Hypoglycemia: A Not-So-Uncommon Malady

When my sister’s family and I lived on the upper floors of a townhouse in London, with our widower dad living on the ground floor, we had to learn how to throw together a low glycemic index snack, real quick.
A trick you might need to know at this holiday time of year.

In this family house in London, if we were having people over for supper, we would invite Pa to join us. The trouble was he would not eat all day because he knew he was coming for “a slap up supper” at the party upstairs.

Though he was of half German origin, and a believer in deferred gratification (to the point where we weren’t allowed to open our Christmas presents until after tea in the late afternoon of Christmas day), this was not a discipline that agreed with his metabolism.

He would come up, well before supper was ready, in a foul mood, irritated that there wasn’t anything to eat yet – even to the point where he would stamp his foot because “I’m so hungry.”

I was a medical student at that time and didn’t appreciate what had gotten into our normally amiable father.

A Not so Uncommon Malady.

He was suffering from hypoglycemia - a condition where the blood sugar (or blood glucose to be more precise) gets low. Typical symptoms are fatigue, dizziness, confusion, sweating, rapid pulse – even coma if bad enough. But the most prominent symptom is irritability.

To the point where even normally placid people become incensed by something as irrational as a stupid TV advert, or the tone of someone’s voice – I have heard of patients who turn violent or start crying. Or people report banging their heads on the wall. One woman I saw reported was diagnosed as mentally ill and put on a cocktail of psychotropic medicines.

Glucose is the only thing your brain can metabolize. It gets low in some people if they haven’t eaten for a long time (the case with our dad). Diabetics taking insulin (which is of course the hormone that lowers blood glucose) are particularly prone if they’ve taken their shot but not eaten. It can occur in some people for no apparent reason.

It occurs also in people who have “reactive hypoglycemia,” where you eat, which stimulates insulin production, but then the sugar drops down again, but too low.

This reactive hypoglycemia roller-coaster is much more likely to happen if you have eaten sugary foods, or foods that break down into sugar very easily (so called high glycemic index foods). Which is the case with refined carbohydrates like white flour in cakes, donuts, puddings, cookies etc, where it is made worse by being combined with sugar.

All that crap whose consumption seems to be an absolutely essential part of the holidays.

Hypoglycemia can be hard to diagnose as people sometimes have symptoms with remarkably normal looking blood glucose levels (normal is about 80-110 mg/dl, or 4.4-6.1 mmol). People can exhibit symptoms with glucose in the 70 to 80 mg/dl range.

Treatment is to give something to raise the blood sugar. In people who are comatose, you have to inject a sugar solution intravenously – which is one of the most dramatic cures.

It’s often the case the person has been brought to the ER, or the rescue squad has been called because they’re in a coma. Then the EMT or the nurse injects a slug of glucose and the person sits up, looks around and says “where am I? How did I get here? What the hell are all these people doing here?” It’s a great parlor trick.

More often it’s not such a drastic case, and you give the person something to eat. You want to give complex carbohydrates (whole grain products), proteins and things with a low glycemic index that will supply glucose to the system slowly, but over a prolonged period. In people with recurrent problems they need to be on a meal plan where they eat small frequent meals.

In our culture, every holiday is celebrated with sugary, high glycemic index foods, which not only make you fat, but put you at risk of reactive hypoglycemia - and in a state of mind where you don’t really appreciate the season of goodwill.

My sister and I finally wised up, and would have a cheese sandwich ready for when our dad came storming up the stairs to join the party.

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