CHAPTER 4 The diagnosis of low blood sugar
I have diagnosed and treated patients with low blood sugar for 35 years, and over this time I have learnt that a simple diagnosis of ‘low blood sugar’ is rarely helpful for the patient and not always accurate. Indeed the diagnostic challenge with low blood sugar symptoms is to provide satisfactory answers to the following questions:
1 Are the symptoms of low blood sugar seen in a patient the result of poor stress handling or a faulty diet, and therefore transient and probably reversible? or
2 Are the symptoms the result of a chronic glandular imbalance, long-term stress, excessive reliance on caffeine, tobacco, alcohol and other drugs, or the many other factors associated with dysglycaemia?
In fact, many people with the symptoms of low blood sugar have several causes running parallel. As low blood sugar masquerades as so many different conditions, and can create such a diversity of symptoms, diagnosis can be difficult. For this reason, and others that will be discussed later, it is not wise to diagnose low blood sugar without professional help. Low blood sugar mimics very many serious diseases and it is therefore essential that the possibility of more serious causes for the symptoms is ruled out.
The clinical diagnosis of low blood sugar falls naturally into several stages.
Family history
Low blood sugar disorders can pass from generation to generation. It therefore follows that a detailed evaluation of a person’s family health is of considerable diagnostic value.
Table 1 – The family connection, 25 patients
Table 1 illustrates the family history of 25 patients with confirmed low blood sugar. These patients have been selected because they are typical low blood sugar cases. You will see that characteristic disorders pass through each family. The majority of patients with low blood sugar symptoms tend to show a previous history in their family of either asthma, migraine, hay fever, diabetes, obesity, chronic fatigue or depression.
Present symptoms
As we know, the symptoms of low blood sugar can be misleading to the diagnostician. Often of more significance than a list of symptoms are the pattern of cause and the time of onset of symptoms. One patient, Mr A, may experience headaches when reading or watching television, while another patient, Mr B, may develop headaches only in the early morning or when he drinks certain types of wine. In the case of Mr A, he may well have eyestrain, but Mr B could be suffering from low blood sugar.
Fatigue at the end of the day may be caused by overwork, anaemia or a variety of ailments. Fatigue on rising, which improves towards the end of the day, offers a strong clue to the possible diagnosis of low blood sugar. A subjective evaluation is never easy, for unless one is familiar with the diagnostic value of symptom patterns, it is very difficult to diagnose one’s own problems.
One of the chief characteristics of low blood sugar sufferers is the combination of physical and mental symptoms coupled with considerable variation in the symptoms. Sometimes the patient may feel on top of the world; at other times he or she may feel exhausted and depressed for no apparent reason. Remember, we are not dealing with a predictable organic disease such as arthritis or anaemia, but an imbalance in the nervous, circulatory, digestive and endocrine systems. Therefore any symptoms may be the expression of a great number of interrelating and fluctuating causes. These causes can include diet, emotional state, menstruation, time of day, stress, fatigue, the side effects of drugs and many other factors.
Past health
No illness suddenly arrives. There are always changes in the body before the symptoms become apparent to the patient. With low blood sugar the early symptoms are usually vague and difficult to identify. The commonest symptoms are fatigue associated with a dulling of concentration, irritability and mild anxiety or depression, feeling thick-headed on waking and a distinct loss of zest before mid-morning.
Early symptoms may also include transitory feelings of panic or breathlessness with cold sweating and headaches, often accompanied by a craving for something sweet. Such symptoms are often diagnosed as being due to overwork, stress or just ‘nerves’. The usual sedatives and relaxants are prescribed, but if symptoms are caused by low blood sugar, any relief will be only temporary. The fatigue will still be there, often without excessive effort or work, and the anxiety will persist, despite a lack of stress.
It is unfortunate that many people with low blood sugar suffer their symptoms because of a false diagnosis. Often they are classified by doctors and family as neurotic when, in fact, the cause of their symptoms is physiological and not psychological.
When looking into a person’s history, disorders often feature that provide clues to future low blood sugar. These include hepatitis, jaundice, morning sickness during pregnancy, biliousness and intolerance of fats, a history of gall bladder trouble, chronic fatigue and overweight. The role of the body’s early warning system is to indicate the development of a biochemical imbalance or damage of some kind. If the early symptoms of low blood sugar are accurately diagnosed before the obesity, fatigue, migraines and diabetes develop, a great deal of pain and distress may be avoided.
Dietary habits
Faulty nutrition is the single most important cause of low blood sugar. The modern Western diet, with its high sugar content, refined starches, artificial additives and low nutritional value, provides an appropriate formula for causing blood sugar imbalances. If we also consider the modern habits of snack meals, frequent coffees and the excessive use of drugs, alcohol, cola drinks and tobacco, it is no surprise that the incidence of high and low blood sugar conditions is increasing at an alarming rate.
As poor diet is a key factor in the development and maintenance of low blood sugar, it is obviously an important clue in the diagnosis of the problem. I find in practice that most low blood sugar sufferers have characteristic dietary habits that provide important leads to the cause of their symptoms. It must be remembered that, for these patients, meals are not simply a question of choice, for the pattern of meals and type of food is strongly influenced by the underlying low blood sugar. Sugary foods and drinks and caffeine-rich or alcohol-rich drinks all provide temporary relief to the symptoms of low blood sugar. Not surprisingly, the diet reflects this and is usually high in these items and in particular there may be cravings for sweet foods far in excess of normal consumption. One of the most significant clues is a person’s sugar intake – two to three teaspoonfuls in either tea of coffee is not unusual. Smoking can also be a clue, as many tobacco addicts experience low blood sugar symptoms.
Because our blood sugar is linked to the appetite, a frequent symptom is hunger. This is not a general feeling of hunger, but more often a craving for a certain type of food. However, the low blood sugar patient, because of the symptoms produced by his condition, often cannot face food. This usually occurs at breakfast time as the blood sugar drops overnight. The thought of breakfast can make a person with low blood sugar feel physically sick. Usually a coffee or cigarette starts the day, and the inevitable ‘high’ provided by the caffeine produces a mid-morning ‘low’ as the blood sugar drops again. So the day consists of small frequent ‘shots’ of sugar or caffeine to maintain