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Has typical hypoglycemia symptoms. Blood test showed normal results. Taking thyroid medication. Insulin test?

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My husband has typical hypoglycemia symptoms... that are most times relieved with sugar ( we use the candy called rockets) but when we test his blood sugar it's completely within the normal range. Certainly too our doc has indicated that the recent test done indicates that he is not indeed hypoglycemic. I've heard that doing an insulin test and not just a blood test may reveal some thinks for us. He is currently on Thyroid medication and after many years of the same dose, has recently had to increase it.
Posted Mon, 1 Jul 2013 in Thyroid Problem and Hormonal Problems
Answered by Dr. Shehzad Topiwala 1 hour later
True hypoglycemia is indeed a rare disorder, in a person without diabetes (who is not on medications that are capable of lowering blood glucose below normal).
Proof of hypoglycemia is a venous plasma glucose level of less than 65 mg/dl. Ideally symptoms need to be present along with improvement of symptoms following treatment with glucose source like food. This is known as the Whipple's triad.
Once this is documented, one can proceed to determine the cause. This usually entails performing a 'prolonged fast test' that requires fasting for upto 48-72 hours, until the blood glucose level drops below 55 and symptoms occur, at which point blood samples are taken for sophisticated blood tests like Insulin, C peptide etc

Occasionally, a condition called Reactive hypoglycemia can occur. it is a complex and sometimes vague entity that is associated with symptoms mimicking hypoglycemia but often there is no true hypoglycemia. It is believed to occur from a rapid decline in blood glucose levels. Typically this is preceded by an excursion in blood glucose such as following a carbohydrate XXXXXXX meal.

Evaluation of this condition can be challenging and is best dealt with by an endocrinologist in person. The thyroid can contribute to low glucose only if it is severely under-treated or untreated.
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Follow-up: Has typical hypoglycemia symptoms. Blood test showed normal results. Taking thyroid medication. Insulin test? 2 hours later
We are certainly under the care of an endocrinologist. He like you, has no specific answers for us as to why my husband might have hypoglycemic symptoms that resolve with sugar... aka rockets. Can you help me to understand if an insulin test might be our path forward?

I thank you,

Answered by Dr. Shehzad Topiwala 14 hours later
There is something called a mixed meal test which is again a fairly complex test to understand and perform, and hence is best conducted under an endocrinologists' supervision and guidance. You may wish to request your endocrinologist to consider doing this, per his or her discretion
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