Case Studies in Hypoglycemia


I have had severe hypoglycemia for at least 5 years now. I have been to several Dr.'s over the period, only to find out I have Hypoglycemia, but "why?" This short writing is to let you know that there might be more the hypoglycemia than meets the eye. I am only a layman who has the disease, so what I say is just experience, not any great relavation or even proof. Keep in mind that hypoglycemia can have other causes, and what I am finding out about me is not necessarily related to what your cause is. However, there is growing evidence that non-diabetic related hypoglycemia could be caused by hormonal imbalances.

The diagnosis I have gotten so far is Adrenal Insufficiency or "Addison's Disease". It is so far a degree of Addison's, not the full blown disease. One of the side affects is fasting hypoglycemia, and no diet seems to help entirely, although some things are not as bad as others. Adrenal Insufficiency is a deficiency in Cortisone, Hydro Cortisone, and sometimes DHEA and other mineral steroids. The symptoms can be a combination of some of the following:

- Weakness - Fatigue - Weight Loss - Nausea and vomiting - Anorexia - Chronic diarrhea - Bronse coloration of the skin. - Darkening of scars and areas of vitiligo (absence of pigmentation) - Cardiovasular abnormalities - Descreased tolerance for even minor stress - Poor coordination - Fasting Hypoglycemia (and of course all of its symptoms) - Craving for salty food

The person who has this can go into a state called Adrenal Crisis. This usually occurs during times of infections (flu, cold, etc.). When it occurs, the following happens:

- Profound weakness and fatigue - Severe nausea and vomiting - Hypotension - Dehydration - Occasional high fever.

If an adrenal crisis is left unchecked, it can lead to a coma, and death from dehydration, and lack of proper levels of glucocorticoids (like cortisone). Blood pressure will often drop also.

The diagnosis for Adrenal Insufficiency at the severe stages is a 24 hour urine collection for 17-ketosteroids and 17-hydoxycoritcosteroids. The first 24 hrs a baseline test is taken. Then you are shot up with an adrenal stimulator (ACTH) and a 2nd 24 hour urine test is made. Normally, a rise of at least 200% will result from the first 24hr period to the 2nd 24hr period. If not, then adrenal insufficiency is a suspect. Blood Urea Nitrogen (BUN) level is increased. Let me warn anybody seeing this, that accept in extreme cases of Adrenal Insufficiency, these diagnostic tests will most likely not pick up Adrenal Insufficiency. In addition, if you have Hypoglycemia during the test, you adrenals will often pump out large amounts of steriods for a short period of time, to compensate for the Hypoglycemia and average out the 24hr test, since these steroids (the glucocorticoids) are Blood Sugar Regulators also. As a result, a standard Endo might give a clean bill of health!!! I went to a Holostic Dr. and they use a test called an ASI (Adrenal Stress Index Test). This test is very sensitive and measures four points in time from the saliva. It will tell you your steroid levels at those four particular points in time. Due to it's high level of sensitivity, if you have Hypoglycemia during one of the four points, you will often see extreme high levels of cortisone output on one point, and below normal levels at other points. However, just the fact that the steroid levels are up and down so much suggests a problem. The diagnosis is not easy unless you have such a severe case that thestandard tests can find it.

The cure is physiological (another words, normal body levels) levels of cortisone, or a cortisone derivative in doses up to 20mg (of hydrocortisone, or the equivellent in a synthetic), split up in 2-4 doses dialy (ie, 4 doses of 5mg daily). In addition, other hormones like DHEA, and a mineral steroid may be needed. I personally tried hydrocortisone (and you body needs this to survive) in 4 doses of 5 mg daily for about 2.5 months. The improvement was dramatic. The hypoglycemia slowly dissapeared entirely. In a normal day before the HC (hydrocortisone), I would often have a Blood Sugar of 65 just 45 minutes after eating. So I had reactive hypoglycemia in addition to fasting hypoglycemia. Other times I could measure the BS and find it at 56-59 just 1 hr after eating, and with certain foods it would go as high as 165 before plummeting. I had serious headaches almost continuously. The confusion for me came when I had terrible flu-like symptoms, and hypoglycemia was not present. In addition, I would go outside and work, and be extremely weak, dizzy, headachy, short tempered, and depressed for at least 4 hrs after to much physical stress. I never felt well. My muscles would ache so much that just walking was a terrible strain. I couldn't so much as touch any grains or complex carbo hydrate without an immediate and powerfull hypoglycemia response. After the cortisone, my blood sugar was rarely below 83, and I couldn't force it above 120 with the foods that made it go high beforehand. I also felt like a new person. But, I wanted more emperical proof, so I got off the cortisone entirely, now for about 2 months to finish some testing. The symptoms have returned slowly, and of this writing are getting stronger every day, though not back to the pre-cortisone level. The other day I worked out in 85 degree heat for 45 minutes and had very strong veritigo (spinning motion), and got what felt like a full fledged flu. While I was on the cortisone I experimented (with the Dr's consent) with higher doses during a bad cold I had. When your body gets stressed from infections, the level of cortisone need goes up dramatically. So people who have even mild Adrenal Insufficiency will often not be able to output the levels required naturally, and go into an adrenal crisis. This being the case, a higher dose of hydrocortisone is required to get out of the crisis mode. I tried it, and it worked!!

As I look back, I find plenty of evidence that this is most likely what I have. The christmas before last I got a flu (real influenza) and had to be walked to the bathroom on a couple of occasions. I collapsed and was almost unconsious for three days. I felt as if I would die because I was so weak and dilerious. In 1990, I went on a stressfull mission to Argentina and caught a terrible unknown disease (of which no virus, bacteria or parasites were ever found). I was very sick just like the flu above. We hadn't eaten for several hours at a time, and didn't rest much either. My hosts gave me orange juice during the sickness, and upon looking back that only added to the complication by producing more hypoglycemia. When I got back into the US, I was hospitalized with dehydration, and no disease was ever found. I even went to a jungle specialist, during the same period for testing, no answers, nothing found. It took over 3 months to fully recover. On several business trips I got the same sickness, and once was ready to call an ambulance, but chickened out due to fear. Another business trip, and broke out in a strange rash and felt like I was having a heart attack, and ended up at emergency. My blood pressure was 146/98, and my BUN was very high. In addition, other things like salt were out of balance.

I'll conclude with saying, don't stop looking for solutions, and be open to other causes that you my never have expected. I still am not 100% sure that adrenal insufficiency isn't just some symptom of another problem. I do know this, the cure works and the danger of 20mg of cortisone daily is fully documented to be almost non-existent. The Dr. who wrote the book I quoted above, has over a thousand patient years of proof of no side affects from cortisone. I called him on the phone about 2 months ago, and he told me about a patient of his for 40 years (he is no longer young!!) who has been taking 20mg of cortisone and living a perfectly normal life. Anyway, don't give up on the search and make sure you keep a journal of every symptom, blood pressures, and whatever else you can document. Eventually, the pieces of the puzzle start to fit.

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This page was last updated on 10 August 1995.
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