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Suggest Treatment For Chronic Hypoglycemia

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Posted on Sat, 24 Dec 2016
Question: I was diagnosed with chronic hypoglycemia when I was 5 and again at 32. I have always eaten six small meals a day to control my blood sugar. I tend toward underweight, I never drink alcohol, I smoke 0 to 3 cigarettes a week, my blood pressure and cholesterol are under lovely control, there is no diabetes in my family, and I am 60. And suddenly my blood sugar is romping between 63 and 175. I don't eat simple sugars. My diet consists of complex carbs, lean proteins, fresh fruits, fresh vegetables, non fat milk, and caffeine free tea and coffee, fruit juice and bottled water. I take a bevy of pills and have a bevy of diagnoses. I get more exercise than most people do because I have to wear two layers of clothes, one under my leg braces and spine brae and one over them, and heavy leather shoes to stabilize the leg braces which go from my toes to mid thighs. Walking is, then, stressful exercise. My doctor is baffled. I am frustrated. We do a weekly blood draw and every week is a new XXXXXXX
doctor
Answered by Dr. Mirjeta Guni (13 minutes later)
Brief Answer:
Some more information is helpful.

Detailed Answer:
Hello,
I have gone carefully through your concerns.
Would you please give some information regarding to your actual weight, height and abdominal circumference.
How was your last HbA1c level?
At what time of the day occurs hypoglycemia more often?
What are your diagnosis and the medication you are taking actually?

Will be a pleasure to help you further.

Kind regards,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Mirjeta Guni (3 hours later)
5'3", 108 this am, 32 was my last HbA1C level, hypoglycemia has been, since age 5, a constant companion. It is of course the worst on waking, when it has become a habit to have a protein drink almost immediately.

I hope there's lots of room to type in this box for the meds and diagnoses:

Hypertension and a new friend: Edema: Amlodipine 10 mg, 1 and Losartan Potassium Preserving 100 mg, 1, HCTZ 50 mg, 1, Lasix 60 mg. 1

Osteoporosis: Calcium supplement, 600 mg (low for the condition because my diet is rich in milk, cheese and yogurt) and of course with the calcium Vitamin D3,
6000 IUs. Somewhat interactive back brace that makes my shoulders stay back and prevents bending forward.

General inflammation: Celebrex 200 mg, 1

Common sense: Multivitamin

Metabolism enhancer: Vitamin B complex, 1

Secondary Progressive Multiple Sclerosis: For word loss, Aricept 10 mg, 1, For incontinence, Detrol, 4 mg, 1; For spasticity, baclofen 10 mg, 6; For MS fatigue and Chronic Fatigue Syndrome, Provigil 200 mg, 3, Restless legs, Mirapex, 1.5 mg. 1, KAFO's (Knee, Ankle Foot braces custom made, both legs) make it possible for me to walk with forearm crutches to compensate for the balance loss caused by the KAFOs.

Sicca Syndrome: Pilocarpine, 5 mg, 3, Refresh Celluvisc, 1 ampoule each eye 2 times daily, best quality skin cream for dry skin patches.

Chronic potassium deficiency caused by chronic kidney failure level 1, caused by dehydration caused by two heat strokes in my life (we say that I can dehydrate just thinking about it): 10 meq, 22

GERD: Zantac, 50 mg, 3

Epilepsy: Keppra, 750 mg, 2

Narcotic induced constipation: Colace 2

Lumbar and T Spine degenerative disease: Norco 10-325, 3 and Tramadol, 50 mg, 6

Herpes: Valtrex 500 mg, 1

Cholesterol: Simvistatin 20 mg. 1

Two TIAs in the 1990s: Plavix, 75 mg, 1

Hysterectomy: Ogen, .75 mg, 1

Peripheral neuropathy (non diabetic and the deep nerve damage type best described as blow torches on my feet): Lidocaine cream

PRN: Dual Epi Pens for wasp/bee venom allergy, various OTC and prescription drugs for constipation and diarrhea.

Corneal dystrophy: 7 pair of glasses to get me through the progression of vision loss and regain, as cornea cells die, bundle, clear, form, die, bundle, clear, etc.

Glaucoma? It's been bandied about since I was 19 but we've never seen any damage. Instead of drops, we watch my pressures and when they hover at 30 or so, do laser surgery which brings my pressures down to 12 or so.

JC Virus: Present in my system so I am anaphylactic to any immune system suppressants.

Peripheral nerve damage (probably scar tissue in the hypothalamus resulting in white and purple hands when I'm not cold, long mistaken for Raynaud's): Nothing; I just wait for it to pass.

Vertigo upon entering or leaving a building with significant temperature changes: Grab bars at home, an assistant out in the wild and woolly world, and various grab bars in that wild and woolly world. (This is apparently hypothalamus damage again.)

I think that's it. It's quite a bit, actually. And still I am not a dark and angry creature. I have a very simple life philosophy. Cherish and savor what you have, snatch back what's been taken and can be recovered, and let the rest go gracefully.

XXXX
doctor
Answered by Dr. Mirjeta Guni (15 minutes later)
Brief Answer:
About causes of low blood sugar:

Detailed Answer:
Dear XXXXXXX
I can really understand your situation.
I appreciate your will and congratulate you for the whole courage you have shown during all these years.
Regarding to your actual concern, i would ask you to give some information regarding to insulin level and c peptid. I think you have checked them. What has been the lowest blood sugar you have had?
Did you exclude a low cortisol level?

Regards,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Mirjeta Guni (3 hours later)
The lowest ever recorded, fasting overnight after 10 pm and blood not drawn until noon the next day was 13. The highest has been 185. I don't even know what a cortisol level is. Or c peptid. My doctors have, except the two who have verified the hypoglycemia, pretty much dismissed it as a child's, young woman's, older woman's fantasy, in spite of my blood sugar, then never going higher than 55. One doctor, when I reported nasty dizziness, nausea and shaking after eating, said I should check my blood sugar. I laughed. When all I can manage is groping my way down the hallway, telling myself over and over again, DO NOT FALL, and drop face first into my bed, I hardly think I can prick my finger, wipe the blood on a strip, and insert it into the machine for a reading. So that never happened. I have had very little testing because doctors have not taken it seriously. Even the 13 was dismissed as, well, you were fasting. Does a normal person's blood sugar dive to 13 after fasting?
doctor
Answered by Dr. Mirjeta Guni (3 hours later)
Brief Answer:
The blood glucose you reported is too low.

Detailed Answer:
Hello again,
The levels you reported are very low.

Symptomatic hypoglycemia with blood glucose levels lower than 45 mg/dl should be evaluated further in details.

If blood test during the presence of the symptoms can not be drawn ambulatory, a 72-hour fast, usually supervised in a hospital setting, can be done to see if insulin levels fail to suppress, which is a strong indicator of the presence of an insulin-secreting tumor.
You should talk to your endocrinologist about this test.


Kind Regards,
Dr.Mirjeta
Note: For further follow-up, discuss your blood glucose reports with our diabetologist. Click here.

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
Answered by
Dr.
Dr. Mirjeta Guni

Endocrinologist

Practicing since :2006

Answered : 2414 Questions

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Suggest Treatment For Chronic Hypoglycemia

Brief Answer: Some more information is helpful. Detailed Answer: Hello, I have gone carefully through your concerns. Would you please give some information regarding to your actual weight, height and abdominal circumference. How was your last HbA1c level? At what time of the day occurs hypoglycemia more often? What are your diagnosis and the medication you are taking actually? Will be a pleasure to help you further. Kind regards, Dr.Mirjeta