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Question:

I am a fifty year old white female who was diagnosed with type II diabetes one and one half years ago. I have been following a strict diabetic diet and lost seventy pounds. This enabled me to keep my sugar levels within the normal range. All other vital signs are extremely good. I also exercise daily.

After about a year of dieting, I began to have trouble with my sugar levels dropping too low (often to the 40's). I tried dividing my food and eating every couple of hours. This helped for a while. Then I found it necessary to add about 2-3 additional carbohydrate exchanges to my diet, especially in mid-afternoon (my normal slump time). I have gained ten pounds (I weigh about 140 lbs and am 5'2" tall). Early episodes of low blood sugar included tingling in my limbs and lips and near collapse. Later, I had several episodes of violent shaking (no passing out, but weak and prone to crying and confusion) which lasted several hours despite taking glucose and eating. My sugar levels now run consistently higher (120's-130's between meals and about 105-115 in the morning) with the extra carbohydrates but I still have episodes of shaking which often pass within 2-3 minutes.

The shaking is stronger than that which I experienced with early episodes of low blood sugar but not as violent as the later episodes. The shaking seems to occur without regard to whether my blood sugar level is up or down and occurs frequently throughout the day and at night. I no longer take glucose or food for the shaking as it seems to pass on its own and I feel okay afterwards. My doctor offers no explanation. Is this common? Should I be concerned? What is the cause?

I am not taking any type of medication. Could a rapid, if not extreme, rise or fall in blood sugar level cause this? I know I am very sensitive to changes in blood sugar level. I can usually estimate fairly well where my sugar level is by how I feel in general and by little sensations,etc. in particular. However, this has me puzzled. I tend to connect the shaking to the diabetes because it began with, and at first only occurred in conjunction with, episodes of low blood sugar.

Answer:

This is not common.

Since the shaking is unrelated to blood sugar, and since you're on no medications, it is very unlikely to be related to the diabetes causing you to "crash" into severely symptomatic and atypical hypoglycemia.

Although I respect your statement that you think you can perceive changes in your blood sugar pretty reliably, I'd prefer to trust the numbers: by the way, if you haven't had your meter doublechecked for accuracy, that would be a very high priority.

Anyway, your statement that "The shaking seems to occur without regard to whether my blood sugar level is up or down and occurs frequently throughout the day and at night. I no longer take glucose or food for the shaking as it seems to pass on its own and I feel okay afterwards" pretty well excludes fluctuating blood sugar as a cause: there'd be some relationship to time of day or meals.

I'd ask a neurologist for an opinion (or get some of the tests that neurologists almost always order as their first advice, including an electroencephalogram (EEG, also called a brain wave test)).

WWQ

Original posting 4 Jan 97

  
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Last Updated: Tuesday April 06, 2010 15:08:52
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