Hypoglycemia


Poor carbohydrate metabolism or poor glycogen storage in the liver often cause hypoglycemia, because both make it difficult for the body to control blood sugar levels.   The diagnostic standard is blood sugar levels below 50 mg/dL, and abnormal response to a sugar challenge given in a test called the glucose tolerance test.

I nickname hypglycemia “sub-clinical glycogen storage disease” (real gsd) because in 1996 while in Kathmandu, Dr Mana was examining a hypoglycemic patient and demonstrated via palpation that the liver had shrunk in size, indicating low levels of glycogen. In TAM, this problem, linked to low blood pressure, fatigue, and nervousness in a disease called ojaskshya, and is considered to be the result of weak digestion and blood deficiency (rasaksaya).  The problem is often found in nerve-natured (Vata prakriti) patients.  It is treated by combining digestive herbs and general rasayana tonics (Bajracharya, 1988). This insight led me to understand much more clearly my treatment goals. Many patients have found relief following the below strategies.

The body’s biochemical response to hypoglycemia usually starts when sugars are in the high/mid 70’s.  While there is some degree of variability among people, most will usually develop symptoms suggestive of hypoglycemia when blood glucose levels lower.

There are two forms of hypoglycemia – one affects the body more, and the other affects the brain more. There is a lot of overlap, but usually it is more one than the other.  The second or “brain form” is less well known, and usually indicates a faster drop in the blood sugar.

Patients with “Body Hypoglycemia” may experience any or all of the following:

  • nervousness
  • sweating
  • intense hunger
  • trembling
  • weakness
  • irritability and anger
  • heart palpitations
  • inability to sleep
  • rapid heartbeat

Patients with “Brain Hypoglycemia” may experience any or all of the following:

  • loss of mental focus
  • slowed thinking
  • mood changes
  • feeling disconnected from people
  • inability to feel emotions
  • trouble speaking
  • blurred vision or spots in front of the eyes

Anyone who has experienced an episode of body hypoglycemia describes a sense of urgency to eat and resolve the symptoms. And, that’s exactly the point of these symptoms. They act as warning signs. At this level, the brain still can access circulating blood glucose for fuel. The symptoms provide a person the opportunity to raise blood glucose levels before the brain is affected.

If a person does not or cannot respond by eating something to raise blood glucose, or is unaware of the problem, the levels of glucose continue to drop. Somewhere in the 50 mg/dl range, most patients progress to neuroglycopenic ranges (the brain is not getting enough glucose). At this point, symptoms progress to mental confusion, changes in heart rate, drowsiness, and emotional changes or changes in behavior.

Of course you can experience both brain and body hypoglycemia at the same time.

 

TIMING OF BLOOD SUGAR CHANGES

While blood sugars can change at any time, the timing can affect how things are perceived as follows:

Early morning low blood sugars – As this is usually the farthest time from your previous meals, you can wake up with headaches, fatigue etc.

Middle of night low blood sugars – For some people, the blood sugar drops in the middle of the night, waking them up, often thought to be insomnia.

After meals low blood sugars –  Be aware that eating too many carbohydrates at meals can trigger a low blood sugar attack, because the blood sugar first goes up, then can plunge down down.

WHAT TO DO ABOUT LOW BLOOD SUGAR

The key is to change your diet. Do not skip meals, or eat too small meals.  Eat plenty of protein at breakfast. In addition to your three normal meals, take 3 additional protein snacks during the day. at 10 AM and 3 PM and before bed. Good things for snacks include, cashews walnuts, almonds, cheese or a protein bar.

For serious cases, there are natural medicine that improve the ability to digest carbohydrates and process and store glycogen in the liver.

•  I sometimes construct an herbal formula using tonics, especially shilajatu and triphala.  This medicine tonifies the blood and aids the liver in storing glycogen(Mitra SK et al.  1996).

• Because the liver is the major storehouse for sugars, liver tonics such as dandelion root, milk thistle seed, bupleurum root and white peony root may also help with hypoglycemia.  Look for signs of restricted energy (Liver Qi restriction), with a tense wiry pulse.

• Digestive aids like ginger root,  black pepper or trikatu are always useful in my experience, and should be combined with general tonics like shilajatu, dang gui root, ashwaghanda root, cooked rehmannia root, shou wu root etc.  The standard tonic chyvanaprash is also useful.

• Hypoglycemia may be a symptom of more serious underlying diseases, such as chronic hepatitis, diarrhea or chronic diarrhea, anemia, and urinary diseases.  These should be investigated and ruled out.