Low blood sugar may be among symptoms of EDS: Case report
Case of hEDS woman with hypoglycemia leads to identification of more patients
Hypoglycemia, or low blood sugar, may be among symptoms of Ehlers-Danlos syndrome (EDS), according to a case report.
A woman with hypermobile EDS (hEDS) came to a clinic experiencing significant neurological symptoms related to low blood sugar that occurred most often after eating or physical activity, but was eventually mostly stabilized with dietary changes.
The researchers later identified several other hEDS patients who were treated for hypoglycemia at the same clinic. “We observe that hypoglycemia can occur in individuals with EDS and may present with largely postmeal and activity-induced patterns,” the researchers wrote. If a person comes in with unexplained hypoglycemia, doctors should also consider a possible EDS diagnosis, they wrote.
The report, “Hypoglycemia Associated With Hypermobile Ehlers-Danlos Syndrome,” was published in JCEM Case Reports.
EDS refers to a group of disorders, of which hEDS is the most common type, characterized by abnormalities in the connective tissues that provide structure to skin, joints, blood vessels, and other organs. Patients also commonly experience dysfunction of the autonomic nervous system (dysautonomia), which controls important involuntary body functions like heart, blood pressure, breathing, and digestion.
Symptoms of EDS, hypoglycemia
Among the functions of the autonomic nervous system is maintaining normal blood sugar (glucose) levels. If blood sugar drops too low, it can lead to significant neurological symptoms including difficulty concentrating, confusion, loss of consciousness, and seizures.
To date, there hasn’t been an established relationship between hypoglycemia and EDS. The scientists described the case of a 33-year-old woman with hEDS who experienced serious symptoms related to reactive hypoglycemia, or low blood sugar that occurs within a few hours of eating.
At an outpatient doctor’s appointment two hours after she’d eaten breakfast, the woman began to feel fatigue, malaise, and excessive sweating, and her blood sugar was below normal. She was hospitalized for seizure-like activity.
Overnight, during which time she did not eat, the woman reported feeling palpitations, lethargy, sweating, and dizziness. Her blood sugar was still low, but when she was given juice, her symptoms were relieved.
On a review of her medical history, the woman revealed that she’d experienced similar episodes of neurological symptoms during high school when she was physically active on hot days.
At age 28, the woman had sustained two concussions from head trauma and experienced multiple seizure-like events associated with low blood sugar. At that time, she was deemed to have an inadequate nutritional status.
She continued to report neurological symptoms that usually occurred a couple hours after breakfast or with physical activity, hot weather, and showering. She went to the emergency room at least 10 times because she lost consciousness.
Laboratory tests at the researchers’ clinic confirmed signs of reactive hypoglycemia.
Blood sugar monitor, nutrition counseling
The woman was given a blood sugar monitor as well as uncooked cornstarch and glucagon, which can be used to raise blood sugar in emergency situations. She also underwent medical nutrition therapy, during which she was advised to eat frequent small meals consisting of foods that have a low glycemic index, or don’t cause large changes in blood sugar.
Despite adhering to this plan, the woman sometimes experienced low blood sugar, particularly after breakfast or activity and overnight. She was followed in a hypoglycemia-focused clinic and remained stable, the scientists reported.
The researchers identified 13 EDS patients seen at that clinic who also experienced reactive hypoglycemia. Most had a confirmed diagnosis of hEDS, and patients commonly also had autonomic dysfunction. “These observations suggested a strong association between EDS and hypoglycemia,” the researchers wrote. Dysautonomia, they said, may be one factor that contributes to hypoglycemia in EDS, along with gastrointestinal disease manifestations.
While there are no established guidelines for managing hypoglycemia in EDS, it “requires a multidisciplinary team,” much like in the general population, the researchers wrote. Nutritional changes are usually the first approach, followed by medications if the hypoglycemia remains uncontrolled.
“Future research will be required to assess the prevalence of hypoglycemia in EDS … and define the pathophysiology [mechanisms] underlying this potential association,” the team wrote.
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