Hypoglycemia help

I am a 37 year old office worker sitting in front of a computer all day. A couple of months ago at work, about 1pm, before lunch i felt dizzy with blurred vision.  I stood up and almost fainted!  I had tingling sensations in my arms, i thought i was having a stroke or heart attack!  They called an ambulance, my blood pressure was 220/140 & they shipped me off to hospital.

They ran tests (bloods, CT+MRI+kidney+chest scans) but couldn't find anything.  They sent me home with BP medication.  The first few days at home were terrible, i had several episodes with severe shakes and my BP was high.  I couldnt really eat much - i felt terrible.  

Things slowly got better over a week.  I changed my diet and started eating breakfast every day.  I gave up alcohol and coffee.  I went back to work.  However i felt terrible most days. Tired, nausea, dizzyness and blurred vision (not as bad as that first episode).  The GP switched me from Coversyl to Noten and then to Micardis which i am on now.  

Episodes of dizzy spells continued.

Then it dawned on me, i sit at work for 3 to 4 hours without eating...  So i bought a blood glucose monitor.  Initially levels were normal however when i started feeling dizzy @ 11am the next day - i noticed glucose levels were 3.3mmol. It was only a mild dizzyness - about half as bad as the day before.  So I started eating more regularly.  Over several days the dizzyness stopped completely, which was amazing!  However today the dizzy spells resumed (still eating regularly) and i felt bad all day.  I think that first "attack" was possibly hypoglycemia?  By the time we got to the hospital perhaps my blood sugar returned to normal or close to it?  

My questions are:

1.  I've never eaten breakfast all my working life and never suffered this before, could this be hypo and why now?

2. Could this be a sign of another illness?

3. What tests should i have to rull them out?

Thanks

[Kevin Pho, MD]

To answer your questions:

1) Hypoglycemia is among the causes that can lead to this picture.  If suspected, there are a number of tests that can cement the diagnosis, including, a 72-hour fast and testing for insulin, C-peptide, and beta-hydroxybutyrate levels.

2) You have already had a thorough evaluation for dizziness.  A referral to an ENT physician to determine inner ear causes can be considered.  I would also consider a referral to a neurologist.

3) In addition to the aforementioned tests, you can also consider tilt-table testing done by a cardiologist, which can look for more uncommon causes of blacking out, or syncope.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin Pho, M.D.
www.kevinmd.com
www.twitter.com/kevinmd