Hypoglycemia Filter: Fasting for abdominal ultrasound

September 17, 2014 5:52 PM

My doctor is wanting me to have an abdominal ultrasound to rule out gallstones. This test requires fasting. I cannot go for long periods of time without eating because my sugar drops. Need advice.

The sugar attacks often send me into a panic attack, especially if I do not feel safe and cannot get to food immediately. The thought of having to fast for this test is causing me extreme distress and anxiety. I do not want to go through the physical and psychological symptoms of a low blood sugar attack. My doctor is trying to get my anxiety level down so I can deal with the test. She has tried to reassure me that I will not die and that I will be ok. I am not at all convinced. How can I get through this test? I eat breakfast as soon as I get up, and the last time I went without breakfast I nearly passed out. Can I have a glucose tablet before the test? A glucose gel? What kind of help on this can I expect from the imaging center? I am terrified of going through this horrible experience and also of what I might have to go through if the test shows stones. I am terrified of getting sick to my stomach due to the low sugar (I have emetophobia). I am also afraid of and dreading feeling horrible from not eating. I can't see myself getting through this test.

posted by msbadcrumble to Health & Fitness (14 answers total)

Trust your doctor. She knows you and knows what's best for you. You'll be in a medical setting and they can assist you.

I have hypoglycemia and I fear fasting, but when I do, I always find that I've over-blown the discomfort of it.
posted by Ruthless Bunny at 5:57 PM on September 17, 2014 [3 favorites]

Can you ask if the doctor will allow you a glucose tablet/gel or a glucose IV drip? She may also be able to prescribe you an anti-anxiety medication to help you take the edge off. Hopefully she can also schedule you for the test to happen first thing in the morning so you minimize the time between when you usually have breakfast and the time you'll actually be having breakfast. Make sure to pack a protein bar or breakfast bar so that you can eat immediately after the test is completed.
posted by quince at 6:07 PM on September 17, 2014 [2 favorites]

I have blood sugar problems. I have anxiety and emetophobia.

Absolutely call your doctor. Often fasting means that you can't eat solids but can have liquids so juice would be okay. Be sure you get the correct information and they know WHY you're asking. I was given wrong information for an appointment about what I could or could not have so be sure to talk to the doctor or their PA, not just the front staff.

Also, can you have a friend or family member take you to your test? So then you can just roll out of bed and go to your test without having to worry about getting ready or driving? Be sure to take food with you so you can eat immediately after, something protein heavy with a side of carbs - jerky, nuts, and a banana would be good.

And as a fellow anxiety sufferer, once you're at the hospital for the test, then that's probably the best place to have a medical issue, right? (And a reminder that you won't have one and will be fine.)

PS: As an emetophobe with chronic stomach problems, I've been able to get a RX for Zofran (generic) that's an anti-nausea med. It works wonders! The label use is to treat chemo-associated nausea but that stuff is a miracle. Ask your doctor if you can get a few pills because you'll get nauseous from not eating.

Source: Blood sugar problems, food intolerances, anxiety, emetophobia, and made it through a colonoscopy prep and fast without dying, puking, or passing out! That's almost two days without real food!
posted by Crystalinne at 6:09 PM on September 17, 2014 [8 favorites]

I feel compelled to ask.. Have you ever actually had documented hypoglycemia (a measured blood sugar below 70 mg/dL)? Because there is a legitimate difference between genuine hypoglycemia and being hangry/hanxious. Both are unpleasant but only the former is potentially unsafe.
posted by drpynchon at 6:40 PM on September 17, 2014 [14 favorites]

The person who can tell you if you can have glucose tablets--or hard candy, for that matter, or liquids, or whatever--is your doctor. Medical professionals these days have tons of experience dealing with people with diabetes and other conditions like that, this isn't a really novel problem.
posted by Sequence at 6:41 PM on September 17, 2014

If the timing is similar, I wonder if you could combine a fasting glucose test with the pre-ultrasound period, and just hang out in the doctor's office during the fasting glucose test. Not sure if you could get both in the same location, but it's a thought, just in case your hypoglycemia hasn't been formally diagnosed as drpynchon thinks.
posted by amtho at 6:53 PM on September 17, 2014

You should talk with your doctor about this. It's their job to take care of you. No one one Metafilter can tell you what you can or can't eat or drink for how long before your ultrasound.
posted by alms at 7:04 PM on September 17, 2014 [3 favorites]

I cannot go for long periods of time without eating because my sugar drops.

It's this that your doctor is using to estimate your treatment. This is uncomfortable in the short-term but useful in the long term.
posted by vapidave at 7:17 PM on September 17, 2014 [2 favorites]

For upper abdominal imaging, the fast is usually 4-6 hours, which might be more accurately (and less alarmingly) described as delaying a meal than as fasting. Can you arrange to have a really good breakfast when you get up and then have the scan before lunch?

One aspect of life with some anxiety disorders is the tendency to catastrophize ("I have to have a test that means I have to fast and when I fast I freak out so I am going to freak out and have a panic attack a really bad one and I won't be able to get through the test and it'll be embarrassing and we'll have to schedule it again and it'll all happen again and I'll never be able to get diagnosed for my stomach pain and I'll have to live with it for the rest of my life or until whatever it is kills me plus my doctor will think I'm an idiot....." and so on). One way to approach catastrophizing is to break the event into teeny bits and examine each one for realism and ways the scenario could play out differently:

"I have to fast" probably not changeable

"when I fast I freak out" always? what if you have a meal first and then fast? what if you plan in advance to make everything as easy for yourself as possible? what if you have a sedative between breakfast and the scan?

"I am going to have a panic attack a really bad one" okay, is this realistic? can you reduce the likelihood of the attack, and/or can you lower the intensity with some of the interventions you've learned in treatment?

"I won't be able to get through the test" the test itself is at most 10 to 20 minutes of having your abdomen stroked with a cool wet wand - it's not possible if you're actually screaming, but it is doable if you can hold yourself pretty still, even if you're rolling your eyes and hyperventilating and muttering nonstop about how you need to eat. Most techs have dealt with worse, so be realistic about the social anxiety piece, too.

You get the idea. Can you work through some of this with your therapist or someone close to you?
posted by gingerest at 10:39 PM on September 17, 2014 [9 favorites]

Call the radiology center and ask if there are foods you can have. Talk with one of the technologists if the receptionist is just reading off of the canned instructions. I believe that the biggest concern for gall bladder imaging is fatty foods. It might be alright to have some fruit veggies or carbs in small amounts.
posted by SLC Mom at 6:33 AM on September 18, 2014

Gallstones can be seen, whether fasting or not. Gallbladder ultrasounds are done non-fasting all the time, please ask your doctor about it as there may be a misunderstanding, and as noted, if they do really want you to be fasting for whatever reason they are the best resource for suggestions for your situation. Your anxiety about the procedure sounds very intense, they may be able to help with suggestions for that as well.
posted by treehorn+bunny at 8:31 AM on September 18, 2014 [1 favorite]

Talk to your doctor more. Explain that it will not be a possibility to do what she asked and ask for other options, like waking up earlier so you get breakfast, but still have a decent amount of time before, or allowing you to have at least juice, etc. I am also hypoglycemic and have had people tell me I need to fast for various tests, and when I tell them that's not happening, they always have found a work around.
posted by katers890 at 8:34 AM on September 18, 2014

Ultrasounds for gall bladder tests usually require 3 hours fasting. If you can snag an 8:00 AM appointment, you could be done by 8:30 and on your way to breakfast.
posted by citygirl at 6:42 PM on September 18, 2014

Response by poster: Thank you all for your comforting responses. I made it through the procedure with three sugar pills, ativan and zofran. The staff were less than helpful and I nearly walked out at one point, but it's done. The scan came back normal so I am very relieved.
posted by msbadcrumble at 11:20 AM on October 2, 2014 [2 favorites]