The medical twilight zone: Hypoglycemia

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Beth frequently suffered episodes of severe anxiety, indigestion, and an odd trembling weakness. She consulted her family physician who could find nothing wrong and labeled her symptoms a case of nerves. His recommendation? More rest and a mild tranquilizer. Prescription in hand, Beth accepted the diagnosis and left the doctor's office feeling reassured. She'll be back. She has just entered a medical twilight zone. Her ailment is not nerves. Her condition has been misdiagnosed. If she's lucky and persistent eventually she'll discover the name for her true problem. Even then her plight will not be over. The training her physician received will conflict with the latest observations of researchers. A test originally devised to detect the opposite of her condition will be used as a diagnostic tool. Disagreement will certainly exist over interpretation of that test. She may be referred to a mental health professional for her medical problem. It seems Beth has hypoglycemia. She is not alone. Estimates of the prevalence of hypoglycemia range from a small number to as high as 49.2 percent of the population of the United States and according to the Adrenal Metabolic Research Society of the Hypoglycemia Foundation, Beth may have to visit as many as twenty doctors and four psychiatrists before receiving accurate diagnosis and treatment.

What is hypoglycemia? Why does it generate such confusion? Can it be avoided?

First, a definition. "Hypoglycemia," Dr. Lynn J. Bennion, a certified specialist in endocrinology and metabolism writes in his book, Hypoglycemia Fact or Fad "is a condition in which the level of glucose in the blood is too low to meet the immediate energy needs of body tissues". Body and brain rebel, producing effects such as those which sent Beth to her doctor. The symptoms of hypoglycemia, or low blood sugar, can vary wildly from person to person and at different times in the same person. They include, but are not limited to, anxiety attacks, fatigue, dizziness, headaches, cold sweats, air hunger, blurred vision and lack of ability to concentrate.

Hypoglycemia generates rampant confusion for a number of reasons. Among them is the fact that there are different types of hypoglycemia. The first is reactive hypoglycemia. A subtype is idiopathic reactive of functional hypoglycemia. In easier to understand language, that means low blood sugar of unknown origin occurring after meals. Medical schools tend to be conservative institutions and have traditionally taught this concept. We learn the second type is fasting hypoglycemia. In attempts to make unknown concepts known research has revealed possible links to everything from early diabetes to cirrhosis of the liver. In between are inborn errors of metabolism, tumors of the pancreas, adrenal deficiency, malabsorption of food, and poor dietary intake, in particular the consumption of excessive amounts of refined sugar. Other factors compound the confusion. In Beth's case, her physician did not accurately name her problem because diagnosis is both simple and difficult. For this baffling condition, the glucose tolerance test until recent years was the only diagnostic tool available and is still the most widely used. In a glucose tolerance laboratory test, the suspected hypoglycemic fasts for eight hours then drinks a solution of very highly concentrated glucose. Thereafter blood samples are drawn hourly and the level of sugar in the blood is charted. If the blood sugar falls below a certain level the patient is presumed to be hypoglycemic. The difficulty with this test arises because it was originally devised to detect high blood sugar or diabetes. For that purpose, a three hour test is sufficient. But, low levels of blood sugar indicative of hypoglycemia are most likely to manifest themselves during the fourth, fifth or sixth hour of a glucose tolerance test. In Oklahoma City, Oklahoma a small informal survey of physicians board certified in family practice revealed that forty percent of the doctors responding administered a six hour test routinely when hypoglycemia was suspected, sixty percent elected to use a shorter version. None used the newer, more accurate method of testing blood sugar after the ingestion of a normal, balanced meal or the preferred technique of measuring blood sugar during actual symptoms. Both of the last two methods mentioned give a more realistic picture of the way an individual's system uses glucose. Just as physicians differ in their view of length of time needed for a glucose tolerance test, so do they disagree over the level of glucose in the blood which should be considered abnormal. In the same survey, readings of anywhere from 50 to 65 milligrams of sugar per deciliter of blood were mentioned as low. Other sources cite levels as low as 40 and as high as 70 milligrams as the point at which a diagnosis of low blood sugar should be made. Our body's metabolism, including the rate at which glucose in the system is used, is unique and individual differences must be taken into consideration. And each physician questioned in the Oklahoma City sample applied the same level to each patient in his practice. But, each physician chose a different level to apply. Hypoglycemia is a condition too diverse to be standardized and attempts to do so have only added to the confusion.

Can low blood sugar be avoided? Like so many questions surrounding hypoglycemia; the answer is yes and no. If the cause is adrenal deficiency or any of the other links now being studied by researchers, the underlying condition must be treated. Truly reactive or functional type genetics and individual differences in basic metabolism are prime considerations in the development of hypoglycemia and are beyond the control of the individual, but awareness of the dangers of highly refined sugar and poor nutrition is not. Healthful diet is the key and must be a prime goal in treating this reactive hypoglycemia. In general, the hypoglycemic requires a diet high in protein and low in carbohydrates. Refined sugar must be virtually eliminated. Both the amount of food and the timing of consumption must be tailored to the needs of each and every individual. Abandonment of three meals a day in favor of small frequent meals and healthful snacks is a helpful and often used tactic. The typical American catch as catch can method of eating, with emphasis on starches and carbonated drinks full of refined sugar, is not for the hypoglycemic. Correction of improper diet does much to eliminate the wide swings in blood sugar level responsible for so much of the misery of hypoglycemia. The same diet that functions to control hypoglycemic reactions also makes sense as a preventive measure.

A knowledgeable, understanding doctor and sound nutrition are essential for proper diagnosis and treatment, of course; but beyond that, the most useful tool of the hypoglycemic is education. Low blood sugar is both hopelessly complex and ridiculously simple to understand, but useful information about avoiding or living with this problem is available in popular literature. There are excellent books for newly-diagnosed hypoglycemics. Refer to the accompanying sidebar for a list of helpful books, then check your local libraries and bookstores.

One final word. According to Dr. J. Michael Lee, a practicing family physician, hypoglycemia "is not the panacea explaining all feelings of malaise". If hypoglycemia is a reality for you, refrain from using it as a catch-all excuse for every twitch and twinge. A cooperating doctor and patient are essential for egress from this medical twilight zone.

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By Vickie L. Kirkpatrick

Vickie Kirkpatrick is a freelance writer from Del City, Oklahoma.

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