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Neuroglycopenia - low blood glucose in the brain

Discussion in 'General ME/CFS Discussion' started by xchocoholic, Apr 16, 2013.

  1. xchocoholic

    xchocoholic Senior Member

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    Hi All,

    I appear to have this as a result of my hyperinsulinemia, dx via GTT + insulin. Taking a glucose tablet with DEX 4 is helping tremendously. It works much better than eating a snack or drinking OJ. I'm using CVS brand dye free DEX4. I don't have diabetes so researching this is taking a long time. So far, I haven't seen any medication that might work other than glucagon injections. [​IMG]

    Dietary changes never helped me with this. I was 98% paleo / low oxalate from 2008 - until Jan 2013. I always needed to eat or drink something sweet to overcome this. I tried to reduce my carbs in the hopes my body would adjust but my brain never did. I had to stop the low carb diet due to feeling faint. I'm prone to petite mals / staring episodes.
    http://durietz.se/diabetes/hypomethod.php

    Page 225 in this book .. here he says this condition is harder to dx if the patient also has hypoperfusion. I have hypoperfusion from OI/OH/POTS.
    http://books.google.com/books?id=Gjc704GR5YEC&pg=PA225&a...mp;f=false
    http://www.health.am/db/more/hypoglycemia-pathophysiology/
    http://www.ncbi.nlm.nih.gov/pubmed/17895322

    There appears to be a link to damaged villi but I'm still putting this together. This is where I saw the possible link.
    http://courses.washington.edu/conj/bess/incretins/incretins.html

    tc ... x

    ps. I'm on the run right now so if these links don't work please just copy and paste.
  2. xchocoholic

    xchocoholic Senior Member

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    http://durietz.se/diabetes/hypomethod.php

    This is the first paragraph from the link above ..

    Quote:
    Problems concerning detection of glucose deficiency

    Glucose deficiency (generally confused with hypoglycaemia, see below), gives rise to two kinds of symptoms. The adrenergic symptoms become impaired or even absent after long duration of type 1 diabetes [1].

    In contrast, the neuroglycopenic symptoms always remain, since they are the direct result of the deficient supply of glucose to the central nervous system (CNS).

    However, these symptoms involve deterioration of the cognitive capacity, so it may be difficult to take corrective measures. That could become a serious problem, generally called "hypoglycaemia unawareness" [2].



    http://www.insulinoma.net/english%20homepage/mainpage/Ehypo_sympt.htm

    I edited the next section a little bit for readability ... This explains the difference between the adrenergic and neuroglycopenic symptoms.


    Quote:
    Symptoms compatible with hypoglycemia occur:

    1. through activation of the sympathetic nervous system and result in uncomfortable adrenergic symptoms posing no danger for the patient

    2. through cerebral shortage of glucose supply and may result in serious and debiliating neurological (neuroglycopenic) symptoms.

    see detailed description of symptoms in insulinoma

    general symptoms = nausea, dizziness, collapse, weight gain

    adrenergic symptoms = sweating, tremor, palpitations, tachycardia, agitation, nervosity, hunger

    neuroglycopenic symptoms = impairment of consciousness, mental concentration, vision, speech, memory, blurred vision, fatigue, seizures, paralyses, ataxia, loss of consciousness, aggressive behaviour
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  3. xchocoholic

    xchocoholic Senior Member

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    second paragraph from ...
    http://durietz.se/diabetes/hypomethod.php

    Quote:
    Unfortunately, hypoglycaemia is an ambiguous concept. There is no single compartment in the body at which all glucose is at the same concentration [3].

    Because the uptake of glucose is from the interstitial fluid (ISF) surrounding the target cells and the supply is into the bloodstream, the concentrations will be unequal under dynamic conditions.

    When the uptake of glucose is larger than the supply, its concentration will decrease earlier in the ISF than in the blood [4].

    On the other hand, when the supply of glucose is larger than the uptake, its concentration will increase earlier in the blood than in the ISF.

    Therefore, when measurements are made in the blood, the glucose deficiency will not be optimally detected.


    http://en.wikipedia.org/wiki/Interstitial_fluid


    Quote:
    Interstitial fluid (or tissue fluid) is a solution that bathes and surrounds the cells of multicellular animals. It is the main component of the extracellular fluid, which also includes plasma and transcellular fluid.

    The interstitial fluid is found in the interstitial spaces, also known as the tissue spaces.

    On average, a person has about 11 liters (2.4 imperial gallons or ~2.9 US gal) of interstitial fluid, providing the cells of the body with nutrients and a means of waste removal.


    snip ...

    Quote:

    Composition

    Interstitial fluid consists of a water solvent containing sugars, salts, fatty acids, amino acids, coenzymes, hormones, neurotransmitters, as well as waste products from the cells.

    The composition of tissue fluid depends upon the exchanges between the cells in the biological tissue and the blood. This means that tissue fluid has a different composition in different tissues and in different areas of the body.

    Not all of the contents of the blood pass into the tissue, which means that tissue fluid and blood are not the same.

    Red blood cells, platelets, and plasma proteins cannot pass through the walls of the capillaries. The resulting mixture that does pass through is, in essence, blood plasma without the plasma proteins.

    Tissue fluid also contains some types of white blood cell, which help combat infection.

    Lymph is considered to be extracellular fluid until it enters the lymphatic vessels where it is then considered to be lymph. The lymphatic system returns protein and excess interstitial fluid to the circulation.

    The ionic composition of the interstitial fluid and blood plasma vary due to the Gibbs-Donnan effect. This causes a slight difference in the concentration of cations and anions between the two fluid compartments.

    _________________
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  4. aquariusgirl

    aquariusgirl Senior Member

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    confused ....u take a glucose tablet with Dex 4? Dex 4 is a glucose tablet... did u mean u take the glucose tablet Dex 4?
  5. aquariusgirl

    aquariusgirl Senior Member

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    thanks. this strikes a chord. how often do u take it?
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  6. xchocoholic

    xchocoholic Senior Member

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    The terminolgy used is glucose made from dex4. I'm not up on glucose enough to know what it means.
    I'm using the dye free version from cvs. They're on sale this week too.

    I'm taking one or two everytime my brain feels like I need sugar aka feels fuzzy or tired. Which means first thing in the morning then as needed.

    Diabetics are supposed to eat something to maintain blood glucose levels after taking
    several of these (typically 4) but I'm not using it that way. Even since I started taking these, I could tell that eating something won't keep my brain working as well as eating one of these.

    I recognized this symptom about 6 years ago but didn't have a name for it. I was using oj or raisins but this is working better and faster.
  7. Allyson

    Allyson Senior Member

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    Interesting thread thanks Xchocoholic- an something i had been wondering about

    I hear the term post- prandial hypooglycaemia the other day

    I might got 3- 4 hour not hungry, not thinkin about food

    then I eat and anywhere from staight after to 30 mins to an hour after i suddenly get stronng sugar cravings.

    i wondered if it asa because the blood had gone tothe diestive system leaving less for the brain ??? but not sure of ll the mechanisms so this is interestinng
    I have a strong family history of type 2 diabeties but i have not got it yet that i am aware of.
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  8. ahimsa

    ahimsa Senior Member

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    As far as I know, Dex4 is a brand of glucose products (liquid and tablets, I think). Here's a link:

    http://dex4.com/products/new/default.aspx

    I'm not sure why the phrase "made from dex4" would be used. It seems like "made by Dex4" would be more accurate. Do you have a link to the site that used that phrase?

    Edit - Here's a link to an NIH database for glucose/dextrose. Click on the synonyms link to see all the different names for glucose. I can't comment on details since I don't know any chemistry or biology:

    http://toxnet.nlm.nih.gov/cgi-bin/sis/search/r?dbs hsdb:mad:term @rn 50-99-7

    (how odd! the link has an "angry face" icon but it still seems to work!)
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  9. Little Bluestem

    Little Bluestem Senescent on the Illinois prairie, USA

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    I wonder if a person who has low blood volume also has low interstitial fluid volume.
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  10. Allyson

    Allyson Senior Member

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    I thought part of the proble was tht due to blood pooling the fliud flow from the venous system into the lymphatic system ??? could that e interstitial too - not sure. That is why some of us get puffy hand sand feet ( nd face in the mornings) and why compression clothing, water pressure and compression clothing can help by pushing that fluid bck into the venous system and boosting blood volume - jsut my guess.
  11. xchocoholic

    xchocoholic Senior Member

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    Hi Allyson,

    I feel the need for sugar after eating a meal too. I'm not diabetic. In fact I over produce insulin, dx via the GTT + insulin test. It's called hyperinsulinemia.

    I took one of these after eating today and felt better immediately. Ya gotta love something that works immediately. :D

    It's just my brain that I can feel reacting to this. I only take one or two at a time and let them dissolve slowly. The only times I've needed two at once was when I was over exerting myself like walking on the beach or doing laundry.

    I was in a situation the other day where I couldn't get any food for several hours and I had to drive and these worked great then. I just kept taking them when my brain felt sluggish / fuzzy.

    You're supposed to put a little under your tongue for even faster absorption.

    Diabetics are told to wait 15 minutes for their blood glucose to rise but that's not what's going on with me. This gives me an immediate boost in my cognitive abilities. Not that I'm a rocket scientist but I sure feel better. :cool: The best way to describe it is that it takes the struggling out of thinking.

    tc .. x
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  12. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    Mechanism of action
    Metformin improves hyperglycemia primarily by suppressing glucose production by the liver (hepatic gluconeogenesis).[65] The "average" person with type 2 diabetes has three times the normal rate of gluconeogenesis; metformin treatment reduces this by over one third.[84] Metformin activates AMP-activated protein kinase (AMPK), an enzyme that plays an important role in insulin signaling, whole body energy balance, and the metabolism of glucose and fats;[85] activation of AMPK is required for metformin's inhibitory effect on the production of glucose by liver cells.[86] Research published in 2008 further elucidated metformin's mechanism of action, showing activation of AMPK is required for an increase in the expression of SHP, which in turn inhibits the expression of the hepatic gluconeogenic genes PEPCK and Glc-6-Pase.[87] Metformin is frequently used in research along with AICAR as an AMPK agonist. The mechanism by which biguanides increase the activity of AMPK remains uncertain; however, research suggests that metformin increases the amount of cytosolic AMP (as opposed to a change in total AMP or total AMP/ATP).[88] Metformin and other biguanides may antagonize the action of glucagon, thus reducing fasting glucose levels.[89]

    In addition to suppressing hepatic glucose production, metformin increases insulin sensitivity, enhances peripheral glucose uptake (by phosphorylating GLUT-4 enhancer factor), increases fatty acid oxidation,[90] and decreases absorption of glucose from the gastrointestinal tract. Increased peripheral utilization of glucose may be due to improved insulin binding to insulin receptors.[91] The increase in insulin binding after metformin treatment has also been demonstrated in patients with NIDDM [92]. AMPK probably also plays a role, as metformin administration increases AMPK activity in skeletal muscle.[93] AMPK is known to cause GLUT4 deployment to the plasma membrane, resulting in insulin-independent glucose uptake. Some metabolic actions of metformin do appear to occur by AMPK-independent mechanisms; a 2008 study found "the metabolic actions of metformin in the heart muscle can occur independent of changes in AMPK activity and may be mediated by p38 MAPK- and PKC-dependent mechanisms.
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  13. xchocoholic

    xchocoholic Senior Member

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  14. xchocoholic

    xchocoholic Senior Member

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    Hi Heaps,

    I'm not sure why you posted the info on metformin. I'm just using DEX4 glucose tablets. I don't have diabetes. I have hyperinsulinemia. One of the articles I listed in the first post on this thread states how neuroglycopenia can be caused by hyperinsulinemia. One article also states how hard it may be to diagnose if the person also has OI.

    tc ... x
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  15. heapsreal

    heapsreal iherb 10% discount code OPA989,

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    i mention metformin as it can improve insulin resistence and lower insulin levels. When looking at how it works it can help maintain better blood glucose and insulin levels as well as help the body use alternative fuel sources such as fats etc. So it helps improve blood glucose by its actions on insulin.

    Something i thought might be worth talking over with your doc and considering??

    I use to get alot of reactive hypo's after eating carbs etc and put alot of weight on when trying to eat low fat, which these diets end up being high carb. I would get the cold sweats, shakes etc and need to eat some type of sugar to stop from collapsing. several times i took my sugar levels during these episodes and it would test low. I have managed to overcome this with low carb diet and lose the weight but eventually even low carb diet wasnt effective, adding metformin has helped alot as i can now eat small amounts of carbs without reactive hypo's, lost weight and my general appetitte isnt out of control. I still mainly eat low carb though. Also my cholesterol and triglycerides have improved as well. For me i think my body over reacted to carbs by increasing insulin too much which would then plummet my blood sugar levels, then the cold sweats and shaking type low sugar symptoms would hit.

    If u have low cortisol levels then this would also make it hard to control blood sugar and insulin levels. Many with oi/pots seem to have low cortisol??
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  16. ahimsa

    ahimsa Senior Member

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    Fascinating. That phrasing sounds so weird to me. It makes it sound like the Dex4 company has somehow patented their own "fast acting" form of glucose.

    Is that possible? I thought glucose was glucose but I have no idea.

    Edited -- I found the phrase "fast acting glucose" on several brands of glucose products (tablets and gel). So I think it's just a marketing phrase and not something specific to the Dex4 brand. For example, here's a brand called ReliOn:

    http://www.amazon.com/ReliOn-Glucose-Flavor-Acting-Tablets/dp/B005PX8TKU

    And here's another brand, Level:

    http://levelfoods.com/products/vanilla/

    And one last link to a diabetes information page that talks in a generic sense about various sources of "fast acting glucose":

    http://type1diabetes.about.com/od/schooldaycareandlaws/a/hypoglycemia.htm
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  17. ahimsa

    ahimsa Senior Member

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    xchocoholic, I forgot to say thanks for responding to my questions! And I hope my post did not come across as nitpicking! I was just confused by that Dex4 comment posted by the CVS folks on their web site.

    I'm so glad that you have found something that helps you. It certainly seems to be true, from what little I've read, that glucose is more easily absorbed by the body than any other forms of sugar. I believe that's why they use it in rehydration formulas, like Pedialyte, that are meant for infants with severe diarrhea.

    Somewhere on youtube there's a video about how hard sucrose and fructose are on the liver when they are consumed in large amounts. They're okay in small amounts but the average diet has so much of them these days compared to 40-50 years ago.
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  18. Allyson

    Allyson Senior Member

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    yes Ahimsa you are quite right - i recall now i was recommended glucose by the IBS dietician and specialist - if you add glucose to a fructose- contwinning food it helps those of us with fructost malabsorption to eat it withouth getting symptoms
    because it is the high fructose - to glucose ratio that causes the IBS symptoms.
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  19. taniaaust1

    taniaaust1 Senior Member

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    Metformin is commonly used for insulin resistance (hyperinsulinemia) and too also help prevent diabetes from occurring as hyperinsulinemia is a prediabetes state which usually will lead to diabetes.
    .............

    I wonder if you have seen someone specialising in insulin issues. (I see two different specialists who specialise in hyperinsulinemia .. my own hyperinsulinemina is quite shocking (and Ive had some very bad hypoglycemia showing on my blood tests in the past too.. levels low enough to cause some unconsciousness).

    When my insulin goes up too high in a spike.. I can go nuts (I dont know if its due to hypoglycemia kicking in right then too).. "agressive behaviour" .. its aweful.. I once smashed my boyfriends car window over nothing.. cause I'd gone aggressive and started kicking around in the car while he was still trying to drive, cause I accidently breached my extremely low carb diet not knowing I did so (beware.. chickpeas are full of carbs!! and I'd just had a big salad of them.. Id asked if it had sugar but didnt think about the chickpeas) and that was the insulin etc reaction it had on me 20 mins later. (my poor boyfriend has ended up with broken car window on 2 different occasions after I broke the diet I need to stay on). Ive no idea how high my insulin is going but it was at 140 my last GTT test (a normal level on that test was 9-52. A insulin level of 140 doesnt give me a bad reaction so I know my insulin is spiking far higher then that at times).

    my hypoglycemia on a standard blood test has been 2.4 (it may of been 2.2 one time (i dont think that was a fasting test either.. fasting normal range is 3.2-5.5). I think with my MCS I also have a whole another dimension to it all as I suspect Im also reacting to the high insulin level on a MCS level too. :rolleyes: (this get tricky when one has so many different issues).

    If you havent seen someone who specialists in hyperinsulinemia you probably should do. A normal low carb diabetic diet is not anywhere near low enough in carbs to stop me from having issues... I need to eat very little in carbs at all to prevent myself from having HUGE issues. Im fortunate that at least one of my specialists understands this.. (he sent me to a nutritionist who has the same issue as I do with the hyperinsulinemia and not being able to eat many carbs at all).

    Have you a specialist who has told you that with the hyperinsulinemia that you need to always have full cream things if having dairy as ithe fat helps to prevent the insulin spiking so much, you also need to eat protein before other things.. (a specialist in insulin would tell you these things). . Insulin spikes goes up... glucose falls down...

    I strongly suspect next time I go back to my original specialist for this that he is going to put me onto drugs for it as no matter what I do my insulin is just going up and up with time (the other one just wants me to try another diet which I already know is far too high due to my past experience with this).

    * Note with the insulin issues be aware that just getting hungry can start spiking insulin even before you eat!! (in preparation for having food).. hence its very important to eat regulary and not let things get to the point where you are getting hungry (I turn into a real bitch if I get hungry.. when I need to eat i need to eat NOW due to the affects of insulin happening).
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  20. xchocoholic

    xchocoholic Senior Member

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    Thanks for the replies. Sorry about the delay. I'm going through a family crisis. Luckily, after years of research and experimentation, I can manage most of my symptoms via meds, diet and supplements. KOW .. Klonopin has been a life saver during this because stress is now triggering seizures. :eek: And increasing my 5HTP from 100 mg to 150 mg at night is helping with my mood. Oh and drinking vitamin water xxx is helping me too. I can't wait for this to be over tho.

    I've yet to see a specialist about my hyperinsulinemia but will as soon as I can. FWIW tho, the list of specialists I need to see is so long I would never do anything but go to doctors if I followed through with all of them.

    I was paleo / low carb it but felt better eating more carbs. Meat for me is essential. Legumes only cause glycemic problems for me. I backed off eating so many veggies too because they weren't helping my fatigue as much as gf grains are. I'm a celiac tho so my digestive tract isn't what it should be. I need easy to digest foods. Even taking strong digestive enzymes didn't help me process the foods (paleo) I was trying to eat.

    So far nothing I eat or drink can take the place of what these glucose tablets are doing for my cognitive abilities. Taking 1 or 2 typically totally clears my head and allows me to think freely. Taking 2 after about 20 minutes of having a long conversation with anyone is working wonders for me. I regain my ability to follow the conversation and use the right words. :)

    Hope you all are doing well. TC ... x
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