Hypoglycemia or something else?

April 16, 2012 3:56 PM

Is this hypoglycemia or am I patient zero in the zombie apocalypse?

Background: For the last 4-6 weeks I've been having a dazzling array of unpleasant symptoms: dizziness, extreme exhaustion, chills &/or flushing, mild palpitations, shortness of breath, occasional nausea, mild aphasia, and tingling/numbness in extremities (worse in my legs). Normally I would assume death was imminent, but this all only happens at around 330-400 each afternoon at work (and lasts until after dinner) and nowhere/no time else.

It happens almost every weekday and does not seem to be affected by how much I've eaten, what I've eaten, at what times I've eaten, or how stressed I am. I have made no dietary or medication changes during this time, BUT I have had a huge amount of disruption to my sleep schedule.

I'm on 20mg of Daytrana daily and the occasional Imitrex. I have ADHD, Meniere's disease, and migraines. There is zero chance I am pregnant. I don't smoke, I drink very rarely, and I don't do any drugs other than what's listed above. I had a reasonably full blood workup done less than a year ago that had 100% normal results, but did not include any screening for diabetes or anything similar re: blood sugar. I have a pretty balanced diet mostly free of sugary crap.

Questions: does this sound hypoglycemia related to you alls? Or could this all really just be from not getting enough sleep? Or, as I naturally assumed immediately, am I about to bring on the zombie apocalypse?

NB if your immediate response is OMG SEE A DOCTOR ASAP please let me know which kind of doctor is the best doctor to see. It will take me anywhere from 6 weeks to 2 months to get an appointment with any GP on my insurance plan, so that is quite literally the last fucking resort. I will go to the ER and swoon dramatically before I bother with that.

sorry if this is a bit rambly but i am super exhausted right now

YANAD, YANMD, TINMA, kthxbie.

posted by elizardbits to Health & Fitness (30 answers total)

What happens if you have a snack around then? It's been a while since I had bad hypoglycemic symptoms, but at a glance, it looks like it has some overlap (nausea, exhaustion), but doesn't scream "hypoglycemic!" to me. (Note: a couple of years ago I had symptoms very like hypoglycemia about that time of day, and after assuming that's what it was I actually tested my blood sugar and discovered it was unexpectedly HIGH at that point in the afternoon.) It's pretty easy to buy a blood sugar monitor over the counter at a drugstore or on Amazon and test yourself; you might start there to eliminate that concern. I actually really love this one: http://www.onetouch.com/ultramini (it hurts way less and is much easier to use than the one I borrowed when I first started testing).
posted by instamatic at 4:15 PM on April 16, 2012

I think I get a mild version of what you describe, usually around the time my ADHD meds wear off (3, 3:30). At its worst, I have chills or flushing, extreme brain fog, not dizziness but I'm unstable on my feet, sometimes nausea and a headache.

It's worse when I haven't had enough sleep the night before, when I haven't eaten enough (especially enough protein), when I'm stressed out and when I'm dehydrated. Conversely, taking care of myself seems to lessen these effects, and this has reminded me that I really need to take a longer lunch break tomorrow to take proper care of myself.

I'd suggest making an appointment with a GP for as soon as you can (if 6 weeks then so be it) and try getting more sleep and maybe keeping yourself hydrated better. If you don't feel better, then at least you have an appointment. You may want to discuss changing your ADHD meds when you do get in to see the doctor if it is a result of the come down.
posted by sarae at 4:28 PM on April 16, 2012

Nearly all of the symptoms you describe are potential side effects of Daytrana. It seems a little strange that a medication administered via transdermal patch would present side effects only at one time of day, but it's worth discussing with the doctor who prescribed it.
posted by maxim0512 at 4:30 PM on April 16, 2012

I have hypoglycemia, and how I generally feel is very linked to my diet during the day. The fact that your current condition isn't really makes me a little suspicious that it might not be hypoglycemia. Also, if my blood sugar drops or spikes I typically have lingering effects after I eat, rather like a "hangover" type feeling, that you don't describe here. Letting my blood sugar get out of whack will result in a terrible headache, nausea and other unpleasantness that lingers for several hours.

That being said, various meds and conditions can do weird things to blood sugar, so I would see a doctor. I would start with your regular adult GP, or perhaps someone with a specialty in internal medicine. It could be that the combination of meds that you're on has suddenly started to give you some trouble.
posted by backwards compatible at 4:31 PM on April 16, 2012

So... this only happens during the workweek? If that's the case, it's probably worthwhile to look at the differences between your workday and your weekend days, in regards to food, sleep, hydration, exercise, etc. I am always a fan of logging that sort of stuff - a google spreadsheet with a bunch of factors and a space for you to describe your symptoms might help, and if you do eventually talk to a doctor, you'll have something concrete to tell them.

It resembles a panic attack more than anything else in my personal experience. That's pretty much the list of symptoms I get when I have them, particularly the chills, tingling, and palpitations. So I wouldn't be particularly surprised if it's some sort of brain chemistry issue, especially if the Daytrana can cause that sort of thing.
posted by restless_nomad at 4:32 PM on April 16, 2012

re: snacks - I knew I forgot to mention something, omg. When the symptoms start, I always try eating something plus a huge glass of water/juice. Nothing seems to make a difference, alas. It's hard because of the nausea, as well, but I can usually at least choke down some OJ and peanut butter on crackers.

re: ADHD meds/Daytrana - this was really my first thought, but 01) it doesn't happen on weekends when I'm at home or out and about, even though I am on mostly the same sleep schedule, and 02) it happens no matter what time I put the patch on in the morning on a workday. So an everyday crash at 330 seems odd if I start at 8am one day and 11am the next 2 days.
posted by elizardbits at 4:35 PM on April 16, 2012

Also, if my blood sugar drops or spikes I typically have lingering effects after I eat, rather like a "hangover" type feeling, that you don't describe here. Letting my blood sugar get out of whack will result in a terrible headache, nausea and other unpleasantness that lingers for several hours.

I do get horrible headaches when I forget to eat, and I guess the hangover sensation does seem kind of familiar - it's hard to judge because I'm tired and grumpy at the end of the day all the time anyway.


So... this only happens during the workweek? If that's the case, it's probably worthwhile to look at the differences between your workday and your weekend days, in regards to food, sleep, hydration, exercise, etc.

Yeah, so far all I can see is that my eating habits are much better outside of work - on off days, I'll eat whenever I'm hungry, but at work I will put it off for 30-60 minutes if I am in the middle of something. And yeah, it does feel pretty similar to a panic attack in that I have no idea what is going on but I really really want it to stop right away.
posted by elizardbits at 4:37 PM on April 16, 2012

What's your caffeine intake like?
posted by restless_nomad at 4:42 PM on April 16, 2012

What about your work environment? Are the symptoms the same when your workday is off-site for meetings or errands? Are you on your feet?Chained to the worst ergonomic setup known to humanity in an office above a metal smelting, plywood, and asphalt facility? I felt awful when they were doing construction next to my office. Do you feel the same on any weekends that involve sitting (or standing) all day, e.g., for a road trip?
posted by salvia at 4:47 PM on April 16, 2012

Pretty low. About 6oz of black tea first thing in morning and then nothing else all day.
posted by elizardbits at 4:48 PM on April 16, 2012

Can you call your doctor's non-emergency helpline and speak to a nurse or intern? They may be able to assess the urgency of the situation, and advise you of the kind of doctor you should see.
posted by Specklet at 4:54 PM on April 16, 2012

weekdays
330-400 each afternoon

Is there anything particular that happens at work around that time?
posted by travelwithcats at 5:37 PM on April 16, 2012

Have you tried eating something before the terrible symptoms start? Scheduling your OJ, PB and crackers for 3?

I used to get something similar later in the day, almost always as I was rushing to pick up my kid after work, accompanied by a cold, soaking sweat. I assumed it was hypoglycemia, too, but always worried the people at her day care would think I was having some terrible drug withdrawal, every day. That was a long time ago and my habits have changed completely so it's gone, but I never did figure out what it was.
posted by looli at 6:07 PM on April 16, 2012

Oh! and I forgot to mention that I've had it happen a couple of random times since, and measured my blood sugar and both times it was totally normal. *shrugs*
posted by looli at 6:08 PM on April 16, 2012

Where do you work? I'll bet it's a big office tower with its own air-handling system.

Those symptoms don't sound like anything is wrong with you, they sound, to me, like something is wrong with your building. All of the symptoms you describe read like a lack of oxygen. The fact that it happens late after-noon makes me suspect that you building management are cheaping out, turning down the number of air-exchanges in the building to save on heating and cooling costs. The air gets freshened in the evening, is good for the morning, bad by lunch and crappy by late afternoon as people huff and puff all day. Night refreshes again, rinse, repeat.

I think you were very close with your guess, not hypoglycaemia, but hypoxia. You may not need a doctor, but an industrial hygienist, or someone from OSHA.

Try taking a walk outside when it happens, turn that fifteen minutes into a half-hour and see how you feel. If that does the trick, then you know to get the building super to do something about it.
posted by bonehead at 6:17 PM on April 16, 2012

re: work env - borall day ing officey stuff, but I have an hourly alarm thingy to remind me to walk around a bit instead of being sat on my ass all day. Plus I've had this same work setup since late 2005 with no problems except occasional irritation at the ridiculousness of all human beings ever.


Is there anything particular that happens at work around that time?

Boredom? Ennui? Clockwatching? It would be kind of funny if this was all psychosomatically induced by my subconscious to get me sent home early.


re: eating earlier - yeah, I've tried that but it doesn't seem to make much of a difference. I think I need to do the spreadsheet suggestion instead of just counting on my memory for everything though,

re: lack of air in the building - unlikely, everyone has windows open all day no matter what the season, plus our HVAC system running full force year round. It's a 10 floor live/work space and everyone has their own individual system.
posted by elizardbits at 6:24 PM on April 16, 2012

Is it possible that you DO experience these symptoms in the weekends, but that you are busy enough out and about that you don't notice them? If I am slightly nauseous, feverish or otherwise slightly unwell I will absolutely notice it and stress about it when I am sitting in front of a computer doing boring work, rather than if I am doing something fun and relaxing or even just watching TV.
posted by lollusc at 6:31 PM on April 16, 2012

Does it happen on weekdays when you don't go to work?
posted by rtha at 6:36 PM on April 16, 2012

When you get up to walk around, also chug a glass (or half a glass) of water.

You might also want to try cutting carbs during the week and seeing if that helps. Especially around lunchtime--no carbs at all. The post-lunch crash after a sandwich is deadly for me (like, contemplating going home sick). But a big salad with cheese, egg, meat (if you eat), beans or chickpeas, is a good option. The fogginess and tingling extremities can be a sign of B12 deficiency, so you might try taking a supplement and see if that helps.

Sleep very well may be the culprit, since that's the only variable. Try a course of strict sleep hygeine for a month and see if that helps. That means getting up at the same time every day, even on the weekends, and going to bed around the same time at night. No screens/bright lights an hour before bed. Make sure your room is cool and dark. No drinking yourself sleepy--if you have trouble falling asleep, 3 mg of melatonin is safe and useful.

Another thing to consider, if you are open to the idea, is that you might have an anxiety problem. Anxiety can be insidious and more than just panic attacks. I had panic attacks wake me in the middle of the night, with the symptoms you describe. Is this what you mean by a disrupted sleep schedule? Clearly I was as relaxed as could be before the attack, so the fact that they don't track to obvious triggers isn't necessarily a reason exclude them as a possibility. Lack of sleep will make me more prone to them. For me, a low dose of Zoloft did the trick.

But vague, non specific symptoms like that need to be evaluated by a doctor specializing in internal medicine. What they will do is evaluate what's going on, and then refer you to a specialist to treat it. I would go ahead and get that appointment made. If you're feeling better in 2 months, great, cancel it. You won't hurt their feelings.
posted by elizeh at 7:25 PM on April 16, 2012

And no nearby construction? Nobody else in your office complaining of anything similar?
posted by salvia at 7:29 PM on April 16, 2012

weekends - might do, but I tend to get a lot more sleep on the weekends so I don't have the already tired thing hanging over me.

weekdays when I'm not at work - this is either a sick day, when I am already feeling super gross, or a holiday, when I've had a lot more sleep, so I don't really get the same feeling.

BUT - as I just noticed right now, I get something very similar every single morning after breakfast - I tend to have a wave of exhaustion right after eating and fall asleep for about 30 minutes (late to work a lot, sigh.)


Try a course of strict sleep hygeine for a month and see if that helps. That means getting up at the same time every day, even on the weekends, and going to bed around the same time at night. No screens/bright lights an hour before bed. Make sure your room is cool and dark.

I already do this, alas. No teevee in the bedroom, I always go to sleep at the same time and wake up at around the same time (maybe +1h/90min on weekends). The horrible problem with getting enough sleep - not to derail this question with another issue - is that my upstairs neighbor is the most horrible stomper ever and I spend a lot of time imagining her gruesome death by savagely fanged crying baby hordes.
posted by elizardbits at 6:59 AM on April 17, 2012

Could it be a different type of migraine that you're used to having a flare-up of Meniere's disease? While I don't get migraines I've heard of them causing nausea, tingling and so on. (I don't know if it's possible though if you have no headache whatsoever.)

You may want to check if there's any decent immediate care centers in your area. If I wasn't going to my GP, I'd do that, or schedule a time with a specialist you'd use for migrane or Meniere's and see if any of them have any leads.
posted by ejaned8 at 7:18 AM on April 17, 2012

This sounds like sleep deprivation to me. What time of the day do you take off the Daytrana patch? Maybe you can try taking it off earlier?

What you might be experiencing is that because of the sleep deprivation that has been building up over time, you are becoming dependent on the Daytrana to keep you awake. If this is the case, then a standard dose of Daytrana would become not enough to keep you awake/alert through the whole day, and what you are experiencing is the Daytrana's effects wearing off.

(I have no idea if the patches are similar technology, but when I was quitting smoking with The Patch, I realized that for some reason, it wore off way sooner than the 24 hours they are supposed to last. )

The other theory might be that you are actually taking too high of a dose of Daytrana, combined with having a metabolism that metabolizes it quickly, or absorbs it too quickly from the patch. (This happened to me when I tried Ritalin XR for my ADHD- it peaked early, and the rest of the day was me suffering the effects of coming down. Which were very similar to what you describe.)

As for the stomping neighbor, maybe what you need is something like a white noise generator to mask the sound. Dead silence is great if you can maintain it, but it makes the relative "jolt" of a loud noise much worse. What works for me is ear plugs + white noise. I just use a radio on a quiet station, or the TV on a boring station like the weather channel.
posted by gjc at 7:37 AM on April 17, 2012

Another thing you could do is get a blood sugar meter and track your blood sugar. You might not be crashing into hypoglycemia. But you might have "over reactive blood sugar" (I forget the name) where after you eat, your blood sugar goes too high, and what you are feeling is not hypoglycemia, but just crashing down to normal.
posted by gjc at 7:43 AM on April 17, 2012

This sounds like sleep deprivation to me. What time of the day do you take off the Daytrana patch? Maybe you can try taking it off earlier?

This seems like an interesting idea, actually. Usually it goes on around 9am and comes off right before I leave work at 5. On my days off, it doesn't go on until at least 11, because I don't like wearing it to the gym. I will try taking it off earlier every day this week and see how things go!

(re: white noise machine - the Meniere's gives me a wide variety of hearing issues such that I leave a fan on 24/7 year round to cover background noises inside my ear. The stomping is loud enough that I can hear it over the sound of my hairdryer right next to my ear when I am drying my hair in another room, and sometimes she paces all night long.)
posted by elizardbits at 8:11 AM on April 17, 2012

it doesn't go on until at least 11 but comes off at the same time - 5pm.
posted by elizardbits at 8:12 AM on April 17, 2012

Typically hypoglycemia responds incredibly rapidly and dramatically to the introduction of sugar. It sounds like you have tried that and noticed no significant change. Almost certainly not hypoglycemia.
posted by The Violet Cypher at 2:32 PM on April 17, 2012

Idk, today I ate a vast and terrifying lunch that made me kind of want to die inside and I had no symptoms other than fatness. I also removed the Daytrana patch at 3pm instead of 5pm because sometimes I am bad at managing the variables in my experiments.

Also I have a neurologist appointment for Thursday to review any potential daytrana issues, yay!
posted by elizardbits at 5:16 PM on April 17, 2012

SIGH. It was the Ritalin.
posted by elizardbits at 4:05 PM on July 25, 2012

Aww, man. Thanks for the update.
posted by restless_nomad at 4:20 PM on July 25, 2012