I'm imagining there's something I'm not doing enough of to prevent it, and probably something better I could be doing to get out of it if it does happen, but I haven't figured out what 😮‍💨

 

[MikeO]

8 hours ago, bumpkin said:

I feel like I've also more-or-less figured out how to recover from those numbers, but I don't have it down to a science, it's more like I'll recognize the presyncope

This is the most important can't count the number of times i have had to sit down right where i am standing even at the grocery store (sit on the floor and pretend i am looking at stuff of the bottom of the rack) @Pistolknows this one.

Like you i am not exactly sure why i get stuck in a rut at times but i found that taking a bolus of fluids does help and to keep moving and not stand in one place too long and not use the recliner helps.

my goto to correct low blood sugar is plain sugar water (4 cubes) and then back it up with some saltines and a little cheese or sausage.

Have you had a tilt table test yet?

[bumpkin]

@MikeO That's a really great method to avoid drawing unwanted attention, it probably gets interesting depending on what aisle you're in at the time 😄 I'm really too stubborn to just sit down whenever I should, but I always catch it in time and make it to the car, and thankfully have not fainted for it (the couple times that's happened in the past trained me pretty quickly on how to sense it coming on in advance).

I know it's important to sit but I have to credit the stubbornness with both keeping me going through the dysautonomia and through the times when I'm toeing that fine line between my body permitting me to stay on my feet a couple mins longer and running the risk of it suddenly overriding my will and removing the option.  I'm fortunate that the presyncope gives me enough warning and that I don't have the fainting as bad as other folks here have reported. I can sense it and can also sorta 'tough it out' and recover enough in the moment to delay needing to take a seat right then. But the cost of that is always the hypoperfusion episode that follows so I've gotten a lot better about sitting sooner. 

Haven't had a TTT but my doc has done the poor mans tilt on me a couple times, during the worst of my condition it was POTS, but that's been upgraded to just dysautonomia. 

And that's like the rule of thumb with hypoglycemia right? Straight-up sugar asap, and then after a few minutes pass you should throw down some kinda carb and protein to follow it up? Man I used to love me some saltines (when you've got GI issues it's really the little things when it comes to food lol) but ever since the dysautonomia symptoms worsened I can't seem to tolerate any kind of crackers or pretzels (the number of times I proverbially shot myself in the foot early on trying to correct an episode with the wrong carbs only to immediately cause myself another episode within the hour 💀) Sweet potato chips became my new go-to rescue carb, they're an acquired taste but I think they came up low-GI on Foodstruct so that's what I went with. 

[MikeO]

46 minutes ago, bumpkin said:

And that's like the rule of thumb with hypoglycemia right? Straight-up sugar asap, and then after a few minutes pass you should throw down some kinda carb and protein to follow it up?

yes the 15/15 rule 15 carbs (simple sugar) and wait 15 minutes. then back up with a few carbs (i do 8g with a protein) so for me this will keep my blood sugar even an stable and i will not end up with a overcorrection.

Of course you could just eat a meal as well.

I will have to look for the sweet potato chips i like trying new foods. I just bought some cauliflower crackers, has a bit of a funky taste to them.

[bumpkin]

11 hours ago, MikeO said:

yes the 15/15 rule 15 carbs (simple sugar) and wait 15 minutes. then back up with a few carbs (i do 8g with a protein) so for me this will keep my blood sugar even an stable and i will not end up with a overcorrection.

Of course you could just eat a meal as well.

I will have to look for the sweet potato chips i like trying new foods. I just bought some cauliflower crackers, has a bit of a funky taste to them.

Right, the thought of a meal at those times just tends to be intimidating cuz of the anticipation of the blood pooling to the stomach lol, but by the end of my frantic snacking effort it ends up almost being like a meal anyway. 

Yeah I like the sea salt sweet potato chips the best. The cauliflower food substitutes are weird ones, I tried cauliflower rice once and it was a no go, haven't touched cauliflower in its morphed forms since lol. I tried the cheddar almond crackers once and those were pretty tasty but I realized macro-wise I probably shouldn't have them again. It's so hard just to eat in this condition 😣

[Pistol]

@bumpkin @MikeO I used to be a RN in a hospital and for hypoglycemic episodes we would give OJ followed by peanut butter crackers.