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Are symptoms of ‘hypoglycemia’ in CFS associated w/ hypoglycemia or orthostatic intolerance in youth

Tom Kindlon

Senior Member
Messages
1,734
From: The IACFS/ME 2016 Conference Syllabus

Are symptoms of ‘hypoglycemia’ in Chronic Fatigue Syndrome (CFS) associated with hypoglycemia or orthostatic intolerance in young people?

Katherine Rowe, Rebecca Gebert, Susan Donath, Angas Hamer & Fergus Cameron

Background:

Symptoms of nausea, feeling faint, malaise and mild anxiety are common in young people with CFS and popularly attributed to ‘hypoglycemia’ resulting in various dietary interventions with little reported improvement.

Objectives:

To determine whether the symptoms are associated with measured hypoglycaemia using continuous tissue glucose monitoring or whether these symptoms are associated with documented orthostatic intolerance.

Methods:

Nine young people with CFS (mean age 20 years) and mean duration of 4.5 years with persistently troublesome symptoms were compared with 10 healthy adult controls without diabetes. Each subject agreed to 3 days Continuous Glucose Monitoring System (Medtronic CGMS). This is routinely used in adolescent diabetics to document food intake, tissue glucose levels and activity levels to monitor control.

Subsequently 8 of these had formal cardiac tilt table testing where heart rate and blood pressure are measured supine and during 70 degree head-up tilt for up to 10 minutes to assess the presence orthostatic intolerance (either postural orthostatic tachycardia (POTS) or neurocardiogenic hypotensive syndrome). If positive, appropriate medical management of increasing salt and fluids, gentle improvement of muscle tone and blood pressure support medications, was implemented.

Results:

The tissue glucose was calibrated with the blood glucose and all fell within acceptable normal range. There was statistical (but not clinical) significance in average tissue glucose in CFS subjects. 6% of time in controls and 16.8% in CFS was spent in the range <4mmol/L glucose (95% CI -23% to +2%, p=0.1) suggesting weak evidence for a difference given the variability and small sample size. The reported presence of symptoms throughout the day was not associated with significant reduction in tissue glucose levels.

Six had confirmed evidence for POTS, one for neurocardiogenic syndrome and one for a combination of both. All 8 reported improvement in all symptoms especially nausea, dizziness and malaise with active treatment of their orthostatic intolerance.

Conclusion:
This study could not confirm a link between putative symptoms of ‘hypoglycemia’ and documented hypoglycemia. This suggests that symptoms frequently attributed to ‘hypoglycemia’ may be due to orthostatic intolerance and further investigation and management of this condition provides more reported relief for these troublesome symptoms.

Dr Kathy Rowe, Senior Consultant Paediatrician, Department of General Medicine, Royal Children’s Hospital, Melbourne, Victoria, Australia 3052
kathy.rowe@rch.org.au No conflicts of interest to declare. RCH internally funded.

 
Messages
15,786
A good example of why the cause of symptoms shouldn't be assumed (and acted upon) without proper investigation. It's not just a matter of useless and frustrating treatments for the presumed problem, but a delay in uncovering and treating the real problem.
 

anciendaze

Senior Member
Messages
1,841
I went that route when the term CFS had not been invented. That detour ended when I refused to do any more glucose tolerance tests. At that time, long before I heard of PEM, I reported that each GTT left me "wiped out" for three days afterward. This comment went in the medical bit bucket.

I also had questions about cortisol, which led to a test that showed nothing because it was looking for quantities of cortisol over a full daily cycle. Recent research shows that ME/CFS patients have trouble bringing cortisol up in mornings, and probably down in evenings, when they are "wired". This is what I described as a "phase lag" many years ago. The concept was simply not in medical thinking.

This is a problem with regulation of endocrine response that does not fit in the "too much/too little" dichotomies.

The term orthostatic intolerance was not in wide use at the time, and was certainly not considered relevant.
 

Sidereal

Senior Member
Messages
4,856
Hypoglycaemia used to be what some clinicians called CFS before the term was invented. Most people who think they have reactive hypoglycaemia when they get that sudden shakiness/crashing don't actually have low blood glucose; these are autonomic symptoms.
 

RogerBlack

Senior Member
Messages
902
Blood test kits are very inexpensive.
I would have loved for my symptoms to be hypos - but alas - glucose meter says no.
 

KME

Messages
91
Location
Ireland
Really valuable study, I think. I've been alarmed at how quick some nutritionists specialising in ME/CFS are to "diagnose" hypoglycaemia based on symptoms alone, or to simply take a person's word for it that they have hypoglycaemic episodes, when those symptoms could also be those of orthostatic intolerance. (The same symptoms are often interpreted as anxiety by psychologists, -iatrists, -therapists and co.) Hopefully this will lead to more people being guided towards effective treatment of orthostatic intolerance.