Hi all,
I have a patient I’ll soon be seeing with persistent pain looking to take a more active approach to rehab and was referred to me by one of her professors. So far we’ve only communicated via email (our in-person initial consult is later this week). However, she informed me that while having a recent physical she was found to be hypoglycemic. Additional testing was performed to r/o autoimmune issues and apparently the next step is to test for an insulinoma. I don’t have specific lab values at this time. Her doctors recommended holding on strenuous exercise but told her she could perform PT pending she “ate a large carbohydrate meal before and after sessions, as well as consumed a sports drink during sessions”. Sounds like questionable advice but I understand the rationale. So now I’m wondering what limitations I have from an exercise dosage standpoint, and looking for any resources on exercise parameters in this scenario. Likely, we can create an effective plan of care around this issue but depending on her goals it would be helpful to have more specific guidelines. A quick lit search kept popping up exercise management for hyperglycemia, not as much for hypo.
There’s a lot more information I’d want to know in this case.
When you say " she informed me that while having a recent physical she was found to be hypoglycemic", this makes it sound like it was an incidentally found “low” blood sugar … which is not something that necessarily requires further evaluation or clinical concern. In contrast, if she has been experiencing symptomatic hypoglycemia, that’s a more concerning issue, and that’s the kind of situation where I’d expect someone would end up getting evaluated for an insulinoma.
There isn’t going to be a predictable threshold for exercise dosage in this sort of situation, unfortunately. If she has been having symptomatic hypoglycemia, I’d just have her eat something before your sessions, and have a beverage on hand in the event that she does develop recurrent symptoms. Otherwise, I wouldn’t have much concern in the absence of symptoms for most individuals (the only exception might be individuals who have not had longstanding diabetes with concern for hypoglycemic unawareness – but that almost certainly isn’t the case here, since she’s undergoing the insulinoma evaluation).
2 Likes
Thanks for the quick response Austin. You are correct in that it was an incidental finding during a routine physical. The initial report she showed me read 60 mg/dl, but my understanding is that additional testing found significant fluctuation, including readings lower than this. Her symptoms are vague and there is confusion between doctors if some of her symptoms such as fatigue and headaches are possibly a result of her blood sugar levels or part of her fibromyalgia dx, or both. However, she has a hx of persistent nausea and some other issues that are prompting doctors to investigate this further.
At any rate, after the initial consult I felt that with proper monitoring and having a beverage/snack on hand it will not affect our initial plan of care from my perspective. Thanks again!
Yeah, obviously hard to say whether it’s related, but with that constellation of symptoms it’s reasonable to evaluate a bit further.
And I agree with your plan. Good luck!