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Possible Hypoglycemia???
Jess5453 posted:
My girlfriend has been having this problem for well over a year now. Symptoms will appear after she's exercised and will only go away with sleep. There have been one or two occurences on days that she didn't exercise, but she was active on those days (such as cleaning the apartment). It's not guaranteed to happen if she exercises, but lately it probably happens 30-40% of the time that she exercises. Her symptoms include: Slurred Speech/Difficulty Speaking - She is usually a fast, smooth talker. When symptoms set in, her speech slows down considerably and she slurs some words. Strange behavior - Her personality is different. She'll be mostly giddy. Cognitive abilities are diminished. She's a quick minded person, but not when these symptoms kick in. Facial expression change - Noticeable change in facial expression. She looks tired. Eyes will look a little droopy. Shakiness - She seems weak. She's not falling over, but she appears shaky and has a little tremble.

She has spoken to her general practioner and he basically diagnosed her as having hypogylcemia. Diabetes tests came back negative. So we bought a glucose meter to start testing her blood sugar levels. However, her blood sugar readings always come back fine when these symtoms have set in. This evening, for example, her blood sugar level was 94 mg/dL. Eating something sugary will make her blood sugar level rise, but her symptoms do not go away. The only thing that makes her symptoms go away is sleeping it off. She will remember the episode mostly, but some things may be a little fuzzy.

So basically, she has all the symptoms of exercise-induced hypoglycemia, except her blood sugar levels aren't low and eating a sugary food doesn't make the symptoms go away.

Any suggestions? Either on what it could be or what kind of doctor she should see. Her general practioner hasn't been any help.

Jane Harrison Hohner, RN, RNP responded:
Dear Jess: Given what you have shared, normal blood sugar by finger stick, and symptoms not improved by raising blood sugar higher, it would seem that the search might be widened.

Some less common causes of her symptoms MIGHT include:

1. Parkinson's Disease

2. Transient ischemic attacks (small strokes which do not give the most clear cut symptoms).

3. Multiple sclerosis (MS)

4. Acute ataxia of the cerebellum

Jess, I do not know why her symptoms seem only to be present after exertion; I am a "Pelvis Person". Honestly, if she were my patient I would refer her to a neurologist for a consult. Usually the best way to get a diagnosis is to have the person go in for the appointment when the symptoms are most clearly present. This can make it easier to evaluate any neurological deficits. Certainly if she exhibits any overt symptoms (falling, speech or cognitive changes) she may need to be seen in an ER. I would urge you to have her follow up with her general practitioner and share the details you have given me.

In Concern,

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