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Dr. Chip
Dr. Chip, Doctor (MD)
Category: Health
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Experience:  Over 20 yrs of Family Practice
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I have been monitoring my blood sugar for the last 4 years.

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I have been monitoring my blood sugar for the last 4 years. I have had a problem with becoming disorientated collapsing for a couple of hours a cause for which has not been established. Recently I was feeling hungry and dizzy and my blood sugar was 18.6 mmol/l. This was after drinking very sugary fruit juice and eating some dates. I was hungry but stopped eating because it was high. It did return to 5.7mmol/l two hours after. Fasting level was 4.8mmol/l. Is the high reading abnormal?
Hi. Is that the first time your sugar has been that high? What studies have been done to get at a cause for the disorientation and what exactly do you mean by collapsing?
Customer: replied 4 years ago.

Blood sugar has registered as 10 mmol/L and 11 before mmol/L but on a transient on off basis. This is the first time it has been this high that I have been able to record.

Collapsing. I feel disorientated confused like I need to sit down before I fall down. I really really can't think straight at all. Instinct is to find somewhere to sit and sleep. If anyone tries to wake me I can usually respond but only for a short amount of time and incoherent way. Then I go back to sleep. I can't think straight. I struggle to stay conscious and I can't move. This last 30mins to an hour. Then I improve and I a bit more responsive but still can't move. I the start to get better. I become EXTREMELY hungry and still feel weak. Will eat something and recover. Feel a bit weak for the rest of the day and sometimes the next day.

I have had fasting blood tests done through out the last 4 years have all been between 4 mmol/L and 5.8 mmol/L. This was investigated a couple of years ago. Thyroid tests were done TSH, Free T4 and antibodies. Cortisol which was 436 nmol/L. Insulin which was 1.33 ug/L. Had chromogranin A done which I think was to check for tumors which was 43.

I have had recent (within the last 6 months) standard blood test and was told they were normal but have not been able to get a copy of the results myself. Are there any specific test I need that you would recommend?

Have you had a glucose tolerance test?
Customer: replied 4 years ago.

No. It is something I thought might be useful. I have always had normal fasting blood sugars 4s and 5s. The doctors thought that this ruled out diabetes. Does this rule out diabetes? Are you suggesting doing the test to check for diabetes or for other things as well or to simply find out what is going on. In itself is the 18.6 mmol/L something to be concerned about or is it only in combination with the collapsing issue that it is worrying? It returned to 5.7 mmol/L over 2 hours. During which I felt hungry but did not eat because I felt that would be unwise if my blood sugar was that high. I had assumed that the collapsing like problem was hypoglycemia until now. Now I have had the very I reading I am question whether hyperglycemia could be the problem. Do you have an opinion on this or this or is hard to say without further tests? I took a fasting reading on my blood sugar monitor the day after the high reading it was 4.8 mmol/L. I suffered from severe vomiting a couple of weeks ago and had to be given fluids in hospital. My blood sugar then was 3.2 mmol/L on my monitor and 4 mmol/L at the hospital after managing to eat a couple of sweets. The vomiting stopped but no cause has been found for that either. So its not been consistently high. Is there anything that could make blood sugar range like this that I need to be aware of?

Just one more question first--have you ever measured your sugar level during an collapse attack and have you had a neurology evaluation with perhaps an MRI of the brain and an EEG?
Customer: replied 4 years ago.

I have never been able to measure during the worst phase of an attack. Have only been able to do so at the end after I have got consciousness back properly. That has always been normal usually like 5.5 and some 4s I think. Not any 6s from what I can remember. Certainly never 7s. No never had an MRI or EEG or a neurology evaluation.

OK--you need the glucose tolerance test along with serial measurements to see if you are having reactive hypoglycemia problems. That said, you may have a problem called POTS or positional orthostatic tachycardia syndrome and you could also potentially have a seizure disorder so I would also have you see a neurologist for a full evaluation.
Customer: replied 4 years ago.

Are you suggesting doing the glucose tolerance test to check for diabetes as well or is that ruled out by the normal fasting blood sugars? Would the transient 18.6 mmol/L in itself be something to be concerned about and investigate? Or is this something you might see in someone healthy after ingesting a sugar load. Would positional orthostatic tachycardia syndrome or a seizure disorder account for the EXTREME hunger I have after the collapsing attacks? The hunger really is quite extreme. I had felt nothing like it before I developed this issue. Or are you suggesting I could have two problems hypoglycemia and a neurological issue. Would you consider these to be related?

Reactive hypoglycemia can be a prelude to diabetes but you don't seem to have true diabetes right now. The elevated glucose level could have been from previous eating before the test. No, extreme hunger wouldn't be something seen after POTS or a seizure but I have to give you all my thoughts here as to how I would work this up. There could be a link between the low blood sugar and the seizures, yes.
Customer: replied 4 years ago.

Ok. That is helpful. The collapsing is not triggered by eating the way I would expect it to be if it were reactive hypoglycemia but by exercise. Are there any tests to do with glucagon that would be worth doing? This is something I have heard of but don't know much about.

Glucagon could be tested if it were found that your insulin levels were high to see if you have a rare pancreatic tumor that secretes glucagon. I think overall, though, that your main problem isn't a blood sugar one but more likely POTS or a seizure disorder. Let me know how it goes and please remember to rate my service to you
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