Diagnosis

For about 7 months now I have been experiencing some odd symptoms that I could not explain away. It began very abruptly in April while I was attending a conference. It was mid-morning and we were all standing up participating in a workshop activity. I began to feel out of sorts and wanted to sit down, but I kept looking around the room at all of the people who were many years my senior and felt silly about needing to sit down if they could still stand. The feeling progressed and I soon left the room, headed for the bathroom. I thought I was getting a stomach bug but upon reaching the bathroom I realized I wasn't exactly nauseous, but more dizzy and queasy. I had to sit with my head between my knees for a while before I felt okay to stand again, and as I returned to the conference room I passed the lunch set-up and shuddered at the mere sight of the food. When we broke for lunch a few minutes later several people asked me if I was okay, saying I looked very pale. I was feeling a strong aversion to food but decided a piece of bread might be worth a try. Within moments of nibbling at the bread all of the symptoms subsided. I went back and loaded up a plate with a salad and a sandwich and even dessert - it was as if I had never felt ill at all.

I called my mother that evening and described the episode. I had a feeling that she might have some insight. "It's your blood sugar," she said, without a moment's hesitation. I can recall countless times in my life in which my mother has interrupted whatever she was in the middle of with the comment, "I feel shaky, I need to eat something," and she is in the habit of carrying snacks around with her at her all times. In my self-centered adolescence I always perceived this as a minor annoyance, and perhaps even a weakness on her part - couldn't she just wait 20 minutes until we were done what we were doing?! I was also in the habit of teasing her for refusing to leave the house without a snack, even if we were on our way to a restaurant for dinner. Oh, how those taunts are ringing in my ears now!

I experienced a repeat of these symptoms, quickly alleviated by eating something, a few times over the next few months, but not with enough consistency or severity to prompt me to call a doctor. Sometime around the beginning of September the frequency of the symptoms increased. Now, although eating would cure the queasiness and shakiness I was feeling, within half an hour I would have an overwhelming need to lie down wherever I happened to be and go right to sleep. I began to think of it as *crashing* and then *sleeping it off.*

The increase in frequency and life-disruption finally prompted me to call a doctor. I have not had a primary doctor since I moved to this area 7 years ago, so it was not as simple as picking up the phone to make an appointment. First I had to choose a doctor, and then I had to wait almost 5 weeks for a new-patient-appointment, which is a much longer ordeal than an ordinary sick visit. During those 5 weeks I crashed at least once a week, if not 2 or 3 times, and I was feeling extremely frustrated at my inability to prevent or manage the symptoms. I did some Googling about blood sugar disorders and diets, but couldn't come up with any definitive information.

When the doctor's appointment finally arrived, I felt both relief and trepidation. Would the doctor think I was a hypochondriac? Would she rue the day Google was invented, spawning legions of self-diagnosers? Luckily, she was empathetic and also seemed to take my concerns seriously. She ordered a very thorough blood work-up, but said that she expected it to come back normal. She explained that only about 4% of the population is clinically diagnosed with low blood sugar - hypoglycemia - but rapidly dropping blood sugar (with levels that still fall within the clinical bounds of *normal*) can mimic symptoms of true hypoglycemia. She proposed that if she was correct and all of the tests were fine, I do a follow-up glucose tolerance test to further investigate.

She was correct - all of the tests came back fine. I went to the lab for a 2-hour glucose tolerance test feeling like I was wasting everyone's time - my own, especially. But then the results arrived in the mail. My fasting blood sugar level was low, but still a few points above the *normal* cut-off. But there were several asterisks next to my one-hour level, and according to the fine print it fell in the range of *critical value*. Critical?! That sounded ominous. I called the doctor and she confirmed what I already realized - I fall within the 4% of the population who are diagnosed hypoglycemic.

While I waited for my endocrinologist appointment, I returned to Google (of course). The type of hypoglycemia I have is called Reactive. As I understand it, when you consume sugar - which includes carbs and starches that get converted to sugar - your blood sugar levels rise. Your body responds by producing insulin, which counteracts the sugar and returns the levels to a more even state. In a person with reactive hypoglycemia however, the body overreacts, producing too much insulin, which tips the balance in the other direction and results in extremely low blood sugar levels.

As much as I would prefer to not have this, I must say it's kind of nice to have a diagnosis. I pride myself on being a trooper (what mother of young children isn't?), and I was feeling very guilty about not being able to just "shake off" the shakiness and subsequent exhaustion and just get on with my day. At least now I know it's not a character flaw on my part, but an actual condition that I can learn how to manage. More on management in a later post...