Sunday, March 23, 2008

Bobblehead's New Journey Into Hypoglycemia


How About Pancreas For Dinner Tonight, Dear?

I got to break in meet a new Endocrinologist Thursday at the University of New Mexico Hospital. I have to admit, I went in pretty pissed off (and Mrs. Bobblehead was also upset). I have been basically ignored and dismissed by my doctors concerning my hypoglycemia for a year, now. Especially Endocrinologists. What in the world is wring with Endocrinologists? Are they all asshats? Hey, if you are an Endocrinologist and consider yourself a good person, write me. Please tell me what I am missing. Honest, I want to know.
My hypoglycemia is driving me and everyone around me nuts. I am moody beyond belief. I have developed a sweet tooth like I never have had before. I crave candy. I never needed candy like I do now. It is worrisome.I gave a basic medical history to the first doctor who came in. I was actually scheduled to see a different endocrinologist. I wanted to see yet a different endocrinologist, a metabolic specialist.
Oh well. Doc #1 interviewed me. He was concerned that my duodenal switch weight loss surgery might be contributing to the problem. I concur with that. I am seeing that about 1.5% of drastic weight loss post-WLS patients are developing hypoglycemia. I might be in that "lucky" 1.5%. Wonderful.
He asked what was I doing to control my hypoglycemia so far. What was the diagnosis? I told him that I had no true diagnosis and that I had no course of treatment except for trying to control with diet.
I added that I was not leaving without a plan forward. Period. He smiled and gave a nervous laugh. I did not laugh back. He knew I was not a happy camper.
After the interview he left. Li and I waited around in the examining room for about 30 minutes. Finally, Dr. #1 came back in with two others. Dr. #2, the original Endocrinologist I was supposed to see was there. He looked very young and he never did speak. Dr. #3 was older, in his fifties. His name sounded familiar to me. He spoke to me openly and honestly. As he quickly figured out my scientific background and my decent understanding of the medicine behind where I was the conversation became technical very quickly. For the first time it became obvious that I caught the attention of an Endocrinologist. He was not overly concerned about treatment, but he was clear that we were both in virgin territory. It looked like my WLS was behind the hypoglycemia. (I will post about WLS and hypoglycemia in a later post. Promise).
In a nut shell, your Islets of Langerhans inside your pancreas make two hormones, glucagon and insulin. In my case, the islets may have actually grown in size or may just be active little buggers. They are making too much insulin. This is not the same as being diabetic. I am not insulin resistant. My insulin works just fine. Since I get too much insulin my blood sugar drops.
And you do not want to be near the Bobblehead when my sugar goes down.
I could have a biopsy to examine my islets under the microscope. But for now, we will try another approach. We will try a drug to limit insulin production. If my hypoglycemia goes away, then the diagnosis is fairly close to being accurate.The drug, diazoxide or Proglycem, is a little scary. A suspension, I need to take a squirt each morning. It builds up quickly, has a fairly long half life (30 hours), and some nasty side effects. Including excess hair on my forehead and hands (back to my Neanderthal Days for Bobblehead). But it is worth a shot for now.When I was getting ready to leave UNM I finally realized why I knew the name of the older Endocrinologist. He is head of the entire department. I had written him earlier (I never heard back from him) when this was first starting. Seems like I got his attention, now.
Will let you know how things go.

[posted by Bobblehead]