Hypoglycemia Association, Inc

This bulletin is not meant to be medical advice. It is written by lay people, dedicated to helping those with hypoglycemia. All cases are individual. If you need medical advice, see your physician.

Many people don't mind a moderate amount of suffering if they can precede it with some pleasure; the sweet taste of a piece of candy, the warm glow from alcohol, the stimulation of caffeine in coffee and soft drinks and the good feeling one gets from a drag on a cigarette or cigar. All of these good feelings occur when the substance causes a rise in the level of blood sugar. There are other things which can produce these feelings of euphoria but, when the substances are used over and over again, it is possible that the adrenal cortex, which has a lot to do with the regulation of blood sugar, can become exhausted. Also, the pancreas may overproduce insulin causing blood sugar to drop too low with symptoms resulting. Then the liver may not have any more stored glycogen (blood sugar) for emergencies. Complaints are forthcoming, saying, "What has happened to me? I can't get those good feelings any more. All I get is the shakes or headaches or whatever." Most of us have done these things to ourselves, so there is no need to feel guilty, just get on with business of correcting the situation.

HAI explains this over and over again, hoping to get through to some, especially teens and college students, that damage done cannot always be repaired completely and the benefits of avoiding doing that damage in the first place are immeasurable. A recent letter from Golenta, CA gave us warm feelings, "Although I and several of my friends have not received a hypoglycemia diagnosis, we have found that watching our sugar intake has helped our health greatly. I would like to know if there is a local chapter of HAI or support groups that would have speakers?" (Sorry, no)

Joseph D. Campbell, PhD, British Columbia, explains in the Townsend Letter for Doctors and Patients, April, 1996, "Sugar addiction usually begins with children. Parents, grandparents, and other relatives, unwittingly bribe them by giving them candy, gum, and many other forms of sugar. Day care centers, even church socials too often exhibit an over-generosity with sweet 'goodies.' Food industries and others have succeeded in getting sugar into may innocent sounding foods such as catsup, condensed and chocolate milk, cough drops and syrup, sherbets, yogurt, sweetened drinks and many cold cereals." He believes that the modern diet can lead to other addictions such as alcoholism.

Reynolds Price, Duke University Professor of English, lambasted students for their "blank faces" in class. He said, "If you listen to students, you'll hear one sentence more than any other: 'I can't believe how drunk I was last night.' For five months the dean of the Duke Chapel cruised with the campus police. He released a 32 page report. In one incident, he witnessed the students reveling around a bonfire fueled with campus benches. (Perhaps if they visited an intensive care unit where long-term alcohol abusers are treated, it might open their eyes. To open your eyes see the next paragraph.) (Balt. Sun 12/15/93)

The Journal of Critical Illness, May 1966, Cliggot Publishing Co., 55 Holly Hill Lane, Box 4010, Greenwich, CT 06831, describe the ICU as a hostile environment for all patients. There is continuous activity with bright lights and loud noises, especially at night. Uninterrupted sleep is virtually unknown. Pain, fear, anxiety, and psychological stress all contribute to this sleep deprivation and fragmentation, which can lead to agitation and delirium. It states that withdrawal from alcohol begins within 36 hours of cessation of intake. It is characterized by tachycardia (rapid heart beat), hypertension, agitation, hallucinations, and tremulousness. Seizures usually develop within 2 days of abstinence, but they have been reported to occur as late as 7 to 9 days after alcohol intake ceases. Withdrawal seizures are generalized and tonic-clonic. One to six seizures typically occur over a maximum of six hours .....A history of withdrawal seizures and/or head injury, concurrent use of psychotropic agents, and a low serum sodium concentration (see HAI Bul 96 and 152) are predictors of alcohol withdrawal seizures. About 1/3 of patients with seizures will progress to delirium tremens. This is the most dangerous manifestation of the condition. There may be fever, myocardial infarction, respiratory failures, and electrolyte disturbances. However, over the last two decades, mortality has declined as a result of improved treatment.

Certain drugs are described that are used during treatment. They warn that patients with delirium tremens may require very large doses of sedatives to control their extreme sympathetic hyperactivity and agitation. The doses must be very carefully titrated. Respiratory depression may occur. Some patients may need intubation and mechanical ventilation. Restraints are especially useful during the period of initial sedation. Whenever possible, patients should be permitted to sleep naturally. Lighting levels should reflect day-night cycles. Patients in stable condition should be able to sleep uninterrupted at night. Thus medication and nursing care schedules should be designed to provide at least 3 hours of undisturbed sleep. There is little need to awaken patients to take vital signs when their heart and respiration rates and blood pressure levels are displayed at a central monitoring station because sound bursts are one of the main reasons patients are aroused from sleep. Conversations close to the patient's bed should be minimized and each patient in the ICU should have a separate room with a door and a window, light dimmers and sound reducing features. Remote alarms on ventilators should be considered. (All of these suggestions should be helpful to all patients everywhere.)

John W. Tintera, M.D., Founder of the Hypoglycemia Foundation which became the Adrenal Metabolic Research Foundation, was reported to have been very successful in keeping his alcoholic patients quiet in the hospital. He wrote extensively on his methods of treatment. Two of his case histories follow:

"As a point of interest, a legal dilemma exists in an Eastern State hospital where a young heroin addict was committed by the courts because he was convicted of stealing to support his habit. Since his mother had a long ardous history of hypoglycemia and his father had a history of severe chronic alcoholism, the psychiatrists agreed to perform a glucose tolerance test. The test revealed a marked hypoglycemia, with the following blood sugar concentrations: fasting 71 mg, half-hour 154 mg, one hour 105 mg, two hours 100 mg, three hours 39 mg, four hours 60 mg and five hours 62 mg per 100 ml. The patient was given a low-carbohydrate, high-protein diet and when there was a noticeable improvement in his psychiatric condition little further persuasion was needed to institute Adrenal Cortical Extract therapy. Now that psychiatric and endocrine therapy are no long required, the problem is whether he should remain in the State hospital, be committed to prison, or be set free."

"P.W., a lawyer age 51, had been active in Alcoholics Anonymous for eight years, having been a periodic 'stress and strain' drinker between the ages of 32 to 43. He was now reputedly a successfully controlled case of alcoholism. He helped others to gain sobriety by giving talks to A.A. members. However, his whole business of living had become a battle. His nervousness, fits of temper, bad disposition, increased apprehension, and worry over many errors in his work, particularly in the late afternoon, were what finally prompted him to seek medical aid. He had observed, however, that food had a stabilizing effect and shortly after dinner he felt like a different person. He ate lots of potatoes and rich desserts. An avid coffee drinker, he took two or more teaspoons of sugar in each cup. His weight was increasing. He had an acceptable extra-salt habit. Physical findings were mostly normal but his blood pressure dropped upon rising (postural hypotension). His glucose tolerance test was: fasting 99 mg, one-half hour 196 mg, 1 hour 199 mg, 2 hours 57 mg, 3 hours 63 mg, followed by severe hypoglycemic reaction where it was necessary to stop the test. The patient was given 10 ml of adrenal cortex extract IV (Eschatin by Parke-Davis) with 50 mg of testosterone propinate IM. He was given a low-carbohydrate, moderate-fat and high protein diet. Oral medication was one Bellergal tablet 3 times daily. He returned for more treatment. After a few weeks he observed that he had not had serious cravings for sweets and had considerably less nervous tension. He said he was able to think again. His eyesight improved enough that he needed new weaker glasses."

Tintera Summarized, "In the mid-forties I had a clear field in the treatment of alcoholics since the general medical fraternity considered them either psychopathic or immoral. Alcoholics Anonymous slowly changed the atmosphere, but the medical profession was reticent in accepting the disease concept of alcoholism. I was eventually given the opportunity to treat these patients in a ward in a general hospital, after much persuasion of the medical board. Although they came to be regarded as sick patients, I was later required to treat them in private rooms. Treatment of the acute phase of alcoholism has now been simplified though the use of Adrenal Cortex Extract and the newer and more effective tranquillizing agents."

"The crux of the alcoholic problem is hypoglycemia -- whether it occurs in the predisposed person with genetic factors influencing his physical and emotional growth, in the social drinker aggravating his already disturbed carbohydrate function, in the chronic alcoholic in the General Adaptation Syndrome (Hans Sleye, M.D.) stage of resistance or fatigue, or in the recovered alcoholic with his psychic and physical complaints. Even in the normal person, a temporary hypoglycemia develops following a debauch. (In 1968 Bill W., Founder of A.A., pleaded with physicians in a 48 page, 81/2" X 11" booklet to use the hypoglycemia diet and vitamins, especially B3, in the treatment of alcoholism. (This is out of print but we have one copy which we xerox from time to time.) Title "The Vitamin B-3 Therapy; A Second Communication to A.A.'s Physicians From Bill W." February, 1968. Bill W. wrote, after a description of the hypoglycemic condition, "The victim is alternately whipsawed between too much insulin and too much adrenalin. Unconsciously, we alcoholics try to cure these conditions -- first by sweets, and then by coffee. The sweets temporarily raise our blood sugar, and be feel better. Coffee also gives us a temporary boost because it lessens the shock of the blood sugar drop. In exactly the wrong way, we are unconsciously trying to treat ourselves for hypoglycemia. If you are on B-3 and Vitamin C already, then add the dietary discipline. If you have hypoglycemia to any extent, the dividends are apt to be very large."

Note: Dr. Tintera passed away in 1969. Shortly thereafter the Adrenal Cortex Extract was removed from the market although, in the Physician's Desk Reference at that time, under "counterindications" was listed "None".

References:
1. Joseph D. Campbell, PhD., 503-777 Blanshard St., Victoria, British Columbia V8W 2G9, Canada (604)383-3498) Townsend Letter for Doctors and Patients (10 issues yearly) 911 Tyler Street, Port Townsend, WA 98368-6541.
2. Hypoadrenocorticism, J.W. Tintera Memo. Issue, 9th Printing, Nov., 1980, Avail. HAI $12.00