A guy from school that I’ve been working with has been getting really light headed and dizzy, and not feeling well (trouble concentrating and being productive at work). We checked his blood sugar and got a reading of 69. He says he gets really anxious and angry and yells at his friend, but then he eats something and he’s fine. No Hx diabetes, but is taking medications that can effect BG. He’s doing readings to prepare for upcoming appointment. They have been between 69 and 150 over the last two days. Any advice/opinions?
How is their blood pressure? Are they checking that?
120/80. He’s super medically proactive. He checked. That was the first thing I asked a few weeks ago when we started discussing it because it was hot out and I assumed he was dehydrated. But, he’s been feeling like this for quite a while. - on and off. He’s spoken with the Docs. One dismissed his concerns. The other Doc was gonna send him to a neurologist to investigate the dizziness. No one has checked BG except us.
We might throw the Dexcom on him for a few days. He is anxious to figure this out. Worthy investigation because of he 69? I think the Doc might call that 80 within 20% variance of a BG machine. So, we are collecting more data. Within 10 min, he dropped from 150 to 90, which would make me dizzy. ??? But, maybe that’s common for nondiabetics.
It could be vascular in nature, i.e. the carotid arteries could be compromised. Dopplers are not painful or invasive, but they are expensive. A physician can listen to his carotid arteries and if they hear anything out of the norm (bruits), then they could order the test and depending upon his insurance, it could be covered.
It could also be something as simple as an electrolyte imbalance. A few blood tests can help determine that. If he is eating a ketogenic diet, he will want to increase his salt intake, which will help, more than hinder.
Just as a note - He is the most medically interesting man in the world. He’s got a lot going on. They sick a lot of medical residents on it. We hoping its something as simple as BG. https://www.youtube.com/watch?v=U18VkI0uDxE
It could be an insulinoma, a kind of tumor that secretes insulin and produces hypoglycemia. He should have a thorough medical investigation.
Hx Hep C, HIV, and bipolar disorder 1. Has been treated for all three. Currently being treated for the last two. Much exposure to DDT as a kid in Egypt, which his Doc and he believe has contributed to some problems. I found this: https://www.sciencedirect.com/science/article/pii/S2214999615013089
We suspect bipolar medications are creating erratic blood sugars, since its a know side effect. But, we will investigate further and he is scheduled for upcoming apt.
Do you anticipate any blood borne problems with us sharing a Dexcom sensor (since the parts are disposable)? I, personally, have had a bunch of MRSA infections within the last year and am a little worried that I am a carrier. Sharing a Dexcom sensor shouldn’t allow him to give me HIV or me to give him MRSA, right? He’s a computer programmer, so he is super interested in the device. @Tim35
I think us T1’s have built up a lot of tolerance to remain mostly functional during low and high bg’s. I think gluconormals are a lot more sensitive to bgs we would regard as only slightly low and thus they complain about hypoglycemia at 70 or something.
Me, when I have good hypo sensitivity, I can tell that I’m “not quite right” at 70. This is not a skill that gluconormals have.
Your friend might have some very slightly aberrant bg’s but for the most part he sounds like a gluconormal.
Not a doctor so really can’t answer this one but I have meet a few people over the years who do suffer from hypoglycemia. All of them have to eat every few hours or they start having symptoms like I use to get when I was low. Not sure how it is diagnosed but it is a medical condition.
I’ve seen people pass out from hypos. They were not diabetics - just hypoglycemics. Maybe this is a bias, but I tend to think of them as really skinny, younger women who get that. You think a 69 is low enough to be considered low? I mean, technically, thats low. But, not really, really, low. I sometimes have symptoms in the 70s.
What is strange is that we sorta expected to see high numbers, not low ones. When my best friend started new bipolar meds, we read the warnings, which included warnings about blood sugar issues. We took note of that because many of his mothers siblings had type 1. We also used to joke a lot about our conditions - that I gave him sympathetic diabetes and he gave me sympathetic bipolar disorder.
If I understand right, this guy has complex medical issues that might make it very hard to control his metabolism. His immediate problem is that his blood sugar levels are swinging wildly. He is taking medications that could cause this?
Half the things people have written below seem like they’d have nothing to do with this, such as low blood sugar and malfunctioning carotid arteries. The specific problem is swinging blood sugar levels.
Have you gotten the list of drugs he’s taking and asked a pharmacist specifically what effect they’re having on his blood sugar? And I’d try to get someone with him when he sees his doctor.
I’m thinking that his other medical problems, especially his bipolar disorder, is getting in the way of his ability to respond effectively, since if he feels lousy and he knows it’s low blood sugar a normal person would reach for some food or sugar. Unless you’re going to be telling him when to eat, this isn’t something you can fix. If he doesn’t have enough sense to come in out of the rain, so to speak, complex issues with his meds and his health aren’t likely to get dealt with properly, either.
Also, while it’s hard to say without knowing exactly what is causing the blood sugar swings, I wonder if he’s eating a balanced diet, and if he isn’t, he’s going to have blood sugar swings if he’s at all prone to them. It sounds like he has several serious illnesses - and both of them resulted from his mental instability.
I’m glad you want to help him, but there are likely to be limits to how successful you’re going to be. This guy has been crashing for a very long time.
If he’s on atypical antipsychotics (which I’m guessing at the bipolar meds you mention), which are known to cause insulin resistance, my guess is he’s experiencing early stages of medication-induced insulin resistance/pre-diabetes, which can involve lows as the pancreas overcompensates for the resistance. This is supported by the fact that he’s also having mild highs. If those meds are necessary though, he may not have much of a choice about it, but a lower carb diet probably would help, as might metformin. I wish more psychiatrists putting people on those meds would then instruct them to keep a better eye on their metabolic health/blood sugars, because this is a relatively common side effect. It’s more likely the treatment for bipolar that increases risk for T2, as well as potentially poor self-care associated with untreated bipolar, than the bipolar disorder itself directly.
The Johns Hopkins Medical website describes a reasonable clinical possibility to consider in such a case:
The pancreas makes insulin, which helps keep your blood sugar level balanced. Tumors on your pancreas, called insulinomas, make extra insulin, more than your body can use. This causes blood sugar levels to drop too low. These tumors are rare and usually do not spread to other parts of your body.
He’s super stable and proactive about his health. however, he has been dieting because he was worried about getting type 2. I have urged him not to do that and the numbers have been better this week - mostly in the 90’s or 100’s. I told him to carry a candy bar and check BG before driving…just in case.
We explored the mayo clinic option for a primary care provider, but his insurance is a “no go” there. Its been my experience that multiple chronic conditions are a mess and its really hard to find a provider that can properly address that stuff.
I feel for him because having a history of mental illness automatically makes doctors not listen to you. Its even worse for them than it is for diabetics. They tend to ignore physical symptoms and place everything squarely on the mind (which my friend did also until we talked). He’s gonna tend to blame mental variables because of his history and I tend to blame physical ones because of my experience with illness. So, we make a good team.
I recall my Doctors flatly ignoring my complaints that I was having seizures, even though I was an EMT. They refused to believe that I had any idea what a seizure was. It took me years to get an epilepsy diagnosis…and a set of really unfortunate and unnecessary circumstances where people were put at risk. I really want him at the Mayo. Any ideas?
Sure that’s possible, but a rare tumor is a lot less parsimonious of an explanation that a common side effect of a medication being used. Plus, you wouldn’t expect to see high values (150s) with an insulinoma.
I would suggest trying to reduce carbs somewhat (not overall calories) and perhaps even more importantly, make sure carbs are eaten with plenty of fats and protein which might stabilize things if it is insulin resistance. I wonder if his version of dieting was eating low fat, which might make things much worse if it meant high carb eating.
I don’t know if your friend needs Mayo so much as someone willing to order a glucose tolerance test, for starters, which if he’s on those kinds of meds, should be a reasonable thing to request. That would presumably show if he is spiking and then dropping due to insufficient immediate insulin responses followed by overcompensation. In my experience (as someone with medical conditions for which specialists and knowledgable general practitioners generally don’t exist), you can get by without a place like Mayo to manage multiple chronic conditions if you take a lot of control over your own medical care and get providers who will agree to order things for you, even if they don’t grasp the full picture.
That’s a great idea!
I often feel like a general contractor, balancing all of the various specialties. It would be awesome if there was one specialist who could look after it all, eh?
I feel like they are sending him down extravagant paths - like, suggesting a neurologist over complaints of feeling ‘light headed.’ He may try to change insurance plans during open enrollment and just get a primary care at Mayo after January, just to give a good, big picture evaluation. I will urge him to get a glucose tolerance test then.
I get frustrated with providers. If there are any hang ups or lack of solutions over the long term, I refer to Mayo because it is close to home and they usually get it worked out in an appointment or two. Things dont drag out into infinity. It a Doc has a question, they just ask a specialist that day. Super convenient.
His psych said he isn’t worried about those numbers - they are perfectly normal. He said diabetics are just more touchy about the 69 numbers because those numbers are low for diabetics. I kinda agree, but kinda disagree with that statement. Overall, its nothing urgent. But, worth looking into come winter.
I had the same symptoms–turns out it was a insulinoma-- Had a distial pancreatectomy which left me a TD1 anyway – and life goes on –