Saturday, February 9, 2008


Tuesday, November 20, 2007

Hypoglycaemia(Low blood sugar)


“Doctor, Dada (eldest brother) is admitted in a hospital in US” Said Dada’s younger brother to me on telephone.
“What? When? What happened?” Shocked I asked impatiently.
“Two days ago in the evening he swooned, lay on the ground, developed convulsions, bit his tongue which subsequently started bleeding----“
“Did it happen around seven P.M.?” I asked
“Yeah, yeah. Exactly. How do you know? Has any one informed you before?”
“No, no.” Without replying his question I asked, ”What happened after that?”
“The emergency ambulance was called for. His EKG (ECG) was recorded. It was normal. His blood sugar was tested. It was normal. He was still unconscious. In that state he was admitted in the hospital. They gave him some medicines. But he took little more time to regain consciousness.”
“Tell him to reduce the dose of insulin.” I advised on telephone.
“He underwent emergency CT and MR scans. Both the investigations were normal. Tomorrow is an appointment for EEG.”
“It will also be normal. If he reduces the dose of insulin, the trouble will be over.” I advised again.
As expected, his EEG was also normal. He was then discharged from the hospital. Two days later he himself talked to me on telephone. He narrated me the incident and said
“I do not remember what happened after I swooned. My all tests are normal. The doctors here took Neurologist’s opinion. He advised me to take anticonvulsant drugs----“
I interrupted and asked
“What dose of insulin are you taking?”
“Twelve units”
“Here in Mumbai you were taking six units. Even with that dose your blood sugar was low in the evening at about seven P.M. Right?”
“I have seen you eat sweets at that time.”
“Now you are taking twelve units, which is quite a high dose!”
“But doctor here I eat more and eating habit is also very irregular”
“You have glucometer with you. You record the sugar level and titrate the dose of insulin accordingly. Do not increase the dose blindly.”
“OK. Should I continue anticonvulsants?”
“Since the Neurologist in US has prescribed, you abide by his advice till you come back to Mumbai. We shall reassess the problem and do the needful.”
“Exactly this is what the Neurologist here advised.”
“When are you coming back?”
“Next month”
“Till then you take the same dose of insulin as you were taking in Mumbai”
When he came back to Mumbai we consulted a Neurologist.
“To be safe you take the newer anticonvulsant.” Said the Neurologist.
He did not tolerate the drug. So I said
“You discontinue the drug but follow the schedule of insulin doses rigidly. Do not alter the doses on your own“
After having adjusted the doses of insulin never ever did he swoon nor develop convulsions.