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Ask Dr. Muneeb Ali Your Own Question
Dr. Muneeb Ali
Dr. Muneeb Ali, Intensivist
Category: Medical
Satisfied Customers: 2771
Experience:  MBBS, MD, MCCM.Currently working in Critical Care Medicine with 10 year experience in Medicine
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Can you please use "chat" (immediate "back and forth"

Customer Question

Can you please use "chat" (immediate "back and forth" format)?



Submitted: 8 days ago.
Category: Medical
Expert:  DIEGO BONILLA replied 8 days ago.


This is Dr. Bonilla.

What is your question?

Customer: replied 8 days ago.


Are you still there? Please let me know ASAP if you are still online-- and, if so, I will immediately reply with my questions. Thanks.


Expert:  DIEGO BONILLA replied 8 days ago.


Customer: replied 8 days ago.

Thanks. Are you able to go "back and forth"?

In regard to my questions, first, I'm a 66 yo with several chronic health issues-- including a couple of extremely rare ones-- bilateral posterior ethmoid sinusitis and elevated serum tryptase. I also have low blood pressure (usually approx 75-80/55-60) and slow pulse (55-60.) And, due to a hiatal hernia/reflux and an "open" LES, I'm on a low fat/high carb diet-- and eat a lot of low sugar grain (oat/wheat) portions daily-- but, I know that they "convert" to sugar. And, last ate approx 6 hours prior to the shower episode.

My urgent questions are related to my having become extremely dizzy while taking a luke warm shower approx an hour ago. I had a similar episode approx a year ago when I became so dizzy while taking a shower that, despite immediately turning off the water and getting out of the shower, I dropped "face down" on the floor before I could even walk more than a couple of feet (suffering a broken nose and two deep facial lacerations.)

However, I was able to get up immediately at that time, and, although still somewhat dizzy, I carefully went downstairs (while holding the hand rail), grabbed a large bottle of Cherry Coke and chugged it (55g of sugar)-- and, after sitting down for a few minutes, seemed to recover (aside from the broken nose, lacerations, etc.)

Anyway, for the first time in since then (nearly a year), I had a very similar episode an hour ago in the shower. But this time, I had a large bottle of Dr. Pepper next to the shower (just in case.) And, after quickly chugging the contents (54g sugar) and sitting down, I barely managed to avoid ending up on the floor again but seemed to recover from the sugar.

My questions: 1) Does that seem likely to be a hypoglycemic event (since I "recovered" after quickly drinking the 50g+ of sugar?

2) Or could it have still been blood pressure related?

In that regard, I need to try to go to sleep very soon.

3) Is there any concern, or should I be "safe" to go to sleep now? Thanks,


Expert:  DIEGO BONILLA replied 8 days ago.

I'll let another expert help you. I have to leave for now.

Customer: replied 8 days ago.

Thanks anyway. I'll read the reply later.

Expert:  Dr. Muneeb Ali replied 8 days ago.


This is a different expert. I dont know whether this reply will be useful for you now but i just saw your query sitting unattended for quite some time.

Anyway in regards ***** ***** queries,

1) The episodes which you have described can certainly be explained as being recurrent hypoglycemic events, however it cannot be confirmed on the basis of the fact that you felt better after using a sugary drink. The reason being that other causes of sudden onset of dizziness can also be transient and improve on their own as well. So while it is likely that these symptoms are due to hypogluycemia it cant be confirmed without additional testing. Now as far as hypoglycemia is concerned, if this is recurrent which it seems to be then you would need to be monitored. Usually what we do in the hospital is to induce a fast for approximately 12-24 hours and once your glucose levels fall then the glucose, insulin and C-peptide levels are checked. This will give us an idea as to what can be the cause here. It is possible that your symptoms are due to an insulinoma which is a benign insulin secreting tumor in the pancreas which once resected can solve the problem.

2) It is equally possible for this to be related to the blood pressure. It is possible that you may be suffering from autonomic neuropathy in which there are marked fluctuations of blood pressure as well as heart rate. These two can fall suddenly and lead to the symptoms which you have described. This would need specialized testing to be diagnosed. Secondly, it is also possible that these symptoms are due to an arrhythmia which is an irregular heart beat. This can transiently impair the blood supply to the brain and cause the dizziness as well as other symptoms like lightheadedness, sweating, palpitations etc. This would need to be diagnosed with an EKG and more importantly a 24 hour holter monitor test which can detect abnormal heart beats during the whole day.

3) I think you would be already asleep, but if you arent YES it is safe to sleep even if you have any of the above issues. Usually all of these conditions are transient in nature and dont occur when you are actually sleeping as the body is not under any stress etc.

So in short, you do need to be evaluated for a number of conditions which includes, hypoglycemia, autonomic neuropathy, arrhythmias or even vasovagal syncope. Since this is a second attack i would recommend that you see your doctor and discuss with him these possibilities.

Do you have any more questions?

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