Hypoglycemia, Incr. Anf, Decr. Vasopressin

[sue1234]

I was reading an article in the NYT about a man who had severe limb weakness due to thyrotoxic periodic paralysis. I had heard of that before, a few years ago before I had POTS and was trying to figure out my thyroid issue. So, it has to do with a change in potassium levels. In the article, it said that he had been eating alot of carbs in the preceding few weeks while his son was in the hospital. The article said this diet would have caused increased insulin levels. The higher insulin would have ushered his extra-cellular K+ levels inside his cells, leaving nothing in the circulatory system to help out the muscles.

So, with my long history of hypoglycemia, I began to wonder if insulin affected sodium levels. I'm trying to see if hyperinsulinemia can connect to sodium levels, thus fluid levels, thus POTS.

I found this article that talks about hypoglycemia's raised insulin levels raising atrial natriuretic factor. I am not really familiar with this, so was reading up on it, too. Apparently, when you have hypoglycemia, it raises your ANF levels 4-5x normal. This ANF, in turn, lowers your vasopressin, which in turn lowers your fluid level, kind of like a diuretic. ANF is also a "powerful vasodilator"(Wikipedia).

http://www.ncbi.nlm.nih.gov/pubmed/8382120

Now, and this statement is just my theory, after that, any time I would stand, with such a lowered volume my body screams out adrenaline to get blood pumped back up to my brain when standing, thus hyperPOTS.

Okay. I have a 20 year history of hypoglycemia and POTS for the last 5 years. A couple of years ago, my vasopressin levels came in low twice. I also have acquired these "vasodilating" flashes. My skin looks dehydrated and I feel dehydrated.

Could it all come back to the hypoglycemia after all?

[firewatcher]

I will have to look into this further as well. I have no measurable vasopressin/ADH and an elevated C peptide, but normal fasting glucose. My endo has never checked it after eating.

[HopeSprings]

Have you played with your diet at all to see if it makes any difference?

[sue1234]

Firewatcher, I am making an appt. with a new endo today. I have "played" around with my last one for the last two years, never really getting to the bottom of my glucose issues. I figure 2 years is long enough, and I'm ready for someone new. This next one is an older guy who received his endo fellowship from Mayo, so maybe he'll be smart or at least access Mayo endos if he has questions about my case.

Naomi, I have played around with my diet. It didn't make any difference in my POTS. I gave up almost all sugar 2 years ago. My diet is not perfect, but alot better. My A1c is so low(4.5) that it proves I spend my fair share of time in hypoglycemia. Besides fighting it for the first half of the day, I feel I must drop alot in my sleep.

I will be bringing this article to my appt., so he can see why I want to get to the bottom of my hypoglycemia.

[sue1234]

I found this article that mentions, in this study, that young women with vasovagal syncope have an insulin sensitivity, and have lowered fasting glucose and insulin. I don't have full access to the article, so don't know if they have altered glucose and insulin patterns on the OGTT.

http://www.ncbi.nlm.nih.gov/pubmed/12766740

[juliegee]

Best explanation I've seen so far connecting dysautonomia & hypogylcemia. Great detective work, Sue !!! Diet has a huge impact on me. Limiting carbs & going heavy on protein is best for me. I think you're on to something- I'll be looking or this in the next issue of the NEJM.

[sue1234]

Julie, it's just to find a doctor who will look at this in depth! Most endos work with diabetes or thyroid, and then get lost with the more complicated endocrine issues.

I found this more-in-depth article about ANF(or ANP). It mentions here that it also decreases aldosterone--ME! ME! So, far, I have low everything that this causes to be low. And Firewatcher, it shows in the diagram how it acts on the kidney regarding the renin and aldosterone.

http://www.cvphysiology.com/Blood%20Pressure/BP017.htm

Hey, this might be the "paradox" in that article from 2005, "Aldosterone-Renin Paradox and Perturbed Blood Volume Regulation in POTS".