Question of the Month: August, 2002

Dear Dr. Laule,

I thought I had hypoglycemia. I get weak and feel really shaky when I eat sugary things, and I have to carry a granola bar with me to eat so I can feel better when I have those spells. My doctor drew a blood sugar after I had not eaten all night, and felt fine. He said the blood sugar was normal so I don't have hypoglycemia. Wouldn't it be better to draw the blood sugar while I felt bad, like after I'd eaten some sugar? What do you think is wrong with me? What can I do to help me feel better? MT, Arkansas

Dear MT:

Science has gained a lot better understanding of hypoglycemia in the last 5-6 years. Some great studies out of Stanford Medical School in California have demonstrated the link between hypoglycemia, type II diabetes, and high serum insulin levels. You didn't say whether or not you have diabetes in the family, but if you do, your odds are even higher that your hypoglycemia is actually based on having higher than normal insulin levels. The underlying problem is called "peripheral insulin resistance," and I will explain this more in a moment.

Determining hypoglycemia from a blood test is difficult, and actually a fasting blood sugar will give very little information. The physicians at Stanford have developed a very elaborate protocol for determining the condition of insulin resistance. A 5-hour glucose tolerance test with insulin level determinations at each interval is helpful, though not perfect. For screening, a fasting glucose and insulin followed by a two-hour postprandial (2 hours after eating) glucose and insulin test catches some people with hypoglycemia. I recently saw a patient whose insulin level at one hour after drinking the sweet drink for a glucose tolerance test was 245. It should be around 20-30. At the two-hour blood draw her blood sugar had dropped to 40, which is quite low. But her symptoms were the worst at one hour, when her blood sugar was 144. One small study showed that people with symptoms of hypoglycemia had their symptoms occur when the insulin levels went up, not when the blood sugar dropped. I've even had one of my patients report being told by her doctor that hypoglycemia was not a real disease, it was a "designer disease," because he could never catch a low blood sugar.

Most of the time I make the diagnosis by the patient's history. I was taught in medical school that 90% of the diagnosis comes from listening to the patient. The laboratory then only confirms what you pretty well already know from taking a history. Sometimes I do lab, and sometimes I just don't feel the need, since most of the treatments I recommend are nontoxic and quite safe.

The mechanics of the blood sugar drop are this: The receptor for insulin on the surface of the muscle cells and the brain cells of the body erodes from genetic, dietary and environmental factors, and the insulin can no longer readily attach to it to usher the glucose from the blood into the cells where it is used as fuel for metabolism. The body has feedback systems, so when the cells are still starving after you've eaten sugar and the blood sugar is getting higher and higher, the pancreas gets a message to keep sending out more and more insulin until it finally overcomes the resistance at the cell receptor level. Then, with the body flooded with excessive insulin, the blood sugar plummets. The fact that the cells are starving for glucose, even while there is plenty in the blood, is part of the reason why you have sugar cravings. Eating a low carbohydrate diet, and plenty of protein which the body can turn into glucose more slowly will give a steadier supply and reduce the need for the pancreas to put out massive amounts of insulin. Complex carbohydrates also slow down the process, as will eating numerous small meals during the day. A recent study showed that women who ate 250-300 calories at a time, multiple times per day, did not have any excessive insulin rises from this eating pattern. DO NOT go with the diets that recommend only protein and fat, and no carbohydrates. Colorful fruits and a high variety of vegetables provide too many health benefits in addition to the carbohydrates they provide. Eating simple sugars, fruit juices, and white, refined sugar and flour are the things that elevate the serum insulin. Check out the term "glycemic index" on the internet, and you will learn more about diet.

One of the safest and most wonderful treatments for hypoglycemia is chromium, which is a modulator of blood sugar levels - in other words, it brings high levels down, and low levels up. Because some people with a family history of diabetes or hypoglycemia do not have enough of the enzyme to convert dietary chromium into the active form called Glucose Tolerance Factor (GTF), I cut straight to the chase so to speak, and recommend GTF chromium. This is readily available in health food stores. In addition, some people with sugar handling problems also have had problems with Candida and other yeasts, to the degree of developing highly symptomatic allergies to the yeasts, so I recommend a yeast-free form of GTF chromium. This form costs a little more, but I think it's worth it to find out if the chromium is going to help you. I've had people take a yeast derived GTF, and feel very bad on it. They then think it was the chromium and refuse to take any more of something that in actual fact could be very helpful to them. Once you have established that the GTF form works, then you can try the less expensive forms of yeast derived GTF, and even chromium picolinate. The dose I generally recommend for someone with a lot of symptoms of hypoglycemia is 200 mcg., one or two twice daily, with or without food.

There are other treatments, but I would not recommend these without knowing a little bit more about you. The yeast free GTF chromium is safe and an excellent place to start, and for many people the only treatment they need.

I hope you find this helpful.

To your good health and joyful living,

Alice R. Laule, M.D.

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