Question: A friend of mine has hypoglycemia (it runs in her family) as well as bulimia. Is there any cure or clinical study being done on these medical problems?
Dr. Hibberd's Answer:
Cures are wonderful, but so often in medicine we need to settle for control while the mechanisms of disease are investigated with a cure as our ultimate target. There are a wide variety of conditions associated with bulimia and hypoglycemia, and while some victims will be cured, many may need to settle for less.
Bulimia nervosa is characterized by recurrent episodes of binge eating followed by self-induced vomiting, laxative or diuretic abuse, vigorous exercise, or fasting. Most patients are normal weight as opposed to the emaciated weight loss seen in anorexia nervosa. Complications usually result from the purging behaviors. Electrolyte and renal disorders frequently exist in chronic bulimic patients, and may occasionally be life-threatening. Bulimia usually responds to cognitive behavioral therapy and SSRI medication (antidepressants).
Symptomatic hypoglycemia (low blood sugar of less than 50 mg/dl) is not common in bulimia despite the binge/purge cycle that is so typical, mainly because the body has extensive counter-regulatory mechanisms for low blood glucose levels. Patients who are pre-diabetic, diabetic on insulin, and suffer from Addison’s disease or other endocrine dysfunctions, are often victimized by hypoglycemia especially with a precipitating binge cycle.
Usually a five-hour glucose tolerance test will unmask symptomatic hypoglycemia. If confirmed, an evaluation for underlying conditions is indicated. Rarely, a 72-hour fast performed in a controlled setting is needed to evaluate hypoglycemia.
Recurrent hypoglycemia should be investigated and treated. This is especially true for those with a family history of hypoglycemia.
Simple over-secretion of insulin in reaction to a large caloric stimulus is a common cause of reported hypoglycemia spells, especially in young women. It is usually treated by smaller and more frequent meals, and is successful for most patients. Rarely, a tumor of the pancreas that produces insulin (an insulinoma) is responsible for recurring hypoglycemia episodes, and is cured after removal of the tumor.
It is well-recognized that many patients with symptomatic hypoglycemia in younger years seem to have a higher risk of developing diabetes in the future. Many physicians recognize this as a pre-diabetic condition. Your friend with "familial" hypoglycemia deserves a full endocrinology evaluation for correctable disorders.
Research in glucose metabolism and eating disorders are popular research topics at present, and we look forward to new treatments especially with the advent of genetic manipulation, the discovery of new receptor stimulation and blockade therapies, as well as with the advent of new stem cell and cell cloning technologies.
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