General Discussion Triathlon Talk » Passing out during races Rss Feed  
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2008-11-04 1:59 PM

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Subject: Passing out during races
I passed out during a race this past Sunday (about 77 degrees, sunny and humid) and want to know why this keeps happening to me! (2nd time in 2 years). I had a great (controlled) swim and bike and felt tired but was plugging away during the run (VERY hilly course). With about 1.5 miles left in the race (Oly distance) I just passed out. I drank 1 liter of water with nuun before the race and sipped my aero bottle every 5 min on the bike (water with nuun).
The first time I passed out the docs thought I might have LQTS (heart issue) but decided it was just dehydration as they did this time. How do I figure out how to drink enough in hot, humid, hilly conditions so this doesn't happen again?


2008-11-18 2:03 AM
in reply to: #1787105

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Subject: RE: Passing out during races
did you have an EKG? Have you seen a cardiologist? Are you dropping without warning or do you know you feel like you might pass out and keep pushing? Dropping without warning does not sound like dehydration. There are other cardiac rhythm problems beside LQTS. You do not want to be a triathlon statistic. Heed these warning signs and get a full work up (stress test, holter monitor).

Julia (MD)
2008-11-18 8:11 AM
in reply to: #1787105

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Subject: RE: Passing out during races
Blood Sugar Levels could also be a factor.
2008-11-18 8:36 AM
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Subject: RE: Passing out during races

aarondavidson - 2008-11-18 8:11 AM Blood Sugar Levels could also be a factor.

Hypoglycemia doesn't cause syncope.

2008-11-24 7:25 AM
in reply to: #1787105

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Subject: RE: Passing out during races

If it's hot and "very humid" your body has a  hard time evaporating sweat and you can overheat. I don't think that's the problem. Besides the consideration of a heart issue it could more likely be a hypoglycemia, adrenal fatigue or salt electrolyte depletion issue. I get hypoglycemia and I'm forced to stuff down at least 500 calories of carbs per hour and make sure to get in at least 300-500mg of salt per hour. If you get dizzy, blurry vision or a faster then normal heart rate your blood glucose could be dropping.  I use a heart rate monitor and when my heart rate starts climbing high with less exertion I test my blood sugar. Many times instead of my normal 80 it drops down to 50 or a little less and I can barely think. My pulse will be racing until I get my blood glucose back up. Another way I correct it is to take isocort. It replaces cortisone and will raise my blood sugar up within minutes of taking it.  These are all related to adrenal fatigue. When you race that entire event is more stressful compared to training. It taxes your adrenals and can deplete cortisol output. Low cortisol leads to hypoglycemia when exercising, 

 You can buy a glucose tester for $15 on ebay to see if your getting hypoglycemic  episodes during training. One study demonstrated +30% of triathletes had episodes of hypoglycemia during races.

 If you have a problem holding salt do to low aldersterone your electrolytes will get out of whack and that can lead to severe cramping, passing out or heart rhythm problems. Olympic distance triathlons are a little short to be running into salt depletion but it can happen towards the end of the race if it's hot out. If you tend to wake up several times at night to pee that's an indicator of salt retention problems. 12 ounces of V8 vegetable juice the night before and the morning of the race can help. 

Adding 1-2 Motor Tabs to each bottle of sports drink can help. They each contain 250mg of salt, some potassium and 65 calories of carbs.

 

jellyfish - 2008-11-04 11:59 AM I passed out during a race this past Sunday (about 77 degrees, sunny and humid) and want to know why this keeps happening to me! (2nd time in 2 years). I had a great (controlled) swim and bike and felt tired but was plugging away during the run (VERY hilly course). With about 1.5 miles left in the race (Oly distance) I just passed out. I drank 1 liter of water with nuun before the race and sipped my aero bottle every 5 min on the bike (water with nuun). The first time I passed out the docs thought I might have LQTS (heart issue) but decided it was just dehydration as they did this time. How do I figure out how to drink enough in hot, humid, hilly conditions so this doesn't happen again?

 

 

2008-11-24 10:19 AM
in reply to: #1823148

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Subject: RE: Passing out during races
Technologist - 2008-11-24 8:25 AM

If it's hot and "very humid" your body has a  hard time evaporating sweat and you can overheat. I don't think that's the problem. Besides the consideration of a heart issue it could more likely be a hypoglycemia, adrenal fatigue or salt electrolyte depletion issue. I get hypoglycemia and I'm forced to stuff down at least 500 calories of carbs per hour and make sure to get in at least 300-500mg of salt per hour. If you get dizzy, blurry vision or a faster then normal heart rate your blood glucose could be dropping.  I use a heart rate monitor and when my heart rate starts climbing high with less exertion I test my blood sugar. Many times instead of my normal 80 it drops down to 50 or a little less and I can barely think. My pulse will be racing until I get my blood glucose back up. Another way I correct it is to take isocort. It replaces cortisone and will raise my blood sugar up within minutes of taking it.  These are all related to adrenal fatigue. When you race that entire event is more stressful compared to training. It taxes your adrenals and can deplete cortisol output. Low cortisol leads to hypoglycemia when exercising, 

 You can buy a glucose tester for $15 on ebay to see if your getting hypoglycemic  episodes during training. One study demonstrated +30% of triathletes had episodes of hypoglycemia during races.

 If you have a problem holding salt do to low aldersterone your electrolytes will get out of whack and that can lead to severe cramping, passing out or heart rhythm problems. Olympic distance triathlons are a little short to be running into salt depletion but it can happen towards the end of the race if it's hot out. If you tend to wake up several times at night to pee that's an indicator of salt retention problems. 12 ounces of V8 vegetable juice the night before and the morning of the race can help. 

Adding 1-2 Motor Tabs to each bottle of sports drink can help. They each contain 250mg of salt, some potassium and 65 calories of carbs.

No offense, but what are your qualifications?  You're giving a medical opinion that conflicts with one of our resident Docs.

Mark



2008-11-24 5:30 PM
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Subject: RE: Passing out during races

I was a Red Badge clearance Nuclear Fireman, Nuclear safety inspector with a health physics background.     I agree that hypoglycemia "rarely" causes syncope in the general population. While rare it has been documented in studies of long distance athletes.  

  When I was in my 20's I was cycling 700 miles per week. I started developing heart problems and hypoglycemic episodes.

My cardiologists put me on digoxin, ace inhibitors, beta blockers, lasix.  I ended up with Mitral valve and tricuspid valve leakage, enlarged left ventricle, PVC's etc,.. Over the years I went from 20 METS Bruce Protocol to 6.8 METS. Numerous 12 leads, Echocardiograms, MRI's, Treadmill tests demonstrated this was the real deal.

My Sp02 dropped to 92-93 awake and 80-85 sleeping. I was forced to use an oxygen tank just to walk around. For many years I studied 12 hours a day looking for the answer. At age 42 I got sick of regular medicine and found a rejuvenation doctor in Beverly hills that treated me for what I thought and was confirmed to be adrenal fatigue, very low testosterone and hypothyroidism. So now 2.5 years later I'm off all heart meds. No oxygen, a 42 resting pulse, no asthma. I can now burn 3,000 calories in a workout and train the next day.

 Extensive blood tests, 64-slice CT, MRI's and echocardiograms show I have a zero calcium score, no leakage, no enlargement a great ejection fraction and very healthy blood markers.  All my cardiologists were shocked! My new cardiologist simply said it was impossible until he compared my new and old echocardiograms. I'm doing a sprint triathlon in 3 weeks with my Daughter and Son. I'm 6'3" 250 pounds with about 11% BF so I won't be hard to miss.  If my doctors treated me for Adrenal fatigue I would never of developed the heart problems caused by the heart medications.

Adrenal fatigue and hypoglycemia tend to be something most doctors dismiss. Over the years most doctors refused to do or didn't even know how to properly do a saliva cortisol test. Things are changing.

2008-11-24 5:47 PM
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Subject: RE: Passing out during races
Technologist - 2008-11-24 5:30 PM

I was a Red Badge clearance Nuclear Fireman, Nuclear safety inspector with a health physics background.     I agree that hypoglycemia "rarely" causes syncope in the general population. While rare it has been documented in studies of long distance athletes.  

  When I was in my 20's I was cycling 700 miles per week. I started developing heart problems and hypoglycemic episodes.

My cardiologists put me on digoxin, ace inhibitors, beta blockers, lasix.  I ended up with Mitral valve and tricuspid valve leakage, enlarged left ventricle, PVC's etc,.. Over the years I went from 20 METS Bruce Protocol to 6.8 METS. Numerous 12 leads, Echocardiograms, MRI's, Treadmill tests demonstrated this was the real deal.

My Sp02 dropped to 92-93 awake and 80-85 sleeping. I was forced to use an oxygen tank just to walk around. For many years I studied 12 hours a day looking for the answer. At age 42 I got sick of regular medicine and found a rejuvenation doctor in Beverly hills that treated me for what I thought and was confirmed to be adrenal fatigue, very low testosterone and hypothyroidism. So now 2.5 years later I'm off all heart meds. No oxygen, a 42 resting pulse, no asthma. I can now burn 3,000 calories in a workout and train the next day.

 Extensive blood tests, 64-slice CT, MRI's and echocardiograms show I have a zero calcium score, no leakage, no enlargement a great ejection fraction and very healthy blood markers.  All my cardiologists were shocked! My new cardiologist simply said it was impossible until he compared my new and old echocardiograms. I'm doing a sprint triathlon in 3 weeks with my Daughter and Son. I'm 6'3" 250 pounds with about 11% BF so I won't be hard to miss.  If my doctors treated me for Adrenal fatigue I would never of developed the heart problems caused by the heart medications.

Adrenal fatigue and hypoglycemia tend to be something most doctors dismiss. Over the years most doctors refused to do or didn't even know how to properly do a saliva cortisol test. Things are changing.

You're entitled to disagree, but I see 2-3 syncope patients a weak year round, and hypoglycemia is not in the differential diagnosis.  There is no physiologic connection between blood glucose and consciousness.

The adrenal fatigue stuff I won't even get into as you're convinced about what you're saying.

2008-11-25 1:33 AM
in reply to: #1787105

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Subject: RE: Passing out during races

Back to the OP,  I would second the suggestion to get to your doctor and get checked out.  If something about competing in triathlons has caused you to pass out twice, then you need to find out what it is.

Without sounding too alarmist, syncope was an early sign of my heart problems eight years ago.  Never actually lost consciousness, but it was pretty scary.

With all due respect to Derek, Julia, Sue, and the other docs here, free medical advice on the internet is usually worth what you pay for it...

Mark

 

 

 

2008-11-25 3:48 AM
in reply to: #1824277

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Subject: RE: Passing out during races
DerekL - 2008-11-24 3:47 PM
Technologist - 2008-11-24 5:30 PM


  There is no physiologic connection between blood glucose and consciousness.

 Please explain this conclusion as you clearly must know something that many doctors and endless medical studies have overlooked. I've seen people die from what the coroner labeled as hypoglycemic death. You can fall into a coma and die from low blood sugar but loss of consciousness is impossible???

 

 Hypoglycemia, including iatrogenic hypoglycemia in people with diabetes, causes brain fuel deprivation that initially triggers a series of physiological and behavioral defenses but if unchecked results in functional brain failure that is typically corrected after the plasma glucose concentration is raised. Rarely, profound, and at least in primates prolonged, hypoglycemia causes brain death.

http://www.jci.org/articles/view/31669/figure/1

 http://www.jci.org/articles/view/31669

Dead-in-Bed Syndrome in Young Diabetic Patients 

 http://journal.diabetes.org/diabetescare/FullText/Supplements/DiabetesCare/Supplement299/B40.asp

http://en.wikipedia.org/wiki/Hyperinsulinemic_hypoglycemia

2008-11-25 6:19 AM
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Subject: RE: Passing out during races

Derikl,  Here is a summation of 128 studies relating to exercise induced hypoglycemia: http://www.alfediam.org/media/pdf/RevueBrunD&M2-2001.pdf

EXERCISE HYPOGLYCEMIA IN NONDIABETIC SUBJECTS MECHANISMS OF HYPOGLYCEMIA DURING PROLONGED EXERCISE

Increased insulin sensitivity and glucose effectiveness Kuipers [43] observed that in 30% of athletes fed with glucose 30 min before exercise plasma glucose levels dropped transiently below 3.0 mmol/l. On the basis of lower plasma glucose levels despite similar insulin levels, he postulated that these hypoglycemiaprone athletes had a higher insulin sensitivity. On the whole the occurrence of hypoglycemia appeared to be determined by a combination of a high insulin sensitivity, a small amount of ingested glucose, and a low sympathetic activity.

 

As you probally already know. When Plasma glucose levels drop below 3 mmol/l Symtoms such as decreased cognition, Aberrant behavior, Seizure and Coma are common (functional brain failure) here's a chart to refresh your memory http://www.jci.org/articles/view/31669/figure/1




2008-11-25 6:41 AM
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Subject: RE: Passing out during races

None of that has anything to do with syncope.  Seizures and coma aren't syncope.  You're drawing conclusions that aren't there.  I don't know anything that other doctors don't know.  If fact, I'm telling you exactly what is known and what the standard of care is.  Hypoglycemia causes a lot of things, but syncope isn't one of them.

http://www.emedicine.com/MED/topic3385.htm

http://www.annals.org/cgi/content/full/126/12/989

You won't find a single mention of hypoglycemia there.

2008-11-25 7:20 AM
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Subject: RE: Passing out during races

Syncope and Hypoglycemia are all over eMedicine. The same site you say that doesn't mention it. http://209.85.173.132/search?q=cache:k-jTNyYLcgAJ:www.emedicine.com/emerg/topic876.htm+syncope+hypoglycemia&hl=en&ct=clnk&cd=1&gl=us&client=safari

Syncope can occur without reduction in cerebral blood flow in patients who have severe metabolic derangements (eg, hypoglycemiahyponatremia, hypoxemia).

 Second quote: on eMed A glucose level, checked by rapid fingerstick (eg, Accu-Chek), should be evaluated in any patient with syncopeHypoglycemia can produce a clinical picture identical to syncope, including the prodromal symptoms, absence of memory for the event, and spontaneous resolution.

 

2008-11-25 7:25 AM
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Subject: RE: Passing out during races
Technologist - 2008-11-25 7:20 AM

Syncope and Hypoglycemia are all over eMedicine. The same site you say that doesn't mention it. http://209.85.173.132/search?q=cache:k-jTNyYLcgAJ:www.emedicine.com/emerg/topic876.htm+syncope+hypoglycemia&hl=en&ct=clnk&cd=1&gl=us&client=safari

Syncope can occur without reduction in cerebral blood flow in patients who have severe metabolic derangements (eg, hypoglycemiahyponatremia, hypoxemia).

 Second quote: on eMed A glucose level, checked by rapid fingerstick (eg, Accu-Chek), should be evaluated in any patient with syncopeHypoglycemia can produce a clinical picture identical to syncope, including the prodromal symptoms, absence of memory for the event, and spontaneous resolution.

 

The first quote is about reduced cerebral blood flow which is not what hypoglycemia is and the second is a "clinical picture identical to syncope" which ISN'T syncope.

Look, you've obviously made up your mind that you're right regardless of what I say.  I will go with hundreds of years of medicine and physiology and the recommendation of experts in both of those fields as to what the causes, workup, and treatment are.  You can believe that blue cheese causes syncope if you'd like.

2008-11-25 7:50 AM
in reply to: #1787105

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Subject: RE: Passing out during races

  Syncope can occur ---> without reduction in cerebral blood flow <---- in patients who have severe metabolic derangements(eg, hypoglycemiahyponatremia, hypoxemia).

 I could quote 100's of articles but you are set in you ways so why bother? My Family founded and still run the Parvin Foundation. They fund the fellowship programs that teach doctors around the world. 

 They have been helping people since the 1960's 

Here are some of the donations they made in 2003 alone

  • City Of Hope () - $ 150,000
  • Ucla Kennamer Fund () - $ 90,000
  • Jewish Free Loan () - $ 75,000
  • City Of Hope () - $ 50,000
  • University Of Hawaii () - $ 50,000
  • Uc Regents Genter On Aging () - $ 42,900
  • One Voice Graduate School Scholarship Program () - $ 40,000
  • One Voice () - $ 35,000
  • Jewish Free Loan Assoc () - $ 25,000
  • Heredity Disease Foundation () - $ 25,000
  • The Music Center () - $ 12,625
  • La Chamber Orchestra () - $ 10,600
  • The Wellness Community () - $ 10,600
  • Ucla Dept Of Chemistry And Biology () - $ 10,000
  • So Poverty Law Center () - $ 10,000
  • Haven House Inc () - $ 5,000
  • Hebrew University () - $ 5,000
  • Camp Max Strauss () - $ 5,000
  • Berkshire Theatre () - $ 5,000
  • Sun Valley Summer Symphony () - $ 5,000

  • 2008-11-25 7:56 AM
    in reply to: #1825040

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    Subject: RE: Passing out during races
    Technologist - 2008-11-25 7:50 AM

      Syncope can occur ---> without reduction in cerebral blood flow <---- in patients who have severe metabolic derangements(eg, hypoglycemiahyponatremia, hypoxemia).

     I could quote 100's of articles but you are set in you ways so why bother? My Family founded and still run the Parvin Foundation. They fund the fellowship programs that teach doctors around the world. 

     They have been helping people since the 1960's 

    Here are some of the donations they made in 2003 alone

  • City Of Hope () - $ 150,000
  • Ucla Kennamer Fund () - $ 90,000
  • Jewish Free Loan () - $ 75,000
  • City Of Hope () - $ 50,000
  • University Of Hawaii () - $ 50,000
  • Uc Regents Genter On Aging () - $ 42,900
  • One Voice Graduate School Scholarship Program () - $ 40,000
  • One Voice () - $ 35,000
  • Jewish Free Loan Assoc () - $ 25,000
  • Heredity Disease Foundation () - $ 25,000
  • The Music Center () - $ 12,625
  • La Chamber Orchestra () - $ 10,600
  • The Wellness Community () - $ 10,600
  • Ucla Dept Of Chemistry And Biology () - $ 10,000
  • So Poverty Law Center () - $ 10,000
  • Haven House Inc () - $ 5,000
  • Hebrew University () - $ 5,000
  • Camp Max Strauss () - $ 5,000
  • Berkshire Theatre () - $ 5,000
  • Sun Valley Summer Symphony () - $ 5,000

  •   

    Please quote me anything that is relevant.  I've posted a standard syncope workup from two good sites that don't mention hypoglycemia.  You replied with two quotes that I've addressed and don't further your position.  I can also quote my med school professors and staff physicians from my residency about both the theoretical and practical aspects of the topic.

    Why bother?  Because you're posting medical information on a medical forum as advice to others.  I'm helping people obtain good information and will point out improper information when it arises.

    BTW, congrats on your family's contributions.  It has nothing at all to do with what we're talking about though unless you're one of those physicians that was trained.



    2008-11-25 8:36 AM
    in reply to: #1825000

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    Subject: RE: Passing out during races

    DerekL - 2008-11-25 8:25 AM blue cheese causes syncope 

    There we go...Jellyfish, did you have a lot of blue cheese before your race? 

    Mark

     

    2008-11-25 8:36 AM
    in reply to: #1787105

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    Subject: RE: Passing out during races

     Look at the 155,000 results for syncope+hypoglycemia on google. Thousands of those articles are written by doctors telling you that you can pass out from hypoglycemia. Hypoglycemia can be a limiting factor in some long distance athletic events.

     Anyone that followed my links in this thread can clearly see what I'm talking about. As for jellyfish, I suggested that carbing up more while racing and keep her salt up when it's hot might help. As for the $15 glucose checker it's an over the counter item. I figured out how to balance my carbs better using it so now I know how much I need to consume per hour and I'm much quicker when I keep my blood glucose up enough. 

    2008-11-25 8:39 AM
    in reply to: #1825040

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    Subject: RE: Passing out during races
    Technologist - 2008-11-25 8:50 AM

       My Family founded and still run the Parvin Foundation. They fund the fellowship programs that teach doctors around the world. 

     They have been helping people since the 1960's 

    Here are some of the donations they made in 2003 alone

  • City Of Hope () - $ 150,000
  • Ucla Kennamer Fund () - $ 90,000
  • Jewish Free Loan () - $ 75,000
  • City Of Hope () - $ 50,000
  • University Of Hawaii () - $ 50,000
  • Uc Regents Genter On Aging () - $ 42,900
  • One Voice Graduate School Scholarship Program () - $ 40,000
  • One Voice () - $ 35,000
  • Jewish Free Loan Assoc () - $ 25,000
  • Heredity Disease Foundation () - $ 25,000
  • The Music Center () - $ 12,625
  • La Chamber Orchestra () - $ 10,600
  • The Wellness Community () - $ 10,600
  • Ucla Dept Of Chemistry And Biology () - $ 10,000
  • So Poverty Law Center () - $ 10,000
  • Haven House Inc () - $ 5,000
  • Hebrew University () - $ 5,000
  • Camp Max Strauss () - $ 5,000
  • Berkshire Theatre () - $ 5,000
  • Sun Valley Summer Symphony () - $ 5,000

  • And this has what exactly what to do with passing out during triathlons?

    Is there a study that links charitable giving and syncope? 

    Mark

     

    2008-11-25 8:47 AM
    in reply to: #1825121

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    Subject: RE: Passing out during races
    Technologist - 2008-11-25 8:36 AM

     Look at the 155,000 results for syncope+hypoglycemia on google. Thousands of those articles are written by doctors telling you that you can pass out from hypoglycemia. Hypoglycemia can be a limiting factor in some long distance athletic events.

     Anyone that followed my links in this thread can clearly see what I'm talking about. As for jellyfish, I suggested that carbing up more while racing and keep her salt up when it's hot might help. As for the $15 glucose checker it's an over the counter item. I figured out how to balance my carbs better using it so now I know how much I need to consume per hour and I'm much quicker when I keep my blood glucose up enough. 

    Google will also give you a ton of results for 9/11 conspiracy theories, UFO's, and HIV as not being the cause of AIDS.

    I should have stopped when you extolled the virtues of treating "adrenal fatigue".  In fact, I think I will now.  

    To the OP, you didn't pass out because of hypoglycemia.  You certainly need to maintain your blood glucose levels during racing, but that's for energy to continue.  You likely had some element of dehydration or some other unknown underlying condition predisposing you to it.  In the end, if it bothers you a lot, talk to an actual doctor and take what you read on the internet (from everybody) with a grain of salt.

    2008-12-19 5:19 PM
    in reply to: #1825142

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    Subject: RE: Passing out during races

    DerekL, I'm sure you've spend much of your life helping people. I'm glad that people like you are in this forum. Look a little deeper on current cutting edge medicine. Those grants were to the Diabetes Endocrinology and Metabolism Center at the - City of Hope. I think they have a wing of the hospital named after my Aunt.

    Today, City of Hope is the largest islet cell isolation, distribution and transplantation center in the western U.S.  Our National Institutes of Health-funded Southern California Islet Cell Resource Center is one of only seven islet cell resource centers in the nation.

    These are the same people that hit the front page of every newspaper as they cured people of Type I diabetes.

       I had the condition that started this thread. I had it first hand and it was not fun. I was struck by a Truck 14 months ago. I have 5 titanium Plates in my head and I have a moderate TBI with Pituitary injury. So after 8 months of being almost a  vegetable my Thyroid, Aldosterone, Cortisol have been medically corrected. I no longer pass out from hypoglycemia and on sunday I just did the Tinsel Triathlon with my Kids. My blood glucose is now rock solid and I've been able to wean off most of the meds. I had to research this and find some cutting edge doctors. The doctors in my area thought like you do. I'm healthier then before the truck struck me, that was my goal and I reached it. 

     The reason I took so long to reply is my Dad just died a few weeks ago. 


    DerekL - 2008-11-25 6:47 AM
    Technologist - 2008-11-25 8:36 AMy 

     Look at the 155,000 results for syncope+hypoglycemia on google. Thousands of those articles are written by doctors telling you that you can pass out from hypoglycemia. Hypoglycemia can be a limiting factor in some long distance athletic events.

     Anyone that followed my links in this thread can clearly see what I'm talking about. As for jellyfish, I suggested that carbing up more while racing and keep her salt up when it's hot might help. As for the $15 glucose checker it's an over the counter item. I figured out how to balance my carbs better using it so now I know how much I need to consume per hour and I'm much quicker when I keep my blood glucose up enough. 

    Google will also give you a ton of results for 9/11 conspiracy theories, UFO's, and HIV as not being the cause of AIDS.

    I should have stopped when you extolled the virtues of treating "adrenal fatigue".  In fact, I think I will now.  

    To the OP, you didn't pass out because of hypoglycemia.  You certainly need to maintain your blood glucose levels during racing, but that's for energy to continue.  You likely had some element of dehydration or some other unknown underlying condition predisposing you to it.  In the end, if it bothers you a lot, talk to an actual doctor and take what you read on the internet (from everybody) with a grain of salt.



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