Dr. Zulfiqar Ahmed
Diabetology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I have been getting weird symptoms after eating a carbohydrate-rich or sugary meal for the past 12 to 18 months. My symptoms include sweating, palpitations, etc. I had a dinner with lots of white bread, and other sugary dishes, with honey and bread, a few days ago. I did not feel well in the morning, so I checked my sugar level, which was 60 mmol. I went to the emergency room and got all the usual blood work done, CBC, liver and kidney function tests, and everything was normal. I understood that my symptoms point to reactive hypoglycemia based on my research on the internet. I have taken down notes of the levels after different kinds of food. I also tested myself several times at night when I did not eat such food (my results at night are in the normal range). My father has type 2 diabetes. I would like to hear your opinion on what I should do next. I am taking Warfarin and Plaquenil to treat APS syndrome. Please help.
Thank you.
Hi,
Thank you for stopping by!
I am here to provide expert opinion on your medical issues.
Reactive hypoglycemia is to have low sugar levels three or four hours after eating and it can occur after having some abdominal surgeries. Insulinoma is a tumor and its symptoms include fasting hypoglycemia, which means having low sugars after eight to ten hours of eating, like low sugar levels in the morning before eating anything. Another important aspect is that it is not significant to have just low sugars. In normal people, blood sugars can go down to 60 mmol.
Hypoglycemia in non-diabetic patients can be defined as low sugar less than 60 mmol, with symptoms of hypoglycemia at that moment, like sweating, palpitations, shaking, and feeling hungry. These symptoms improve after eating sugary food. So if you have these three symptoms in addition to fasting hypoglycemia, then it is significant, and you need to rule out insulinoma. We can test when blood sugar is less than 45 to 50 mmol and check insulin and C peptide at that moment. If it is in favor of insulinoma, we can do a scan to localize it.
Your fasting sugars are normal, so I do not think it is insulinoma. If your sugar levels go down after a heavy carbohydrate meal and it happens three to four hours post-meal, you might be having reactive hypoglycemia. It may occur before developing diabetes type 2 diabetes in some cases. I suggest you check the following:
1. HBA1c (glycated hemoglobin).
2. Blood sugar after two, three, and five hours of eating. Let me know the results.
I hope this information helps provide some insight into your symptoms.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you
Patient's Query
Hi doctor,
I conducted a self-test of 36 hours of fasting, drinking only plain water. My lowest sugar level was 70 mmol. The normal should be 80 mmol to 94 mmol. I checked every couple of hours. I assume that it is in line with what you said. Please advise.
Thank you.
Hi,
Glad to have you back!
I am here to help you get the best medical advice.
I suggest doing HBA1c and if that is less than 5.7, just take more frequent meals. It would be fine.
I hope this information helps provide some insight into your symptoms.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you.
Patient's Query
Hi doctor,
Thank you for your reply.
I kept checking my blood glucose levels at home. I got the following results after a heavy carbohydrate meal eaten after six to seven hours of fasting:
After two hours -160 mmol.
After three hours - 150 mmol
After four hours - 120 mmol etc.
I got results of 192 mol and even 211 mmol and 231 mmol a couple of times. If I ate something before the heavy carbohydrate food, the sugar does not rise much above 120 mmol. To clarify your opinion, you recommend doing the test you mentioned (three-month average). In the event it is fine, should I just ignore it and keep eating more frequent meals with complex carbohydrates? Do I need to check anything else?
Thank you for your assistance and attention.
Hi,
Glad to have you back!
I am here to help you get the best medical advice.
It is pre-diabetes, and these three-month sugar levels will show how high your sugar has been over the past three months. Now, the sugar levels you mentioned show you have early diabetes, but that test will confirm it. Let me know once you get the results.
I hope this information helps provide some insight into your symptoms.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you.
Patient's Query
Hi doctor,
Thank you for your reply.
To conclude the discussion and before I get the test done, I would like to point out that I followed your instructions on testing blood glucose several times while eating only simple carbohydrates for breakfast and measuring at two, three, four, and five hours. In general, it looked like after four hours, I started dropping to the low to mid-60s, and at five hours, it started to correct up back towards the high 70s and 80s. I assume that would make it reactive hypoglycemia, as you have mentioned.
My last question before I conclude is, if, as you mentioned, the test is fine, can I still develop diabetes later? Or will it only stay as reactive hypoglycemia?
Thank you.
Hi,
Glad to have you back!
I am here to help you get the best medical advice.
Usually, it may indicate that you are going to have diabetes shortly. As previously mentioned, it can also occur after some abdominal surgeries, but you do not have any such history. HBA1c will let us know if it is pre-diabetes, diabetes, or no diabetes right now. Anyone can develop diabetes at any time, especially those who are at risk, but risks can be decreased by good lifestyle modifications. By taking fewer carbohydrates, doing regular exercise, and trying to lose weight, you prevent developing diabetes.
I hope this information helps provide some insight into your symptoms.
Please do not hesitate to reach out if you have any further questions or concerns.
Thank you.
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