i started writing this in response to the topic under CCSVI but have posted it here instead - sorry in advance for any non sequiturs as a result.
Okay, so, one potential cause of hypoglycemia: suboptimal trivalent chromium status.
excerpts from a google scholar search on the terms hyperinsulinemia, chromium:
http://scholar.google.ca/scholar?hl=en& ... =&as_vis=0
Chromium supplementation for women with gestational diabetes mellitus
L Jovanovic, M Gutierrez… - The Journal of Trace …, 1999
Effect of chromium chloride supplementation on glucose tolerance and serum lipids including high-density lipoprotein of adult men
R Riales… - American Journal of Clinical Nutrition, 1981
Chromium action and glucose homeostasis
BW Morris - The Journal of Trace Elements in Experimental …, 1999 -
Chromium improves insulin response to glucose in rats
JS Striffler, JS Law, MM Polansky, SJ Bhathena… - Metabolism, 1995
and, an interesting abstract:
Chromium deficiency after long-term total parenteral nutrition
A 63-year-old female developed unexplained hyperglycemia and glycosuria during administration of a total parenteral nutrition regimen on which she had been stable for several months. Because the patient had no history of diabetes or evidence of an infection, chromium deficiency was considered. Plasma chromium level was 0.1 g/dl (laboratory reference interval: 1.8–3.8 g/dl). Fourteen days of supplemental intravenous chromium chloride (200 g/day) allowed complete withdrawal of exogenous insulin with no further hyperglycemia or glycosuria. Correction of unexplained glucose intolerance following vigorous chromium supplementation indicates that the patient had chromium deficiency. Subsequent plasma chromium levels remained unchanged, possibly reflecting the sensitivity limits of the assay that was used, the uncertainty that exists regarding appropriate reference intervals for this element, and the fact that plasma levels do not always correlate with total body stores.
on the other hand... keeping in mind that chromium chloride is relatively poorly absorbed...:
The effects of chromium supplementation on serum glucose and lipids in patients with and without non-insulin-dependent diabetes
Seventy-six patients with established atherosclerotic disease were treated daily with either 250 μg of chromium orally as chromium chloride or a placebo for a period of 7 to 16 months (mean, 11.1 months). Serum chromium increased from 2.69 ± 0.09 to 12.12 ± 0.77 nmol/L (mean ± SE, P < .005). Serum triglycerides were lower (1.68 ± 0.11 and 2.10 ± 0.14 mmol/L, respectively; P < .02) in the chromium-treated patients than in the patients who received placebo, and serum high-density lipoprotein (HDL) increased (from 0.94 ± 0.05 to 1.14 ± 0.07 mmol/L, P < .005) in the patients who received chromium. There was no change in serum cholesterol or blood glucose during the study.
Chromium picolinate increases membrane fluidity and rate of insulin internalization
The effects of chromium chloride, chromium nicotinate, and chromium picolinate on insulin internalization in cultured rat skeletal muscle cells was examined. Insulin internalization was markedly increased in cells cultured in a medium that contained chromium picolinate and the increased internalization rate was accompanied by a marked increase in the uptake of both glucose and leucine. The effect was specific for chromium picolinate since neither zinc picolinate nor any of the other forms of chromium tested was effective. The increased insulin internalization rate may result from an increase in membrane fluidity since chromium picolinate and to a lesser extent, chromium nicotinate, increased the membrane fluidity of synthetic liposomal membranes
Effect of Chromium Supplementation on Glucose Metabolism and Lipidshttp://care.diabetesjournals.org/content/30/8/2154.full
No significant effect of chromium on lipid or glucose metabolism was found in people without diabetes. Chromium supplementation significantly improved glycemia among patients with diabetes. However, future studies that address the limitations in the current evidence are needed before definitive claims can be made about the effect of chromium supplementation.REVIEW ARTICLE
Chromium Research from a Distance: From 1959 to 1980
Walter Mertz, MDhttp://www.jacn.org/cgi/reprint/17/6/544.pdf
Key teaching points:
• Chromium is recognized as an essential element.
• Chromium potentiates insulin action.
• A major challenge in chromium research is the development of practical methods for diagnosing chromium deficiency.
What is this test?
This test measures the amount of chromium in blood. It is used to evaluate and manage chromium exposure or poisoning, and chromium deficiency.
What are related tests?
-Chromium measurement, urine
-Glucose tolerance test
A study. regrettably small n. but a starting point:
Effects of supplemental chromium on patients with symptoms of reactive hypoglycemia.
Anderson RA, Polansky MM, Bryden NA, Bhathena SJ, Canary JJ.
Metabolism. 1987 Apr;36(4):351-5.
"To determine if chromium (Cr) is involved in hypoglycemia, eight female patients with symptoms of hypoglycemia were supplemented with 200 micrograms of Cr as chromic chloride for three months in a double-blind crossover experimental design study. Chromium supplementation alleviated the hypoglycemic symptoms and significantly raised the minimum serum glucose values observed two to four hours following a glucose load
. Insulin binding to red blood cells and insulin receptor number also improved significantly during Cr supplementation. These data suggest that impaired Cr nutrition and/or metabolism may be a factor in the etiology of hypoglycemia
Chromium treatment does not appear to affect glucose levels in kwarshiokor, a protein-energy deficiency disease in which, in this study at least, the patients had 'normal' chromium levels:
Chromium(III) in Hypoglycemia and in Impaired Glucose Utilization in Kwashiorkor
"...The diabetic glucose tolerance curves returned to normal following treatment with a high-protein, high caloric diet for 1-2 weeks. Chromium deficiency did not appear to be responsible for the rapidly reversible impaired glucose utilization seen in patients with kwashiorkor in Cairo, Egypt, United Arab Republic."
Therefore, it would seem a chromium test would be useful before deciding whether chromium might be implicated in a particular individual's hypoglycemia.
OPTIMAL CHROMIUM VALUES
Biological Trace Element Research
Volume 79, Number 3, 205-219, DOI: 10.1385/BTER:79:3:205
Concentrations of seven trace elements in different hematological matrices in patients with type 2 diabetes as compared to healthy controls
"This study aimed to compare the trace element status of patients with type 2 diabetes (n=53) with those of nondiabetic healthy controls (n=50). The concentrations of seven trace elements were determined in the whole blood, blood plasma, erythrocytes, and lymphocytes of the study subjects. Vanadium and iron levels in lymphocytes were significantly higher in diabetic patients as compared to controls (p<0.05 for iron and p<0.01 for vanadium). In contrast, lower manganese (p<0.01) and selenium (p<0.01) concentrations were detected in lymphocytes derived from patients with type 2 diabetes versus healthy subjects. Furthermore, significantly lower chromium levels (p<0.05) were found in the plasma of diabetic individuals as compared to controls
. Trace element concentrations were not dependent on the degree of glucose control as determined by correlation analysis between HBA1c versus metal levels in the four blood fractions. In summary, this study primarily demonstrated that trace element levels in lymphocytes of patients with type 2 diabetes could deviate significantly from controls, whereas, in general, no considerable differences could be found when comparing the other fractions between both patient groups. Therefore, it seems reasonable to analyze metal levels in leukocytes to determine trace element status in patients with type 2 diabetes and perhaps in other diseases."
Ooh.. here's one with values/units!:
"Our results indicate that the chromium concentration ranges of serum and urine
for diabetics are 0.22–0.36 and 4.54–5.90 μg/L
, respectively, significantly lower than 0.66–0.84 and 7.80–9.68 μg/L for the normal
(P<0.001), which implies that the elderly diabetics probably lack chromium."
So, these patients had a third
of the chromium in their systems compared to healthy controls? Yikes.
Too bad I can't find anything on chromium levels in MS patients... grr.
http://www.whfoods.com/genpage.php?tnam ... nt&dbid=51
"Romaine lettuce is an excellent source of chromium while onions and tomatoes are very good sources of this mineral. Other food sources of chromium include brewer's yeast, oysters, liver, whole grains, bran cereals, and potatoes. Many people do not get enough chromium in their diet due to food processing methods that remove the naturally occuring chromium in commonly consumed foods."
Hope that sheds a bit of extra light.
PS ON SUGAR CRAVINGS
Long-term safety evaluation of a novel oxygen-coordinated niacin-bound chromium (III) complexM Shara, AE Kincaid, AL Limpach… - Journal of inorganic …, 2007
"... A significant volume of research studies have demonstrated that chromium (III) complexes play a significant role in regulating appetite, reducing sugar cravings and increasing lean body mass."