Recurrence of a stroke as a sign of hypoglycemia is common in diabetics. The unfortunate part is that we as professionals usually cannot accept it as such and have to do a repeat scan before we can settle our bedside diagnostic deficiencies. This good warning then becomes a liability rather than a sign to check glucose, confirm the hypoglycemia and avoid a potential catastrophe, or better still go straight for life saving act and give glucose.
It is a lot easier for me as a pre existing attending GP to diagnose it because I know the client. It should be just as easy for me as a son to tell my mother who is diabetic that the reason she woke up weaker in the previously affected MCA distribution area is due to hypoglycemia and ask my sister to feed her something to correct it. Boy children tend to disable themselves in many a family.
What is not easy is that being a doctor my comprehension of disease has already being tainted by physiology and pathology before physiology and therefore deviation from standard even if it's more than norm is uphill
The pathology behind this is that recovery post stroke may be just enough to return normal function to the patient provided blood supply and glucose level into the area is optimal. Any compromise of the two or even the cell mass as one gets older (degeneration) will cause recurrence in the same distribution.
One can complicate matters and start saying the patient could have epilepsy, TIA’s, hypokalemic periodic paralysis, myasthenia gravis or Lambert Eaton myasthenic syndrome, but then even most GP’s become intellectually challenged class, let alone the public.
Not only is the extension of possibilities going to be rare in reality but they will be little affected by the glucose given, which is life saving in hypoglycemia. A patient with no access to hemoglucotest could use this as the hypoglycemic sign in its own right rather than something to run away from, embrace it.
The glucose will theoretically drop the potassium a little more in hypokalemic periodic paralysis though, and I won’t hold it against you. The idea is you will safe a million potentially fatal situations at the expense of worsening one periodic paralytic syndrome due to hypokalemia.
Straddling the boundary between a medical text and general publication was never going to be easy, and I won’t pretend otherwise but then as I am here to answer any questions related to this or any in our blogs or website, you just need to scream.
If biochemistry and physiology of health of health are the elements of every mix then results are guaranteed
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