“Rare” Form of Bipolar Disorder Results in Memory Loss and Seizures

All the signs pointed to my son, Leo, having bipolar disorder. His mood swings alternated between terrible periods of depression when he wanted to kill himself, less tumultuous “normal” periods when he was the sweetest kid on the block, and door-slamming, food-throwing temper tantrums that at age 10, were reminiscent of those days when I carted him out of Winn Dixie under my arm, with him screaming because he couldn’t have a bag of candy. These periods alternated from month to month. That, and the fact that I had been diagnosed and treated for bipolar disorder by one psychiatrist and three psychotherapists, Leo’s diagnosis seemed like a slam dunk: he had inherited my bipolar disorder. But how wrong the doctors were. He had inherited something…but it wasn’t bipolar disorder. It was a missing protein.
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Test Results From 5-Hour GTT

I got the results today from last week’s 5 Hour Glucose Tolerance Test (GTT). My endocrinologist told me that I had classic reactive hypoglycemia, for which there’s no pill and no cure. “I hate giving people this diagnosis,” he said, “because there’s nothing I can offer by way of treatment.” My glucose peaked at 135 mg/dL, then plummeted to 49 mg/dL (and possibly even lower).
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Why Test for Reactive Hypoglycemia?

I’ve had a couple of emails asking me, “Why test for reactive hypoglycemia?” Especially considering that it’s a benign condition. It doesn’t lead to diabetes. It doesn’t have mortality associated with it. And it has “minimal” morbidity. Essentially, even if you don’t follow a reactive hypoglycemia diet, the most you can probably expect is a continuation of symptoms, and feeling utterly miserable. So why the expensive tests?

There are three reasons to test:

1. So that you have a diagnosis for reactive hypoglycemia and can therefore treat it

   Prediabetics and “regular” hypoglycemics need to follow one kind of diet (I’ve heard The Atkins, Paleo, and Low GI-diets work for some), but reactive hypoglycemics need to follow a stricter diet that involves, amongst other things, eating every two hours.

2. So that a more serious disorder doesn’t go undetected

   You might think you have reactive hypoglycemia, but what if you have a more serious disorder, like prediabetes, atrial fibulation, or insulinoma? The only way to tell if you have the high insulin sensitivity associated with RH or the low insulin sensitivity associated with prediabetes is to get tested using the Hyperglucidic Breakfast Test.

3. To avoid unnecessary–and expensive, tests for epilepsy or other neurological disorders

   Reactive hypoglycemia has, historically, been mistaken for bipolar disorder, personality disorder, epilepsy, and other diseases. My son, Leo, had already had a CAT scan, an EEG, and many emergency room trips before being diagnosed with reactive hypoglycemia. You can read about his upmteen emergency room trips here. His pediatrician referred him to a neurologist and we were well on our way to a diagnosis of epilepsy or other seizure disorder before I figured out that he might have RH.
   

4. Reactive hypoglycemia may be hereditary

   Unfortunately, Leo and I do not know the exact mechanism that has caused us to have the disorder. It’s probably hereditary–a missing enzyme or wonky gene perhaps? Either way, he can look for signs in his children, so that they don’t end up in the emergency room, or go through miserable periods of time in elementary school, passing out on the playground and seizing in front of his friends. A firm diagnosis of RH also saved us from spending thousands more on tests, and I hope the info on this site might save someone else from following the same path…

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Reactive Hypoglycemia

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The Reactive Hypoglycemia Test

There are a few tests your doctor might recommend you take to diagnose reactive hypoglycemia. As discussed in my article How To Get Diagnosed for Reactive Hypoglycemia, there really are only two ways this can be done (Hyperglucidic Breakfast Test and at Home). There are a couple of others your doctor might recommend. Here are their descriptions.

Hyperglucidic Breakfast Test

In this test a patient is given a meal of of bread (80 g), butter (10 g), jam, skimmed concentrated milk (80 ml), sugar (10g) and powdered coffee (2.5 g), equivalent to a typical high-carb symptom inducing meal: 9.1% protein, 27.5% fat, and 63.4% carbohydrates. Your blood will be drawn at s everal intervals after the test, which is considered the “standard” in testing for reactive hypoglycemia. Why is this the best test? In a recent email to me, researcher Dr. Jean-Frederic Brun told me that reactive hypoglycemia is caused by high insulin sensitivity (and a lower risk of diabetes) whereas the type of hypoglycemia usually seen in prediabetics is caused by low insulin sensitivity. This test will be able to tell the difference.

Ambulatory Glucose Sampling

An at home test. You can do this yourself, if you are comfortable and familiar with blood glucose monitors, or your physician may ask you to perform the test under his guidance. When symptoms occur (sweating, shakiness, palpitations etc.), you sample your blood glucose and note the level. You should also consume sugar/carbs, and note if it alleviates the symptoms. A drawback with this method is that by the time you experience symptoms, your body may already be compensating for too much insulin, and raising your blood glucose levels–by the time you prick your finger, your blood glucose level may already be above the threshold for a reactive hypoglycemia diagnosis.

The Glucose Tolerance Test

The most widely used test, but due to the fact that ten percent of people who take this test will have false positive results, it is not valid as a stand alone test for reactive hypoglycemia (see page 366 of this Clinical Biochemistry book for more on this). You will be asked to drink a glucose drink, then your blood will be tested regularly (every 1/2 hour or hour for as long as 3-5 hours after consuming the drink). Although this is the most widely used test, the high number of false positives also makes it one of the most unreliable tests and should not be used as a sole tool for diagnostic purposes.*
If do do have this test, make sure your doctor orders your insulin levels to be tested as well.

The Breakfast Test

Also not a valid test. Similar to a GTT, with a breakfast test you will be asked to consume a “meal” and your blood will be drawn at intervals. Numerous problems have been cited with this test, including the fact that patients with reactive hypoglycemia rarely have symptoms or a blood glucose drop with this test, which consists of a balanced meal, and not the high-carb meal which typically produces symptoms.

A 42-72 hour fast

Done in a hospital setting, this test is used to diagnose a rare pancreatic tumor called insulinoma. It is so rare a tumor, and so expensive a test, that you will most probably never be asked to have this test done.

The Hypoglycemic Index

A blood test that many researchers have concluded as having no value in the diagnosis of reactive hypoglycemia. If you are ever asked to have this test done to diagnose your reactive hypoglycemia, refer your physician to this article. *see Lev-Ran A, Anderson RW. The diagnosis of postprandial Hypoglycemia. Diabetes, 1981, 30, 996-999

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Top Ten Signs That You May Have Reactive Hypoglycemia

Do you have an array of vague, seemingly unrelated symptoms that you think might be reactive hypoglycemia? According to the Merck Medical Manual, Hypoglycemia is generally considered to be blood glucose levels of below 50 mg/dL. Read the following list of symptoms; if this sounds like you, you may have this condition.This list isn’t exhaustive, and just because you have some (or all) of the ailments on this list doesn’t necessarily mean you have reactive hypoglycemia. A diagnosis for this disorder is like a puzzle: the more pieces you have, the better armed you are to see the big picture of what might be causing your health issued.

1. Do you have a “food allergy” or frequent stomach upsets but you can’t pinpoint the cause?

   One of the first signs that your blood sugar is dropping can be feeling sick to your stomach. But a drop in blood sugar isn’t visible. Perhaps it’s lactose intolerance, you think. So you avoid pizza and lasagna. Or it’s a sensitivity to gluten, so you stop eating bread. But you still get ill, and blame food poisoning, or “bad food” or “stress”. Whatever food is making you feel “ill,” you’ve been unable to adjust your diet to feel better.

2. Do your hands shake after meals? Two hours after meals? Three hours after meals?

   Trembling, shaking, cold hands/feet, and a cold nose can all be signs of low blood sugar. My hands and feet would tremble 2 1/2 hours after high carb meals, like I was naked in Antarctica. I had no idea that a glass of apple juice and a piece of toast would stop the shakes in ten minutes.

3. Do you seem unusually clumsy when compared to everyone else?

   

   Your clumsiness or “butterfingers” may be more than you’re just uncoordinated: people with reactive hypoglycemia are also often clumsy. There’s a whole article I wrote about clumsiness and reactive hypoglycemia, and you can find it here. My son, Leo, went to the emergency room sixteen times for various falls, broken bones, and even a fall with a seizure before he was diagnosed with reactive hypoglycemia.

4. Do you often feel faint and have to sit down?

   Feeling dizzy or faint, especially if you feel better after drinking juice, is a sign of low blood sugar. I used to get dizzy in grocery stores, and I would drink juice to feel better. My son complained of feeling like he would pass out frequently (and often did). I have passed out on many occassions: getting my blood drawn, out at a dance club…before realizing that the “fainting” occured hours after a meal.

5. Do you crave sugary foods like chocolate cake, candy, cookies, or sodas?

   Most people like a slice of cake, but craving sweet foods might be a sign you have reactive hypoglycemia. Before my diagnosis, I used to crave sugar-loaded foods like chocolate cake from my local coffee shop, smothered with sugary frosting. I would swear that the cake would lift my mood. And the truth was…it did. It elevated my blood sugar levels and made me feel better. The trouble is with cake and refined sugar, is that mood elevation was only temporary, and soon I would be on a “down” and craving sweets again.

6. Do you suffer from sweaty hands?

   Sure, there are many reasons for sweaty hands, but that could also the first sign of blood sugar levels dropping for me. My husband always knows it’s time for me to have a snack when he holds my hand and it’s cold and clammy.

7. Have you had panic attacks, or have you been diagnosed with a panic disorder?

   Those panic attacks might not be due to stress at work. I have suffered from panic attacks for years, and so has my brother. We thought it was a family disorder. I even went on medication (Buspar) for a year. But I never could shake the feeling of feeling frequently nervous and shaky. I’d have heart palpitations and stomach churning and trouble breathing…all symptoms of a low blood sugar crash. If you have had panic attacks and are an anxious person, think about when these attacks happen. If they tend to occur after meals (1-3 hours after), and you feel that perhaps the diagnosis doesn’t quite “fit”, you may have this disorder.

8. Do you get hungry to the point of feeling ill?

   

   Does your hunger consume you? If you often get a feeling of starvation, that is, you have to eat now or you’re going to die…this could be a sign of a blood sugar problem, especially if you find yourself craving carbs.

9. Do you often have trouble thinking straight?

   Mental confusion often occurs with low blood sugar. In fact, the lower blood sugar gets, the more the brain struggles to operate. My family has always called me “scatterbrained” and “forgetful.” I forgot birthdays. I forgot where I put my car keys. I forgot names. As I reached my forties, I would joke it was “early Alzheimers.” Once I was diagnosed with reactive hypoglycemia and began to treat my disorder, my “confused” symptoms diminished.

10. Do you have unexplained mood swings?

    Mood swings go hand in hand with uncontrolled reactive hypoglycemia. Do you have mood swings that cannot be explained by pre-menstrual syndrome, bipolar disorder, or other ailment? Does your stress level not seem to be commensurate with your ability to throw dishes, slam doors, and burst into tears?

This is only a partial list of symptoms. People with reactive hypoglycemia have listed up to an astonishing sixty different symptoms. It takes only a little time and cash to be tested (actually, you can do it for free if you follow the advice in my article How to Get Diagnosed With Reactive Hypoglycemia, and send off for a “sample” blood glucose monitor). What do you have to lose?

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How To Get Diagnosed for Reactive Hypoglycemia

If you think you might have the condition (click here for the top ten signs you may have reactive hypoglycemia), you should read this before you make an appointment with your doctor.

Let me first tell you that I knew my symptoms were reactive hypoglycemia before I went to the doctor. My ten-year-old son, Leo, has the condition, so it wasn’t difficult to figure out what might be causing my mental confusion, mood swings, heart palpitations, hand tremors, cold sweats and anxiety two hours after eating pizza. My doctor, however, had other ideas…

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