Free Hypoglycemia Report
Here are some causes of recurrent hypoglycemia in addition to lack of warning. And I would like to prepare you, for some of them are too technical. They are not as plain and simple as we had before:
1. Anti-insulin antibodies could complicate the problem by maintaining unusually high concentration of insulin. Since we do not want to be part of the problem but be part of the solution, let us here and now say that the thing to do in such a case is to set less rigorous blood targets. Hypoglycemia hopefully will be more under control.
2. Increased insulin insensitivity
3. An unrecognized low renal threshold for glucose
4. Unacceptable insulin treatment
5. Insulin over treatment
6. Obsessional over control
7. Intentional exploitation or fecklessness- Oh, I don’t like this last one, do you?
Most doctors are in no doubt when it comes to the diagnosis and treatment of recurrent hypoglycemia. They are however uncomfortable when it comes to recurrent ketoacidosis. They are only too happy to be rid of these cases.
The ketoacidosis cases are usually composed of overweight girls. They take large doses of insulin. Their early admissions are attributed to intercurrent ill health. Lately however, some other things have to be considered like unpredictable insulin assimilation irregularity in blood flow and other causes of resistance to insulin.
Often these girls are troubled, frustrated, and depressed. They also go from one doctor to another hoping they will find someone with answers to solve their problems. Mind you, the doctors are not of one mind whether their emotional distress is the cause or effect of their brittle diabetes.
There are three theories regarding this. The first theory is that the problem could be organic and maybe due to some inappropriate metabolic responses. Some of these are known but others are still waiting to be discovered. Do you want to know the result of this debate. It will be in the next page.
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Proponents of this organic theory have pointed out that their patients have been examined by psychiatrists and have been awarded a clean bill of mental health so they adhere to the fact that known reasons behind the instability have been excluded.
With the second theory, it is believed that the emotional tension could be the main cause of the disruption of diabetic control. This disruption is believed to be due to physiological mechanism. Supporters of this theory have effectively treated patients with family therapy.
The third theory is the one I like the least because it seems to put the blame squarely on the shoulders of the patients. In this case, it is believed that the emotional tension might be the main cause of the disruption of diabetic control through improper behavior.
However, advocates of the third theory have oodles of medical case histories that diabetic patients may interfere with their treatment in order to gain something like attention or the desire to punish others.
Loughlin and Mosenthal reported that a third of the children with recurrent ketoacidosis came from broken homes. Many of the children, they said, admitted they would rather stay in the hospital than at their homes.
Rosen and Lidz established that all their twelve patients intentionally induced their recurrent ketoacidosis. What would motivate them to do this? They said the reasons were different and Stearns documented these.
Stearns emphasized that the inappropriate behavior could be a need for self punishment and for attention. I am not holding my breath though. Clearly there is a need for a study on a larger scale and a longitudinal investigation on the matter. Hypoglycemia could be fatal and deserve more attention than it gets.
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