Doc: ‘Hypoglycemic’ self-diagnosis may be inaccurate
Dear Dr. Roach: Please explain the difference between hypoglycemia and diabetes.
A few years ago, I had major surgery. After the surgery, I felt lightheaded and weak and when I relayed this information to a nurse, she came in with a large glass of orange juice, saying my sugar was down. I explained to the nurse that as a hypoglycemic I could not have orange juice, that she was to give me protein to bring down my insulin level and not try to bring up my sugar level.
I suggested she talk to my doctor.
Hypoglycemic people will have no problems as long as they don’t break the food and drink rules and follow a hypoglycemic diet. It is a great way to lose weight healthily.
Dear Anon.: “Hypoglycemia” means “low blood sugar.” It is most frequently seen in people with diabetes who take too much insulin or too much of a medicine that causes the body to make insulin.
This is more likely when someone isn’t eating his or her normal amount, or with ingestion of alcohol, which prevents the body from making sugar.
In people without diabetes, the most worrisome cause of hypoglycemia are tumors, which can secrete insulin or insulin-like hormones. The high insulin levels bring down blood sugar, sometimes to a very dangerous level, since the brain is absolutely dependent on sugar as an energy source.
Persistent very low sugar levels can cause irreversible brain damage and death, which is why the nurse wanted to give you orange juice (which is a fast way of getting sugar into the blood).
It’s absolutely the right immediate treatment in any case of severe hypoglycemia in someone who can still safely swallow. (Those who cannot swallow will need to get that sugar intravenously.)
Symptoms of hypoglycemia relate to the low sugar itself, and also to the body’s response. As blood sugar goes down, most people have symptoms of sweating, anxiety, hunger, tremor and palpitations. These are warning signs that remind us to go and get food.
However, if blood sugar gets below about 50 mg/dL (2.8 mmol/L), then people can become confused and sleepy. This is dangerous because they often are no longer able to get food (again, why the nurse wanted to give you orange juice).
A search for the cause of hypoglycemia should be undertaken in people with accurately measured severe low blood sugar (less than 40 mg/dL or 2.2 mmol/L) with symptoms that are relieved by raising blood sugar.
However, the vast majority of people with symptoms of hypoglycemia do not have this worrisome type of hypoglycemia. I suspect that what you have is now called “postprandial syndrome,” where blood sugar can “crash” after ingesting a large quantity of sugar, and can cause tremor, dry mouth and other symptoms.
These symptoms can be avoided by not consuming excess sugar and by eating meals that include protein, fat and fiber.
Email questions to ToYourGoodHealth@med.cornell.edu.