Then we need to dig deeper to figure out what’s actually causing those symptoms.
[quote=“Surreal, post:17, topic:766886”]
[/QUOTE]Thank you.
Right. Someone can have an anxiety disorder that presents with symptoms consistent with hypoglycemia and happen to run low sometimes and be checked at one of those times. But if the same symptoms exist when the blood sugar is corrected then it does not qualify.
In old test taking mode, the third rules out “true-true-unrelated.”
Not for healthy non-diabetics it’s not.
As Surreal has already pointed out, there’s plenty of evidence that such individuals regularly run glucose levels well below 70 with no ill effects. So to diagnose hypoglycemia in a non-diabetic, we need to look for glucose levels below 55.
At tgis point, I’m not sure If there is ANY cite you will accept, but I will try one more time. This is from the department of Internal Medicine at the University of Michigan. It’s titled “Hypoglycemia (Low Blood Sugar) in People Without Diabetes”
cite. And yes, I know it is entirely possible to have low blood sugar and be asymptomatic, but the threshold, again, is 70.
Those cites do not address the issue being discussed.
We are talking about making the diagnosis of the clinical disorder of hypoglycemia in a non-diabetic. To make that diagnosis, glucose levels need to be less than 55.
From UpToDate.com, which reports the medical standards. Rapid overview of hypoglycemia in adults
What?! My last site was entitled EXACTLY THAT. “Hypoglycemia (Low Blood Sugar) in People Without Diabetes”. I suppose there could be different policies at different places, but I would rather stick with what the University of Michicgan Recommends. This is an instance where UpToDate misses the mark. And possibly dangerously so.
If a patient comes in diaphoretic, tachycardic, and nauseus, with a blood sugar 12 points bellow normal, but has no history of diabetes, I am still going to call that hypoglycemia. You can be irresponsible if you want and delay addressing the blood sugar because the glucose isn’t low enough for you and therefore doesn’t meet your version of Whipple’s triad in a non-diabetic, but that’s not how I’m going to operate, and that’s not how you should, either.
But I give up, I didn’t think you would accept a cite anyway, even if it was titled “Hypoglycemia (Low Blood Sugar) in People Without Diabetes”. That’s how you were able to read the phrase “People Without Diabetes” and then post but… but… “We are talking about making the diagnosis of the clinical disorder of hypoglycemia in a non-diabetic”.
No need to get nasty, I’ve been trying to keep it civil.
You still don’t seem to appreciate the difference I’m trying to draw. Though I admit I could have been more clear on the difference the other physicians in this thread and I are referring to vs. what you are keying on. Recurrent hypoglycemia syndrome vs. an episode of low blood sugar which casually gets referred to as ‘hypoglycemia’.
Normal people have fasting glucoses that range from 70-99.
Some, and even most people may have symptoms if their blood sugars fall below 70. But symptoms reliably develop in most people once the blood sugar goes below 55.
In order to diagnose someone with the syndrome of recurrent hypoglycemia, the accepted medical standard in the US is Whipple’s Triad, using a blood sugar value of 55.
I’m not saying I don’t offer someone who feels wobbly and happens to have a glucose of 65 a glucose tab, or a Snickers bar. THAT is standard therapy. Even so, many experts argue that’s more of a comfort measure than truly medically necessary, as such folks rarely progress below 50, where permanent damage to the brain can occur. Me, I prescribe glucose tabs in that setting.
I’m saying I’m not going to diagnose them with recurrent hypoglycemia syndrome unless they have a glucose below 55, plus the other two points in the Triad. Nor will I thus embark on a workup for insulinoma, insulin autoimmune syndrome, pituitary insufficiency, or adrenal failure, or other possible cause. Because working up people for causes of recurrent hypoglycemia when their glucose is greater than 55 rarely proves fruitful.
This article on recurrent hypoglycemia by an endocrinologist at the Cleveland Clinic suggests using 50 as the value before starting such a workup.
Can you see what I’m saying now, and reply without accusations of irresponsibility, incredulity, and dismissing my assessment on how to diagnose and manage the over and improperly diagnosed syndrome of recurrent hypoglycemia?
You are trying to change the goalposts. You did not once refer to recurrent hypoglycemia. The OP didn’t ask about recurrent hypoglycemia. No one was discussing anything chronic, and your reaction to a cite entitled “Hypoglycemia (Low Blood Sugar) in People Without Diabetes” wasn’t to try to find common ground, it was to claim that it didn’t address non-diabetics. Just no, doc. Just no.
Seems like it’s similar to the distinction between *depression *(“I’ve been really sad this week because my best friend died.”) and Major Depressive Disorder. We may call both of them “depressed,” but one is a temporary state of being that happens in healthy people, and the other a medical diagnosis. It’s not like you’ll ignore the feelings of depression in someone who’s best friend just died, but you know it’s likely to resolve on it’s own, without subjecting someone to the bother and expense of full testing for a diagnosis.
I have to agree with armedmonkey’s point, if not their tone, though. The OP was asking about hypoglycemia, the symptom, not E16.2 Hypoglycemia, Unspecified - the diagnosis. (I can’t find an ICD10 code for “recurrent hypoglycemia”)
The whole discussion started out about fasting hypoglycemia predicting diabetes. And to my medical mind, which has had to assess plenty of patients for complaints they feel must be hypoglycemia, that means the type of hypoglycemia as defined in UpToDate.com as I spelled out. My statements in subsequent threads were directed at expanding on that view of hypoglycemia. So I don’t feel I moved the goalposts; we perceived different goalposts from the start.
And while your link was a very thorough overview of hypoglycemia and its symptoms and treatments, what I wrote was that it didn’t “address the issue being discussed”. And I’ll cop to being self-absorbed enough that I meant it didn’t address the issue that I was discussing at that point, how to use Whipple’s Triad to make a legit diagnosis of the type of hypoglycemia that requires detailed workup to rule out insulinomas, autoimmune disease, etc. So yes, it was relevant to the thread, relevant to what you and others were saying, but not what I was focusing on. My bad.
But I still stand by my point. You should document glucose levels under 55, along with the other two points made by Dr. Whipple, before pursuing workup. And also plenty of healthy people can run glucose levels between 55 and 70, and be asymptomatic and have it be normal for them, and not need intervention or evaluation.
First off, let me apologize for my tone. It started out as just very, very informal, but it turned angry as I started to believe other professionals weren’t even listening. I shouldn’t have let it do that. I should have just rationally stuck to my guns and upgraded my politeness and professionalism. Second, please believe that I don’t really discount Whipple’s triad, I was just making a joke. It may not be one that truly landed, but hey, it wouldn’t be the first time that happened. Whipple’s triad makes sense as a whole, but if you pick it apart, it can seem tautological. I found humor in that.
Next, I respect your position, Qadgop, but I just can’t agree. My reasoning for not agreeing actually relies on Whipple’s triad, and it is this: If a patient does present with symptoms, has a blood sugar 12 points below normal, and those symptoms are relieved by raising the blood sugar, what else are you going to call it?
DSeid mentioned the “real world” up thread. In my mind, what I just described is the real world. It does not have to be below 55, it just has to be symptomatic and relieved by raising the blood sugar.
But this whole thing is kinda dumb. I don’t believe for a second that Dr the Mercotan wouldn’t treat a patient for hypoglycemia just because their glucose was 58. Of course he would. He’s not going to whip out his Rx pad and prescribe zofran for nausea and toprol for the tachycardia while discounting the blood glucose; the first thing he’s going to do is see if the guy can drink some orange juice. That’s the real world.
Lastly, this stupid argument about whether it is 55 or 70 isn’t helping the OP at all. To me the OP’s question should be this: “Is fasting hypoglycemia considered an early sign of type II diabetes.” And the short answer for that is no, it’s not.
I didn’t see this post until now, but whatdya’know, I saw my endocrinologist yesterday to see how what my diabetes was up to, and I asked him the exact question, but with opposite premises from this cite, which I am curious about then, and with a different (vague but considered) response. Perhaps because of the different premise, but now I’m all confused:
My understanding is that anxiety for some reason (something with adrenalin?) causes acute hyperglycemia. I distinctly remember being given orange juice by an annoyed doctor who told me “get a grip, stop crying, you’re just making the numbers stay high”–which I later interpreted as being more than just a temporary sounds-scientific-just-stop-crying statement.
Fast-forward 25 years to yesterday. Me, with bipolar disease previously known occasionally as anxious-mania or or anxious-depression (two for one!) can go through chronic horrible anxiety, and asked if that might have been, or can be, contributory to hyperglycemia. His answer, FWIW, no, as to chronic. But he seemed therefore to agree with the answer in the acute scenario.
Cx: not “anxious-mania,” but something like “melancholic-mania.” Or that might be just for the/my mixed-state symptom.
[BTW, very roughly put, suicide from this disease is not for the nexus of symptoms commonly thought of “depression thoughts,” but to stop the merciless anxiety.]
Anxiety can cause acute hyperglycemia, yes. Flight or fight response releases glucose into the bloodstream, so you have energy with which to flight or flee. But in a person *without *diabetes, their body quickly shuttles all that glucose - and sometimes extra - into the cells on the back of insulin. So Anxiety without diabetes can cause a brief moment of hyperglycemia, and then by the time they decide it’s worth going to the ER, all that sugar is in the cells already and they are hypoglycemic. Give 'em sugar, and it corrects the hypoglycemia, but not the anxiety and those symptoms of anxiety.
There’s a lot of overlap in symptoms between hypoglycemia, hyperglycemia, and acute anxiety, actually. This is why even diabetics can’t always tell if they’re hypo or hyper without testing (although I’ve had more than one tell me that hypo feels like you’re drunk, and hyper feels like you’re high on weed - feelings which I’m not entirely confident I could tell the difference between reliably.)
Hypoglycemic symptoms, those shared with anxiety/panic attack in bold, and those shared with hyperglycemia in italics:
**Shakiness
Nervousness or anxiety
Sweating, chills and clamminess
I*rritability or impatience *
*Confusion, including delirium *
Rapid/fast heartbeat
Lightheadedness or dizziness **
Hunger and **nausea **
*Sleepiness *
**Blurred/impaired vision
Tingling or numbness in the lips or tongue
*Headaches ***
*Weakness or fatigue *
**Anger, stubbornness, or sadness
***Lack of coordination ***
Nightmares or crying out during sleep **
Seizures
*Unconsciousness *
There are only so many alarm bells your body has to ring when something is wrong. Symptoms are a great start to figuring out what might be wrong, but they’re usually not enough all by themselves. That’s why we look for signs (objective measurements, like labs and blood glucose readings) as well as symptoms.
I’m sorry, but I have to say this. Quit citing UpToDate. It’s on my computer at work, too, and it’s a good resource, but c’mon man, it’s just a subscription based encyclopedia. It ain’t the bible.
No, it’s not the bible, and it’s not a source for cutting-edge information. But it is reliably referenced with decent supporting evidence, is regularly updated, and does reflect pretty well the generally accepted standards of US medicine these days. And practitioners who follow its guidelines in general are practicing better medicine as a whole than those who practice based on what’s touted by drug reps, to be sure. 
And henceforth I will work harder to be less self-absorbed and focused on my own points when responding to knowledgeable input from other posters such as yourself.
But I don’t guarantee I’ll be that much better that quick. I’m still not sure all of you are real. I know my patients are though, since I can see and smell them.
Oh don’t even get me started on drug reps. Well, don’t get me started on device reps, because that’s probably the RN equivalent of an MD drug rep. I know this may come as a surprise, but I’m not always polite to them. 
Since you’re an armedmonkey perhaps you could show them your other “devices”? There’s more than one way to get a pushy rep out the door. 