On June 6th, 1993, I presented a paper at The XXI Proceedings of The Neurootological and Equilibriometric Society (NES) in Linkoping Sweden, entitled “Functional Hypoglycemia: Clinical Fact or Fiction, classification by glucose/insulin tolerance.” My presentation time was 2:00 p.m., after a noonday lunch. I started my presentation, acknowledging a difference of opinion as to whether or not this subject – known as postprandial drop – was a clinical condition. I asked the audience to observe those sitting next to them. Over half the audience was already dozing into a dream world. The half that was still alert became believers.
In our 14, 384 oral glucose tolerances with insulin assays, there was 5,128 or 36 percent with lowered glucose levels after the first hour of peaking. The glucose levels were between 20 and 59 mg/dl. Seventy-five percent or 3,858 of the 5,128 oral glucose tolerances with insulin assays confirmed hyperinsulinemia, type 2 diabetes.
Conclusions:
1. In 5,128 glucose/insulin tolerances with hypoglycemia, 75 percent (3,858) demonstrated hyperinsulinemia, type 2 diabetes.
2. Hypoglycemia associated with hyperinsulinemia, type 2 diabetes is designated functional hypoglycemia.
3. Functional hypoglycemia is identified by insulin assay with oral glucose tolerance whenever the lowered glucose levels are between 20 and 50 mg/dl after the second hour up to the fourth hour postglucose load.
4. Alimentary hypoglycemia is characterized by glucose/insulin tolerance with euinsulinemia or hypoinsulinemia. The lowered glucose levels in hypoglycemic range occur before the two-hour postglucose load.
5. The hypoglycemia designated alimentary is due to rapid gastric empting or “dumping.” This occurs with gastric resection, duodenal pathology, or a functional evacuation by accelerated peristalsis of varied causes.
6. Postprandial hypoglycemia joins obesity as an indicator for the identification or exclusion of hyperinsulinemia, type 2 diabetes by oral glucose tolerance with insulin assays.
In the real world, postprandial hypoglycemia, whether functional or alimentary, is truly a subjective clinical entity.
R. Myers expressed postprandial drop in his cartoon “Broom-Hilda” in
The Chicago Tribune, April 26th, 1976. This gifted cartoonist presents four sequential drawings. The first introduced a silent Broom-Hilda. The second shows her quivering, saying, “Oh Drat!” In the third drawing, she has now quivered down to one-third of her size. In the fourth drawing, she is now totally collapsed, stating, “I hate those sudden drops in blood sugar levels.”
I can personally relate to postprandial drop and the clinical hypoglycemia drop during my oral glucose tolerances. The drowsiness lasts about 30 minutes. Reading during this time is almost impossible. Driving an auto is actually dangerous at this time. I am convinced that hypoglycemia postprandial and hypoglycemia associated with oral glucose tolerances are “fact and not fiction.”
In The Wall Street Journal’s September 12th, 2008 front-page article entitled “Pilot Fatigue Spurs Calls for New Safeguards,” The National Transportation Safety Board addressed pilot fatigue and the danger associated with “exhausted, overworked, and downright sleepy pilots.” One symptom of fatigue that is being studied is micro sleep. What is not being addressed is postprandial drop, the drowsiness following eating. Postprandial drop definitely occurs in some of the pilots of commercial airlines. How do I know? Pilots are human: they are not exempt from alimentary or functional lowering of their blood sugars.
Should every pilot, even those with normal blood sugars, be tested by oral glucose tolerance with insulin assays, in order to exclude or identify increased insulin with lowered blood sugars?
ABSOLUTELY NOT!
ONLY THOSE CONCERNED ABOUT THEIR FUTURE!
In our 14, 384 oral glucose tolerances with insulin assays, there was 5,128 or 36 percent with lowered glucose levels after the first hour of peaking. The glucose levels were between 20 and 59 mg/dl. Seventy-five percent or 3,858 of the 5,128 oral glucose tolerances with insulin assays confirmed hyperinsulinemia, type 2 diabetes.
Conclusions:
1. In 5,128 glucose/insulin tolerances with hypoglycemia, 75 percent (3,858) demonstrated hyperinsulinemia, type 2 diabetes.
2. Hypoglycemia associated with hyperinsulinemia, type 2 diabetes is designated functional hypoglycemia.
3. Functional hypoglycemia is identified by insulin assay with oral glucose tolerance whenever the lowered glucose levels are between 20 and 50 mg/dl after the second hour up to the fourth hour postglucose load.
4. Alimentary hypoglycemia is characterized by glucose/insulin tolerance with euinsulinemia or hypoinsulinemia. The lowered glucose levels in hypoglycemic range occur before the two-hour postglucose load.
5. The hypoglycemia designated alimentary is due to rapid gastric empting or “dumping.” This occurs with gastric resection, duodenal pathology, or a functional evacuation by accelerated peristalsis of varied causes.
6. Postprandial hypoglycemia joins obesity as an indicator for the identification or exclusion of hyperinsulinemia, type 2 diabetes by oral glucose tolerance with insulin assays.
In the real world, postprandial hypoglycemia, whether functional or alimentary, is truly a subjective clinical entity.
R. Myers expressed postprandial drop in his cartoon “Broom-Hilda” in
The Chicago Tribune, April 26th, 1976. This gifted cartoonist presents four sequential drawings. The first introduced a silent Broom-Hilda. The second shows her quivering, saying, “Oh Drat!” In the third drawing, she has now quivered down to one-third of her size. In the fourth drawing, she is now totally collapsed, stating, “I hate those sudden drops in blood sugar levels.”
I can personally relate to postprandial drop and the clinical hypoglycemia drop during my oral glucose tolerances. The drowsiness lasts about 30 minutes. Reading during this time is almost impossible. Driving an auto is actually dangerous at this time. I am convinced that hypoglycemia postprandial and hypoglycemia associated with oral glucose tolerances are “fact and not fiction.”
In The Wall Street Journal’s September 12th, 2008 front-page article entitled “Pilot Fatigue Spurs Calls for New Safeguards,” The National Transportation Safety Board addressed pilot fatigue and the danger associated with “exhausted, overworked, and downright sleepy pilots.” One symptom of fatigue that is being studied is micro sleep. What is not being addressed is postprandial drop, the drowsiness following eating. Postprandial drop definitely occurs in some of the pilots of commercial airlines. How do I know? Pilots are human: they are not exempt from alimentary or functional lowering of their blood sugars.
Should every pilot, even those with normal blood sugars, be tested by oral glucose tolerance with insulin assays, in order to exclude or identify increased insulin with lowered blood sugars?
ABSOLUTELY NOT!
ONLY THOSE CONCERNED ABOUT THEIR FUTURE!
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