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Chapter 176 Hypoglycemia and anorexia nervosa has been a reported to be cause in the literature. Reactive hypoglycemia may also result from the use of oral hypoglycemic drugs. These sulfa drugs (sulfonylureas) appear to stimulate the secretion of additional insulin by the pancreas as well to as enhance the sensitivity of body tissues to insulin. Common examples of this class of drugs are listed in . – Because glucose is the primary fuel for the brain, low The normal fasting blood glucose level is between 65 and 100 mg/dL. A fasting plasma blood glucose measurement greater than 126 mg/dL on two separate occasions is diagnostic of diabetes. Although the most specific criterion for the presence of hypoglycemia is a blood glucose level of 40 mg/dL or less, a blood glucose level below 50 mg/dL should arouse clinical suspicion. explains in detail how to interpret the results of a GTT. Diagnosis Response Normal No elevation >200 mg<200 mg at the end of the first hour<140 mg at the end of thesecond hourNever <20 mg below fasting Flat No variation more than ± 20 mg from fasting value Prediabetic >140 mg at the end of the second hour Diabetic ≥200 mg at the end of the second hour Reactive hypoglycemia A normal 2- or 3-hour response curve, followed by a decrease of ≥20 mg from the fasting level during the final hours Probable reactive hypoglycemia A normal 2- or 3-hour response curve, followed by a decrease of 10-20 mg from the fasting level during the final hours Flat hypoglycemia An elevation of >20 mg, followed by a decrease of ≥20 mg below the fasting level Prediabetic hypoglycemia A 2-hour response identical to the hypoglycemic prediabetic response but showing a hypoglycemic response during the final 3 hours Hyperinsulinism A marked hypoglycemic response with a value of <50 mg during the third, fourth, or fifth hour Many of the symptoms linked to hypoglycemia appear to be the result of increases in insulin or epinephrine. Therefore, it has been recommended that insulinor epinephrine (adrenaline) be measured during a GTT because symptoms often correlate better with elevations in these hormones than with glucose levels. Several studies have shown that the glucose-insulin tolerance test (G-ITT) leads to a greater sensitivity in the diagnosis of both hypoglycemia and diabetes than the standard GTT. As many as two thirds of subjects with suspected diabetes or hypoglycemia who have normal GTTs will demonstrate abnormal insulin tolerance tests. lists the various patterns seen with the G-ITT. PATTERN RESPONSE Pattern 1 Normal fasting insulin 0-30 units. Peak insulin at 0.5-1 hour. The combined insulin values for the second and third hours is <60 units. This pattern is considered normal. Pattern 2 Normal fasting insulin. Peak at 0.5-1 hour with a “delayed return to normal.” Second- and third-hour levels between 60 and 100 units are usually associated with hypoglycemia and are considered borderline for diabetes; values >100 units considered definite diabetes.Pattern 3 Normal fasting insulin. Definite diabetes. Pattern 4 High fasting insulin. Definite diabetes. Pattern 5 Low insulin response. All tested values for insulin < 30. If this response is associated with elevated blood sugar levels, it probably indicates insulin-dependent diabetes (“juvenile pattern”). ). In such cases, symptoms of hypoglycemia can range from mild to severe and include such things as food cravings, headache, depression, anxiety, irritability, blurred vision, excessive sweating, and mental confusion. Courtesy of Dr. Michael Lyon. These authors also believe that such volatility is at the heart of most weight problems. Their data indicate that rapidly fluctuating blood sugar levels are generally related to some degree of insulin resistance and made worse by more than moderate consumption of foods with a high glycemic impact. is an excellent screening method for hypoglycemia. was linked to hypoglycemia. Although all of these symptoms may be due to hypoglycemia, thereare obviously other causes in many cases. The tremendous public interest in hypoglycemia and sugar intake was fueled by a number of popular books like Sugar Blues, by William Duffy; Hope for Hypoglycemia, by Broda Barnes; and Sweet and Dangerous, by John Yudkin. The popularity of these books and the diagnosis of hypoglycemia were met with much skepticism from the medical community. Editorials in the Journal of the American Medical Association and the New England Journal of Medicine during the 1970s denounced this public interest in hypoglycemia and tried to invalidate the concept. Although most medical and health organizations as well as the U.S. government have recommended that no more than 10% of the total caloric intake be derived from refined sugars added to foods, added sugar accounts for roughly 30% of the total calories consumed by most Americans. The average American consumes more than 100 lb of sucrose and 40 lb of high-fructose corn syrup each year. This sugar addiction playsa major role in the high prevalence of ill health and chronic disease in the United States. Buy Membership for Complementary Medicine Category to continue reading.