New Treatment for Reactive Hypoglycemia: Pioglitazone

An exciting piece of research came out of Japan in October of 2009 and was published in a Japanese Clinical Neurology journal called Rinnsho Shinkeigaku. The case study was of a nondiabetic, 20-year-old woman with myotonic dystrophy (an inherited, degenerative disorder) who suffered from reactive hypoglycemia. Her blood glucose level went down to 57 mg/dl at the 120 minute mark of an Oral Glucose Tolerance Test and she was diagnosed with reactive hypoglcyemia. Pioglitazone treatment improved her results on the Oral Glucose Tolerance Test and relieved her symptoms.

Pioglitazone is a drug used for the treatment of type 2 diabetes. It is what is called a “thiazolidinedione antidiabetic:” it lowers blood sugar by making cells more sensitive to insulin. By lowering the body’s sensitivity to insulin, pioglitazone also alleviates the major problem for reactive hypoglycemics: an over-reaction to high insulin and the resultant plummeting blood sugar levels.

Should this mean we should all rush out and ask for the drug? Probably not–but it’s wonderful that researchers are finally taking this disease seriously and looking for answers. It’s important also to note that use of Pioglitazone comes with certain risks, including an increased risk of heart failure. Reactive hypoglycemia comes with a host of unpleasant symptoms, but unlike type 2 diabetes isn’t life threatening. It’s worth considering whether your symptoms justify an increase in heart failure risk (along with all of the other side effects inherent in taking prescription medication).

Reference:
Yamamoto T, Oya Y, Furusawa Y, Nonaka I, Murata M. Successful treatment of recurrent hypoglycemia by pioglitazone in a patient with myotonic dystrophy] [Article in Japanese]Rinsho Shinkeigaku. 2009 Oct;49(10):641-5.[

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Chronic Hypoglycemia Symptoms

Hypoglycemia can cause a wide array of ever-changing symptoms. Chronic hypoglycemia may manifest as stomach ailments, lethargy, blackouts and seizures. The following article (published on EHow, where I am a contributing writer), lists the more common symptoms of chronic hypoglycemia. Read full article.

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What is Reactive Hypoglycemia?

I got an interesting letter in my mailbox last night from Martha in Tucson who asked me “what exactly is reactive hypoglycemia?” I realized that I’d put a lot of information out here on the blog, but nothing that states concisely what the condition is.

Simply put, reactive hypoglycemia is a blood sugar disorder; it’s a symptom of an underlying condition. You can read about the causes here, but most are benign (just bothersome!). If you have reactive hypoglycemia, your body’s gluco-regulatory system (the part of your body that turns food into fuel) does not operate normally. You will experience blood sugar highs that you probably won’t notice, and blood sugar lows that you most probably will (ranging from mild shakes and feeling ill, to severe nausea, fainting and even seizures). There’s more about symptoms here.

Please look around the site for more in depth answers–and welcome!

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Blood Sugar Support Supplements Part Two

Which Blood Sugar Supplements are the Best For Reactive Hypoglycemia?

There’s a whole lot of supplements out there, ranging from the cheap ($10 a bottle) to the expensive (over $100 a bottle). I spent days researching yesterday’s article, Blood Sugar Support Supplements Part One, in which I reviewed the benefits (or lack of benefits) of many common ingredients. Today, I’m going to take a look at several popular brands.
Read the rest of this entry »

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Blood Sugar Support Supplements Part One

The first time I saw a Blood Sugar Support Supplement was in Wal Mart. It was a mixture of cinnamon and ginseng with a few fruity extracts thrown in. I took them for a few days, and didn’t notice any difference in my overall health. They are sitting in my medicine cabinet barely touched, and this blog post is a reminder to myself that I need to throw that bottle out.

The promise of an all-natural blood sugar support supplement continues to be an alluring thought. The FDA does not control the supplements industry, meaning they can claim anything they like and do not need any proof of safety (unlike prescriptions). There’s no way of telling by their advertisements if their claims are true or false, and often the manufacturers “forget” to mention flawed studies (they’ll only tell you about the good ones).

I decided to do some research and find out exactly what the ingredients do in these supplements. Does the research bear out some of these manufacturers claims with regards to blood sugar control? How do these supplements pertain to reactive hypoglycemia?
Read the rest of this entry »

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Reactive Hypoglycemia’s Great Imitators

Leo and I went through about a dozen different diagnoses on our way to receiving a diagnosis of reactive hypoglycemia. They included: low blood pressure, anxiety disorder, bipolar disorder, “stress” and a handful more. In the past, people with RH. have been diagnosed with a host of disorders including behavioral disturbances, alcoholism, allergies, rheumatoid conditions, restless leg syndrome, anxiety neurosis, seizure disorders, hyperthyroidism, and cardiac arrhythmia.
Here are a some disorders that are commonly mistaken for RH.
Read the rest of this entry »

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The Prediabetes – Reactive Hypoglycemia Myth

I’ve read in dozens of articles across the internet that reactive hypoglycemia is one of the first signs of diabetes. According to many prominent researchers (including Achim Starke, MD and Jean-Frederic Brun), it isn’t. In a recent email to Dr. Brun, I asked him why reactive hypoglycemia is often linked to prediabetes. His response was that in “medical studies emphasis is always put on pathologic situations.” Most of the time, says Dr. Brun, prediabetic hypoglycemia occurs late after the meal (more than 4 hours) while reactive hypoglycemia (hypoglycemia at 2-3 hours) is “…on the opposite (lowered risk of diabetes).”

In other words, if you have true reactive hypoglycemia (with symptoms appearing at 2-3 hours), the statistics say you are more likely to have a lower risk of diabetes. This article will help explain why even my own doctor got it wrong.

How can so many physicians get it wrong? As a mathematician who teaches statistics classes at the college level, I have a pretty good idea. Read the rest of this entry »

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Why You Shouldn’t Believe Everything You Read on The Internet About Reactive Hypoglycemia

I’ve talked about how there’s a lot of bad information out there on the web about reactive hypoglycemia. One of the main culprits is reactivehypoglycemia.net. I skimmed through their site when I was first looking for information on reactive hypoglycemia. Here are just some of the errors I found hidden in their “information”:

• Error 1: Reactive Hypoglycemia can be caused by breast cancer and liver tumors

  While it’s true that some women undergoing treatment for cancer experience hypoglycemia, and that liver tumors can (rarely) be responsible for hypoglycemia, it’s important to know that hypoglycemia and reactive hypoglycemia are two separate conditions. For more on that subject, see my article Top Five Common Misconceptions About Reactive Hypoglycemia. A liver tumor (insulinoma) is a rare tumor (A New England Journal of Medicine article estimated this at four cases per 1 million person-years). So rare that doctors rarely consider it as a cause for reactive hypoglycemia. Patients are more likely to have “regular” hypoglycemia with insulinoma.

• Error 2: “Reactive Hypoglycemic is a medical condition with no known underlying medical problem such as diabetes.”
  It used to be that doctors didn’t know the cause, but most of the underlying physiological causes of reactive hypoglycemia are now known thanks to modern research. It is not correct to state that reactive hypoglycemia is a disease of unknown cause.  It may be hard to track it down, but there’s always a cause because reactive hypoglycemia is a set of symptoms, not a disease.
• Error 3: “the blood sugar drops irrespective of there[sic] food intake–this condition is referred to as reactive hypoglycemia”

  

  Reactive hypoglycemia is related to food intake. See this article here for a lengthy discussion about this topic.

• Error 4: “Avoid any form of breads or soups is also a good idea as they too contain high quantities of sugar in them”

  Wrong again! There are many varieties of soups and breads that are not adulterated with sugar. In fact, some sugars (fructose and evaporated cane juice) may not cause a hypoglycemic response. The problem is that you need to eat a balanced diet, as in carbs, protein, and fiber. Carb-heavy meals will set off your symptoms. See my article The Hypoglycemic Diet if you’d like to read more about what to eat and what not to eat.

• Error 5: Glucagen: “This hormone is the one mainly responsible for keeping the balance of levels of sugar in their blood”

  Actually, a complex cornucopia of glycoregulatory hormones is responsible for maintaining correct blood sugar levels. Insulin, epinephrine, and glucagen are three of the “main” regulators.

• Error 6: “Emergency Foods: Cup of Fat Free Milk, Tablespoon of honey or corn syrup, fruit juice or Regular soda, 2 tablespoons of jam and raisins, 7 small gumdrops, 8 Lifesavers”

  Rest assured that as bad as you feel when your blood sugar drops, there is a zero mortality rate with reactive hypoglycemia (the same is not true with diabetes related hypoglycemia, but that is an entirely different matter). If you do crash, do not eat candy or corn syrup unless you want to start the roller coaster off again. Choose a piece of whole grain toast, a small carton of juice, or if you feel really bad, a glucose tablet. Milk will not raise your blood sugar sufficiently to make you feel better. You need carbs!

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Reactive Hypoglycemia Caused my Son’s Nightmares

A Nightmarish Disorder

I had a recurring nightmare as a child. Every night I would take a bath, run out of the bathroom, and watch rats stream down the stairs and eat my grandmother. The nightmare changed over the years, but they were always terrifying, and woke me up frequently at 4 a.m. I was often unable to get back to sleep, and felt tired, irritable, and stressed through lack of sleep. My youngest son, Leo, inherited my disorder, and as early as 2-years-old would wake, screaming at 4 a.m. As he continued to have nightmares through his early years, if only we had realized we could have avoided our nightmares by a simple diagnosis and eating a slice of toast before bed. Our path to this discovery is long and winding, but one that many reactive hypoglycemics will recognize.
Some Moms are soccer moms. Some are karate moms. Myself? I’m an emergency room mom. My youngest son, Leo, went to the emergency room sixteen times before he was ten years old (my oldest son has only been to the ER once!). Leo’s unfortunate ability to fall off of tables, break bones, and walk into walls, combined with both of us suffering from frequent nightmares, plus my frequent ER visits for falls, “gas” palpitations, and panic attacks, is eventually what led to both of us getting a diagnosis of reactive hypoglycemia.

Panic Attacks

My first visit to the emergency room was for a panic attack back in 1990. I couldn’t breathe, my heart was beating so fast I thought it would burst, and I felt an incredible wave of foreboding, like this was the moment I was going to die. The ER doc gave me Valium, which calmed me down, but for the next 18 years I would struggle to ward of panic attacks, which would come at any time, any place. I was given a diagnosis of “anxiety disorder” and put on a drug–Buspar–for one year. I stopped taking it after I realized it wasn’t making me feel a whole lot better–it was just making me feel better about feeling panicky, if that makes sense. Some time later, my brother also started to have panic attacks. We thought that, considering my mom had also suffered from them, that we had some kind of hereditary anxiety disorder. This notion was cemented after my son, Leo, began to show signs of anxiety at an early age, especially fear of the dark.

Our Little Devil

Leo’s first visit to an ER was when, at age 1 1/2, he climbed up onto a kitchen table and fell off.He bashed his forehead and had a goose egg on his noggin for weeks. A week after the table incident, an almost identical accident occurred, leaving Leo with two “horns” on his head. The second time, we didn’t go to the ER. Just two days after our little devil had sprouted his horns, Leo investigated the dining room window sill, slipped off the box he had pushed over and climbed up on and caught his nose on a hook in the wall. The hook went up his nose, and as he fell down, ripped open his nostril. Blood gushed all over my shirt as we charged to the emergency room, just six blocks away, with Leo’s nostril flapping in the wind like a shirt tail. It took a plastic surgeon an hour to glue his nose back together, repairing his nostril with plastic surgery super glue.

Sixteen, and Counting

Leo can recall every time he went to the emergency room with a pride normally reserved for winning Tae Kwon Do tournaments. To me, it sounded like the Twelve Days of Christmas: four cuts stitched up, three major falls, two broken collar bones, one broken leg, and a grand mal after falling off a wall. Perhaps the most memorable was when he walked into a shovel and sliced off his ear, or when he walked into the nail sticking out of the deck (yes, really, he just walked into it. We’ve already explained that one to child welfare). The scariest was the grand mal when he fell off a wall. After the ambulance carried him to the ER, a cat scan, EEG, and several other expensive (and as it turns out, unecessary) tests revealed nothing. In the meantime, Leo would often look sickly, passing out at school when the weather got too hot in the Florida summer and often complaining of stomach aches or that he just wasn’t feeling well. Blood tests revealed nothing. Our Leo, said the doctors, was a healthy, normal little boy.

And Now, for Something Completely Different

I went to the ER in 2004 with heart palpitations. These weren’t the kind of palpitations that normally accompanied a panic attack. My heart was beating at a normal 70 beats per minute, and I didn’t feel stressed. But I could feel my heart jumping in my chest about every fourth or fifth beat, like it was struggling to beat. I felt calm as they escorted me to a room and connected me to a heart monitor. Whatever it was, I just wanted them to fix my heart. Two hours later, the doctor discharged me, blaming excess stomach gas for my palpitations. I went home with a bottle of Tums. The primary ingredient in Tums is sugar. While I assumed that the Tums were targeting my stomach gas, in reality they were working to raise my blood sugar level and stop the palpitations.

I would have marked my palpitations off as an isolated incident if it wasn’t for the following year, when I went to the doctor after about of flu, with my blood pressure down to 70/50. He immediately hooked me up to an IV, while I began to worry about some autoimmune disorder. I seemed to get sicker, for longer, than anyone else I knew. I often felt malaise, I sometimes went to bed for hours. Sometimes days. “It seems you’re always sick,” my husband said. Perhaps the biggest clue I missed as to what might be wrong with me is that my husband would take me out to a nice restaurant to “cheer me up.” After a nice meal, usually followed by a chocolatey desert, I always felt better.

Rosetta Stone

Leo had his second seizure about a year after his first, when he fainted while playing at a friend’s house. Unfortunately, we did not have health insurance because my husband had recently been laid off (my job as a part time college professor didn’t come with health insurance) and we could not afford the $1,000 a month Cobra premium. Seeing as Leo had already been through almost every major diagnostic test imaginable, we decided to wait until we had health insurance again before seeing the pediatrician. That’s when I began to really research his symptoms: nightmares, fainting spells, clumsiness, mood swings, general malaise, weakness, tiredness. The most common ailment that popped up in the search results was an anxiety disorder. But what, I asked myself, is a ten-year-old boy doing with an anxiety disorder? I read about multiple sclerosis, and fibromyalgia, and bipolar disorder, none of which explained the bizarre list of symptoms my son had. And then I found a post on a discussion forum which described the exact same symptoms my son had. A friendly poster suggested that it could be a disorder called “reactive hypoglycemia.”

“Food Allergies”

I had suffered from a severe “food allergy” for over a year at this point, and I couldn’t quite pin it down to a cause. I thought it was lactose intolerance (it turns out it was that, a little bit), but after cutting dairy out of my diet, a couple of hours after eating a meal, I would shiver and shake, sit on the toilet for half an hour with stomach cramps, experience blurred vision, and generally feel all over malaise. A handful of Tums would make me feel better, after a while. (Sugar raises blood glucose levels: Tums’s primary ingredient? You guessed it…sugar).

The Diagnosis

A month after Leo had his second seizure, we obtained private health insurance. His pediatrician recommended that we see a neurologist. I asked her is she thought it could be reactive hypoglycemia and she shook her head. “You should take him to a neurologist,” she said. “Two Grand Mals is something to be concerned about.” This is where I told a little white lie, and told her that I had been diagnosed with reactive hypoglycemia (I just omitted the fact it was a self diagnosis). I also told her that my policy had a $5000 deductible (true), and that I would appreciate it if she could give Leo a Test for Hypoglycemia to rule out reactive hypoglycemia before we went to a neurologist. She agreed, but I don’t think she was expecting the lab results to come back with a firm diagnosis of reactive hypoglycemia.

Peanut Butter and Toast

It’s been a month since Leo received his diagnosis of reactive hypoglycemia. I learned that when blood sugar levels plummet in the middle of the night, the body reacts to the panicky sensations by producing a nightmare. We changed both our diets, and include a slice of Ezekiel 4:9 bread (a high protein, low carb toast) with peanut butter before going to bed. I haven’t had a nightmare in that time: Leo had one, when he forgot to eat his toast before going to bed. We made other, significant changes to our diet, which you can read about in another article.

The Moral to the Story is…

I could fill a book with the bizarre health incidents that have happened to my family over the last two generations (yes, my mother most probably had reactive hypoglycemia as well, we think). If you or your family members have had a list of strange ailments and disorders like us, my advice is to write everything down, and if you think reactive hypoglycemia is the cause, be insistent with your doctor! It is difficult to obtain a diagnosis, but the test is remarkably easy and cheap (if you haven’t already, see my article on How to Obtain a Diagnosis for Reactive Hypoglycemia).

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Top Five Common Misconceptions About Reactive Hypoglycemia

1. Reactive Hypoglycemia is the same thing as Hypoglycemia.

They are not, and this distinction is extremely important because they are treated differently. According to the McKinley Health Center at the University of Illinois, reactive hypoglycemia can be managed with:

• nutritionally balanced meals, frequent meals and snacks
• Regular exercise
• Smoking cessation
• Weight management
• Medical supervision, if indicated
• Regular blood sugar checks, if advised

Perhaps most importantly, reactive hypoglycemia does not lead to a more severe condition. On the other hand, hypoglycemia (without the “reactive,” is often a sign of more severe disease such as pre-diabetes). Hypoglycemia is often treated by eating a low carb diet, but three meals a day instead of the six meals recommended for reactive hypoglycemics. That’s why it’s important to get a proper diagnosis…you will not feel better if you are reactive hypoglycemic and you follow a diet for hypoglycemics!

2. Reactive hypoglycemics cannot eat carrots or potatoes.

If you’ve read my article on How to Get Diagnosed for Reactive Hypoglycemia, you’ll have read that my doctor told me to avoid eating carrots. The misconception that carrots are a high glycemic index food and therefore should be avoided is simply untrue. I quote here from Yale-New Haven hospital:

“carrots have a glycemic index of 92 which is high. But, in a typical serving size of one-half cup, there is only 4.2 grams of carbohydrate. So, the calculated GL is only 3.9 which is low (GL = 92/100 X 4.2), showing that this food is unlikely to cause a disturbance in blood sugar or insulin response”

In plain English, don’t eat four cups of carrots in one sitting. The decision to eat, or not eat a food does bring up an interesting point. I’ve found that I can eat most foods in small quantities, if I balance those foods with something else. For example, I will eat potatoes in a vegetable soup…just not a whole baked potato on its own with butter.

3. If you have reactive hypoglycemia, avoid all soups–they’re too high in sugar.

Totally untrue. The key here is to read your labels. Compare Campbells’ Tomato Bisque with Amy’s Kitchen Chunky Tomato Bisque. They both have a similar sugar content: one serving of Amy’s soup has 14g of sugar obtained from High Fructose Corn Syrup, while one serving of Campbells’ has 15g of sugar obtained from High Fructose Corn Syrup. The difference is the type of sugar being used. High Fructose Corn Syrup (HFCS) has a High Glycemic Index, meaning that it has a big effect on your blood sugar level (this is bad because the aim here is to keep your blood sugar stable, not raise it to the kind of level that will necessitate a large crash). Evaporated Cane Sugar is an unrefined sugar which is quickly burned off as energy and has a negligible effect on blood sugar. The moral here is you can eat soup, but avoid soups that are sweetened with high fructose corn syrup or other refined sugars.

4. You can never eat bread again.

Pure rubbish. You just need to eat nutrient dense bread like Ezekiel’s 4:9 (available in the freezer section of my local Publix) or whole grain breads (check for no sugar or high fructose corn syrup). Pumpernickel and Sourdough tend to have a lower GI, but like any other food you consume as a reactive hypoglycemic, you should check your labels and avoid anything sweetened with sugar or high fructose corn syrup. Don’t be fooled by the label “whole grain” either. I made the mistake of purchasing a loaf from my local store thinking it was healthy, only to find it has HFCS. I stick almost exclusively to Ezekiel’s now…they have a great cinammon raisin variety and also make hamburger buns and English muffins. I never have a blood sugar spike after consuming these products.

5. Reactive Hypoglycemia can lead to diabetes, coma, and/or death.

See item #2: reactive hypoglycemia can make you feel like you need to be hopitalized, but it isn’t indicative of a serious health problem. There are extremely rare cases of coma and death in patients with other ailments such as Grave’s Disease, but unless you are one of these extremely rare individuals, you body will eventually recover and raid food stores to raise glucose levels back to normal, even if you don’t eat. Get your yearly blood work, and if all looks good, don’t worry about slipping into a coma…you have a better change of being killed by a cataclysmic storm (about 1 in 4,000 lifetime risk) than you do dying by anything vaguely related to your reactive hypoglycemia.

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