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Medical Edge Newspaper Column from Mayo Clinic
HYPOGLYCEMIA: AN INDICATOR TO ACT
DEAR MAYO CLINIC: What is hypoglycemia and how can one “get it” at age 78? —
Tucson, Ariz.
ANSWER: Hypoglycemia is a condition marked by an abnormally low level of blood sugar (glucose), your body’s main energy source. It is commonly associated with the treatment of diabetes, although people without diabetes can experience low blood sugar as well. Either way, hypoglycemia isn’t a disease itself but an indicator, like fever, of an underlying health problem.
I will assume here that you are not a diabetic, because if you were, you would not be asking this question. Hypoglycemia is familiar to people with diabetes — especially those treated with insulin — who are ever mindful of potential swings in blood sugar levels.
Before you seek the cause of your hypoglycemia, it’s important to document that this is indeed what you have. Many individuals who experience the typical hypoglycemic symptoms of tremor, sweating, anxiety or heart palpitations — having heard about hypoglycemia in the news, or being acquainted with a diabetic, or feeling better after eating — jump to the wrong conclusion. Such symptoms characterize a wide range of other conditions as well. When symptoms occur, you should give a blood sample — drawn from a vein rather than a finger stick (given the poor accuracy of the latter technique in the low blood sugar range). Laboratory analysis can then confirm whether the sample is low in glucose or not.
If it turns out that you do have hypoglycemia, its most frequent non-diabetic cause in someone your age is a drug taken for some other condition. For example, in the presence of kidney failure, the painkiller Darvocet (propoxyphene combined with acetaminophen) as well as the drugs Bactrim and Septra (sulfamethoxazole combined with trimethoprim) — used for treating urinary-tract infections — are common culprits. And quinine, often employed in North America for leg cramps, can cause hypoglycemia whether the individual has renal insufficiency or not. There is also the possibility of a drug mix-up — inadvertently taking medication meant for someone with diabetes.
“Treatment” in such cases simply involves reduction of dose, substitution or (if you have taken a wrong drug) elimination.
When drugs are excluded as a possibility, and the low blood-glucose level from your laboratory test is accompanied by an elevated insulin level analyzed from the same sample, then the cause could well be pancreatic in nature — perhaps a tumor or enlargement of the insulin-producing cells. If your insulin level is low, then the hypoglycemia is likely the result of a condition, such as renal failure or adrenal gland insufficiency, which will be readily apparent to your physician. In any case, further testing and medical treatment will then be needed to bring the underlying problem under control.
If it is not already apparent from the above discussion, let me emphasize that hypoglycemia in someone without diabetes needs evaluation and treatment. Hypoglycemia is merely a symptom, not a diagnosis, and a symptom of a possibly serious problem that must be addressed. So if you experience telltale signs such as confusion, abnormal behavior and visual disturbances (double or blurred vision, for example), please seek medical help right away. Or be sure to educate a family member, friend or colleague on your potential symptoms in advance so that he or she can help you get the attention you need.
— F. John Service, M.D., Ph.D., Endocrinology, Mayo Clinic, Rochester, Minn.
Additional Resources
Endocrinology
Hypoglycemia
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave.,
Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2006 TRIBUNE MEDIA SERVICES, INC.
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