Prediabetic Conditions
Although much of the existing literature on diabetes deals specifically with diabetes mellitus, it is important to recognize that there is a wide range of blood sugar disorders. Particularly in North America, diets high in refined carbohydrates, combined with inactive lifestyles, are contributing to growing numbers of people with insulin resistance, hypoglycemia, hyperinsulinemia, and syndrome X. This puts our population at risk for diabetic complications, cardiovascular disease, and other serious conditions.
Insulin Resistance and Hyperinsulinemia
Information on insulin resistance is of critical importance because the metabolic changes that precede the development of diabetes often occur 10 or more years before the disease actually manifests. Early recognition of insulin resistance can help prevent hyperinsulinemia, dyslipidemia, hormonal imbalances, increased mortality rates, and cardiac risk. Many people can develop some of the complications of diabetes, such as peripheral neuropathy, even before their blood glucose levels are consistently outside standard normal blood test ranges. Thus, part of early recognition of the potential for diabetes to develop includes monitoring for glucose levels in the ‘high normal’ range and looking for symptoms that may be related to diabetic complications.
Hypoglycemia
Hypoglycemia, or low blood sugar, occurs when blood glucose values are less than 50 mg/dl (2.8 mmol/l). The three essential aspects of hypoglycemia as described by Whipple’s triad are: low plasma glucose, symptoms associated with hypoglycemia, and symptomatic resolution when blood sugar is returned back to normal. The diagnosis of hypoglycemia is usually based on symptoms because blood sugar levels are only low while patients are experiencing symptoms.
The adrenergic symptoms related to hypoglycemia are linked to catecholamine levels. These symptoms include diaphoresis (sweating), palpitations, apprehension, anxiety, headache, and weakness. The lack of blood sugar supply to the brain will cause neuroglycopenic symptoms and result in confusion, irritability, abnormal behavior, ‘spaciness’, and possibly even convulsions and coma.
Fasting Hypoglycemia
Severe fasting hypoglycemia usually indicates an organic cause. These include pancreatic disorders, liver disease, pituitary-adrenal disorders, CNS disease, non-pancreatic neoplasms, and idiopathic hypoglycemia of childhood.
Pseudohypoglycemia
Pseudohypoglycemia is a false positive laboratory reading of hypoglycemia that happens due to chronic leukemia, hemolytic anemia, or polycythemia. The mechanism for the false positive in leukemia is due to the glucose utilization by leucocytes in the blood sample after it has been drawn from the patient.
Reactive Hypoglycemia
Reactive hypoglycemia, also called postprandial hypoglycemia, is by far the most common form and tends to be misdiagnosed or overlooked. It results from the poor function of the organs that regulate blood sugar. Symptoms range from irritability when meals are missed to drastic mood swings, and their wide breadth may be confused with other disorders. It is associated with food cravings, particularly for sweets or carbohydrates, but once these foods are consumed, sluggishness occurs rather than satiation.
Syndrome X
Syndrome X refers to a metabolic syndrome of hyperinsulinemia that is associated with high blood pressure, high triglyceride levels, and low HDL (‘good’ cholesterol) levels. Predisposing factors include a family history of Type II diabetes, a diet high in carbohydrates, and a sedentary lifestyle. Truncal obesity, fatty liver, difficulty losing weight, and hypoglycemia often accompany this condition.
