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Low blood sugar, usually called hypoglycemia, has many causes. The most common one relates to our fast-paced lifestyle. Excessive sugar intake, frequent snacking, and caffeine or cola beverages contribute to this frequent malady. When the blood glucose level falls rapidly, emergency “fight-orflight” stress responses take over. The individual feels weak, very hungry, and frequently becomes irrational. Emotional reactions to hypoglycemic episodes vary from agitated to angry, depressed to suicidal. Personalities change rapidly, but return to normal function with some form of food.

Rather than frequent feedings such as the “six meal a day” diet, I recommend the following regimen: First, begin the day with a wholesome, hearty breakfast. Some whole grain cereal, bread, nut butter, or fruit makes a great way to start the day. Avoid coffee and frequent snacks. They both aggravate any tendency to low blood sugar. Mealtimes should be at regular intervals, usually five or six hours apart. Stress factors can affect hypoglycemia. Exercise is a great way to reduce or relieve stress. Try for an hour or two of extra sleep at night. Or find a weekend for a refreshing minivacation.

Careful testing of your blood, including the five-hour Glucose Tolerance Test (GTT), may help your medical advisor to “fine-tune” your dietary and lifestyle regimen. Most individuals can overcome this metabolic imbalance, particularly the so-called reactive hypoglycemia. This type comes several hours after a meal or sugar-rich snack. It responds very well to the remedies mentioned above. Rarely, tumors of the pancreas may produce abnormal secretions of insulin. In such case the symptoms of hypoglycemia occur during a fast, often early in the morning. Removal of the tumor is necessary to cure this uncommon condition.

Finally, diabetes mellitus may be associated with hypoglycemia. It occurs in the context of early diabetes, erroneously termed borderline. Overdoses of insulin will produce hypoglycemia. They occur during vigorous exercise or at night. Adjusting the insulin dosage along with dietary modification will level the blood glucose fluctuations in all but the most “brittle” diabetics.

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We now turn to the common problems of metabolism that can often be treated, controlled, or prevented in a home setting. Knowledge of sugar diabetes is important, because of its high prevalence. This disease has been recognized from antiquity. Both Greek and Chinese writings have mentioned it; and in the sixteenth century Paracelsus initiated the study of the chemistry of diabetic urine. The word mellitus, introduced by Thomas Willis one hundred years later, describes the sweetness of the diabetic urine, “as if imbued with honey.” This rapidly led to a dietary approach to this disease, until finally Langerhans, a medical student, in 1869 described the islets in the pancreas where the basic production of insulin occurs. Two Canadians, Banting and Best, finally prepared the extract from dog pancreas that was capable of reducing the elevated blood glucose level. A fascinating long history of discoveries marks the approaches to understanding and treating this common disorder.

It is estimated that there are about 200 million diabetics in the world and approximately 4.2 million in the United States. This disease is more frequent in older people. Hence, as the population grows and becomes older, diabetes will continue to increase. With treatment, the life expectancy of the diabetic is increasing, and since inheritance is an important factor, the more diabetics that have children, the greater will be the prevalence of this disease, Obesity is also on the rise and appears to precipitate diabetes among those predisposed to it.

Next to obesity and thyroid disorders, diabetes is the third most common problem in metabolism. Interrelated are the metabolic or hormone, and vascular or long-termed components of this disease. The latter consist of an accelerated arteriosclerosis that leads to premature aging and particularly affects the eyes and the kidneys. Gangrene of the foot, arteriosclerotic heart disease, blindness, and kidney failure (uremia) are the most frequent manifestations of the vascular syndrome. Statistically, the diabetic is faced, not only with a decreased life expectancy, but also with the eventual possibility of disabling complications.

The early detection of diabetes first involves a high index of suspicion. This disease is two and half times more frequent in relatives of known diabetics. Furthermore, 85% of diabetic patients were or are overweight. Four out of five diabetics are over 45 years of age. Mothers who deliver large babies have a high potential for the development of diabetes.

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We now present a few common symptoms and the possible relationships to specific endocrine diseases. Clinical experience is certainly important in interpreting these relationships. Nevertheless, the suspicion that there is something wrong is often the first step toward an accurate diagnosis.

Weakness and increased fatigability are without doubt the most frequent symptom of adults seeking medical diagnosis. In the majority, these complaints derive primarily from emotional or psychological disturbances. When hormone abnormalities are suspected, one should inquire first whether the symptoms have been accompanied by weight loss. If so, insufficiency of the adrenal gland, overactivity of the thyroid, and diabetes mellitus should be considered.

Adrenal insufficiency is usually accompanied by increased pigmentation, low blood pressure, and perhaps salt craving. Hyperthyroidism is suggested by goiter (enlargement of the thyroid gland), bulging eye changes, tremor, and heat intolerance. Sugar diabetes is usually accompanied by excessive urination and increased thirst. Without weight loss, but with symptoms of weakness and fatigability one could consider underactive thyroid, underactive pituitary gland, overactive parathyroid gland with high calcium levels, and hypersecretions of aldosterone, another hormone from the adrenal gland regulating the salt balance. The first of these are associated with hypoactive reflexes, intolerance to cold, dry skin. Hypopituitarism is suggested by delayed or absent menstrual cycle, impotence, decreased tolerance to cold, hypoglycemia, and low blood pressure. Hyperparathyroidism is usually associated with bone pain, kidney stones, and increased urination. Elevated aldosterone levels are accompanied by high blood pressure, muscle weakness, and signs of potassium depletion.

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One of the rapidly growing areas of scientific research involving body processes is the specialty of endocrinology. This science deals with hormones and the related glands producing them. Interacting closely with all hormone mechanisms is the field of nutrition. Dealing primarily with the science of body chemicals, nutrition relates to foods and diseases produced by overabundance or lack of these specific nutrients. It is now generally agreed that hormones do not initiate new events in the complicated chemistry of metabolic processes, but rather produce their effect by regulating enzyme systems of the body. From this one may conclude that a true understanding of any disease and the factors regulating their production. Characteristically, abnormalities in the hormone or endocrine system arise from either an increased or decreased hormone secretion. This deviation from “normal” produces the characteristic syndromes of endocrine disease.

The suspicion that a hormone problem may play a role in the patient’ s illness often comes initially from the physical appearance of a patient. Hypothyroidism or myxedema often produces puffiness of the face and appearance of mental dullness, with drying of the skin, hair loss, and tendency to fluid retention. Overactivity of the thyroid gland, on the other hand produces just the opposite hyperthyroid state, with nervousness, tremor, weight loss, prominence of the eyes, and a continuous perspiration.

Dwarfs and giants are commonly produced from variation in pituitary glands secretions, particularly growth hormone. The adult form of giantism is called acromegaly and occurs after the normal body height has been reached.

This hormone excess often enlarges the hands and feet. Overactivity of the cortex of the adrenal gland, called Cushing’s syndrome produces a characteristic obesity with thin arms and legs, increased tendency to bruising, a hump on the back of the shoulders, and roundness of the face like a full moon. Reduced function of the adrenal cortex is called Addison’s disease. It is characterized by increase pigmentation of the skin, weakness, salt craving, weight loss, and low blood pressure.

A rapid step towards the accurate diagnosis of these hormone problems has come with new laboratory tests, such as the radioimmunoassay. Most of the body’s endocrine hormones can be analyzed now. Although the tests are expensive they are available in most large cities. One single determination of the hormone level does not necessarily establish or exclude an endocrine abnormality. Wide fluctuations in hormone secretions are seen during a twenty-four hour period, Some disorders of the adrenal glands, particularly, may result from a loss of the normal cyclic 24-hour pattern. This is particularly seen in conjunction with disturbed sleep pattern, work schedules, and other tendencies toward irregularity.

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