Your Concern About Hypoglycemia

by Richard C. Raynard, Ph.D.
Clinical Psychologist

At the 5th Annual National Phobia Conference in Washington, D.C., Dr. Frederick Neuman spoke on hypoglycemia and the confusion around this condition, especially in the over-emphasis placed on the links between this and agoraphobia. Dr. Neuman supported his findings by his own clinical research and extensive reviews of literature on the subject.

Dr. Neuman focused on the common over-diagnosis of hypoglycemia in agoraphobics. His own caseload at the White Plains Phobia Clinic was used to draw a clear picture. At one time, 25-50% of his clients reported hypoglycemia upon entry to his clinic. Without exception, none of these clients were hypoglycemic, as was shown by subsequent glucose tolerance tests.

Despite these test results, however, it is generally extremely difficult to convince an agoraphobic that they are not hypoglycemic once they have been told (or have read) that they have this condition. Phobics are frequently in distress, have difficulty concentrating on practice, and are distracted by the attention needed for a hypoglycemic's diet once they believe they have this condition, and this often inhibits treatment.

Dr. Neuman reports that the typical blood sugar levels of the clients he tested for hypoglycemia was between 50 and 60 milligrams or higher, which is within the normal range. The blood sugar level at which normal functioning is disrupted is 35-40 milligrams, however, measures of blood sugar levels below 50 are relatively common in the general population. (Levels of 40-55 milligrams fall in a gray area in which some people have symptoms, but the majority do not.) The overall data suggests that hypoglycemia is as common among non-phobics as it is in agoraphobics!

Not all experts feel that a Glucose Tolerance Test is a completely valid diagnostic tool. Doctors also disagree about what constitutes a normal blood sugar level. According to the American Diabetes Association, normal is between 50mg% and 150mg% (mg% means milligrams of glucose per 100 milliliters of plasma). Individual glucose tolerances wary, though: 50mg% may be normal for one person, but too low for another. Some nutritionists believe that food allergies can also foil the Glucose Tolerance Test. For example, the glucose solution from corn (one of the most allergenic foods around) may cause a reaction that mimics the symptoms of hypoglycemia.

One opinion is that carbohydrates play a part in hypoglycemia. Carbohydrates are divided into two groups: complex (starches) and simple (sugars). The starches in whole gain breads, rice, pasta and potatoes, are absorbed into the blood stream slowly, maintaining a small, steady flow of glucose. The sugars in candies, cakes and fruit juices, however, are broken down at lightening speed, causing blood glucose to shoot up. This causes sensitive insulin-response mechanisms to overreact, dropping blood glucose way down again. When sweets are cut out of your life, the seesaw may stop. It is also normal for blood sugar to dip if you skip a meal, or have an alcoholic drink, especially on an empty stomach.

The American Diabetes Association also agrees that there is no good evidence that hypoglycemia causes depression, chronic fatigue, allergies, nervous breakdowns, alcoholism, among other disorders. Everyone's blood sugar levels drop at one time or another. The ADA says that low blood sugar is overdiagnosed and "used too often to explain problems ranging from overeating to bizarre behaviors".

A thorough Glucose Tolerance Test should take five to six hours, and tests blood sugar levels before you drink a glucose solution and after, at timed intervals. The results are charted on a graph. A healthy response is a steep rise in blood sugar after the drink, then a gradual decline to normal. A hypoglycemic experiences a steep rise, then a very sharp drop below normal.