What in the world happened to me (health related)

In My Humble Opinion
1

I almost passed out last week, for no discernible reason that I can tell. My best guess is dehydration, but… who knows? I’m fine now, I have a doc appointment in a couple weeks, and plan on mentioning it to him. But in the meantime, I know you all loooove to diagnose, so have at it.

Here’s what happened:

I’m 46 years old, T1 diabetic, in fairly decent shape, could stand to lose a few pounds but not obese or anywhere near. If it’s relevant at all, I had my period, and it was a bit heavier than normal, although normal is “next to nothing”, so any amount of blood is “heavier than normal.” I was a bit crampy, which isn’t unusual. Not so crampy that it kept me from doing anything other than complaining some :smiley:

Hubby and I were on vacation last week. We woke up, had breakfast (nothing fancy, some eggs, toast, etc at a diner).

We decided to take a bike ride. I bike fairly regularly, anywhere from 1.5-2 hours at a time, let’s say 8-25 miles or so, depending on if we’re doing technical trails or just on paved roads. This ride was longer than I normally go, but also MUCH easier than normal, being a fully-paved, flat bike ride. We did about 37 miles in ~3 hours. It was not overly hot, I was not working very hard, and I drank in total about 1.5 bottles of water during that time. During the ride I felt fine, not overly tired or thirsty or anything.

We got back to our room, took a quick shower, and went out and grabbed some lunch. I had a beer (also not uncommon for me :D), a fried-chicken sandwich and fries (a bit heavy of a lunch for me, but I was on vacation!).

About 3/4 through the sandwich, I started to feel really, really weird. Very dizzy & queasy. Black spots in my vision. I was afraid I was going to pass out, though I’ve only passed out once in my life and that was 20+ years ago so it’s not like I’m an expert. Of course, being diabetic, my first thought is “holy crap, I’m going low.” Nope. Both my CGM and a finger prick test had my blood sugar at over 100.

I was sweating visibly, to the point that Mr. Athena was wiping it off my face with a napkin. Couldn’t eat anything, couldn’t really do anything but sit there and hope I didn’t pass out.

After 15-20 minutes, I felt better enough to do the one-block walk back to our room. I laid down for maybe an hour, slept a little bit, had some ibuprofen, and then… I was fine.

So WTF? It was a very scary incident for both of us, and I’ve never had anything happen to me like that in my life. I still can’t believe it wasn’t low blood sugar, but all my devices said I was fine. Any ideas?

2

Are those typical symptoms for a low glucose reaction for you? If so, I’d bet money it was hypoglycemia, despite the readings. Capillary readings can vary quite a bit from the venous ones, which are more accurate.

Otherwise I’m inclined to think a vasovagal hypotensive episode might have occurred, and suspect your hydration status was a bit low.

that’s my 2 minute review, shoot from the hip prelim dx.

3

Hard to say what my typical low symptoms are, because I generally catch myself in the 60-70 range and I don’t get much lower than that. (Yay CGM!) But if I had to take a guess, yes, that’s what I would expect getting REALLY low would feel like. If you’re right… gads, that’s scary that neither of my high-dollar fancy thingamajigs gave me an accurate reading.

Dehydration could certainly be the cause as well. I didn’t FEEL dehydrated, but I also know you don’t necessarily feel it. And I’d just hydrated! With a deeelicious Flanders red ale!

4

Sweating like that is how one of my other diabetic friends reacts with low bloodsugar. I don’t sweat but I do “get sideways.”

I find also that my period affects me in different, surprising ways each month. Some times it saps my energy like I was hooked to some mad scientist’s machine.

Could be that with the bike ride, the beer, and not yet having had lunch, your period was just enough to put you over the edge of malfunction.

Also maybe you didn’t have enough salt for the day.

5

I have reactive hypoglycemia. If I am dehydrated, I can get symptoms of low blood sugar, even though my reading is OK.

This is just a guess, but I suspect if you are really dehydrated, you can get a higher sugar reading than what is available to your brain. Once, I managed to get myself dehydrated before a blood test, and they couldn’t get blood to flow into the test tubes very well. It took forever. And my sugar reading was high. It was like 140, which is exceptionally high for me. My doctor had me come in to repeat it. I drank lots of water, blood flowed like crazy, and my reading was 80-something.

I was feeling kind of dizzy the whole morning of the 140 reading, although it was more like a sleep-deprived dizzy, not an “I’m about to pass out” dizzy, and I didn’t get the low blood sugar shakes. I attributed it to the fasting, even though I fast whole days on days like Yom Kippur, and don’t feel that way. The day I drank lots of water, I felt totally normal.

The one time in my life I passed out, it started with nausea and black spots in my vision. It was right after giving blood. A large glass of water and a small glass of OJ fixed me up after I came to (lying down). I was walking home anyway, not driving, and I bought a Gatorade for good measure, but I was totally fine after replacement fluids and sugar.

Seeing a doc is the right thing to do. Who knows? it could be a brain tumor. :smiley:

6

Ah. Good point. It’s very rare in the US, where too much salt is more common, but sodium depletion can cause loss of consciousness and seizures. There’s even an intractable form of epilepsy that is caused by a sodium channel defect (in other words, no matter how much is in your diet, it doesn’t get to your brain in sufficient quantities).

7

You say you were eating lunch, so I guess you were sitting down when it happened? My first thought was orthostatic hypotension due to dehydration, but that would have been standing up.

8

Just wondering if you are on any type of birth control? My wife was on a b/c that made almost that exact situation happen to her on occasion. She had to switch it up to stop it from happening anymore.

9

IANAD, but when I was reading the OP I thought it sounded like what my wife experience when she has a vasovagal episode. Hers seem to happen most often when she’s dehydrated or has been standing a long time.

I’m just chiming in because I’m tickled that I had the same thought as our esteemed Dr QtM. :slight_smile:

10

If she was sitting down when it happened, I doubt it was vaso vagal. Sounds like how my sister described her very first migraine.

11

I’ve seen more than a few vasovagal responses occur while patients were seated.

12

First, IANAD

Others have touched on some of the points but…

Exercise - possibly leading to dehydration despite drinking water? Can lower blood pressure
Quick shower - warm water can dilate peripheral blood vessels lowering blood pressure.
Eating - a bit heavy meal, blood flows to stomach, lowering systemic blood pressure
Alcohol - another vasodilator, lowers blood pressure, though one isn’t usually enough to make much difference.

All makes me think of vasovagal syncope of which sweating and visual changes are also symptoms. If you experience something similar again try laying down immediately. If that gives you prompt relief then that is again characteristic of a vasovagal response.