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LOW BLOOD SUGAR "SYNDROME" IN PRIVATE PRACTICE
OP Kapoor
Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
Some patients and doctors are very fond of blaming certain symptoms to "low blood sugar". It appears to me that like low blood pressure, low blood sugar "syndrome" does not exist or is extremely rare. A number of patients will tell the doctor that "as soon as I eat or drink some sweet drink, my complaints are relieved". The doctor accepts this as the diagnosis of an attack of low blood sugar.This is the reason why in private practice you find hundreds of neurotic women and men who misguide their practitioners by saying that they have a 'tendency' to have "low blood sugar" attacks. All these patients should be treated as functional patients unless proved otherwise.
Most of the symptoms of hypoglycaemia can occur in normal population. The method to clinch the diagnosis is:-
The blood sugar level duting the attack should be 40 mg or less. After administration of sugar orally or IV, the symptoms should disappear and the blood sugar should return to normal. In fact, in many thin women, it is common to see readings of blood sugar upto 40 mg without any symptoms and these blood sugar levels do not call for any treatment.
Remember that in a normal, non-diabetic person the fasting blood sugar level is 80-120 mg. So most of the reports of low blood sugar like 60 or 70 mg are normal and can be thrown in the dust bin! In fact, even after the person has starved for 72 hours (the test which is done to exclude insulinoma), hypoglycaernia cannot occur in a normal person! In these days the modem practitioners should know more of physiology of fasting blood sugar when the functional symptoms and neurosis is increasing day-by-day and which should get a properlabel!
Patients having fictitious hypoglycaemia (by self injecting insulin) are very rare in our country. Also insulinoma is one of the most rare tumours in private practice.
Coming to the hypoglycaernia seen often in private practice-the three most common causes are:
1. Patients on insulin therapy.
2. Patients on oral anti-diabetic drugs.
3. Obese and alcoholic patients who experience hypoglycaemia during the post-prandial period due to sudden rise of insulin levels.
In fact none of these patients should be diagnosed as functional or neurotic.
In the first and second causes the drugs must be withdrawn immediately and patient must be given sugar by mouth or IV or an injection of glucagon should be given. If not treated in time, this hypoglycaemia can lead to paralysis and other organic neurological syndromes.
Regarding the last cause, the patient should be advised to reduce weight, omit alcohol and start doing regular exercise.
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