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A 47 year old white woman, while she was being evaluated for atypical chest pain, mentioned that she had had a life long history of a “sugar intolerance”. On further questioning she described her symptoms as a severe headache, sweating, nausea, vomiting, abdominal pain, and fainting occurring shortly after she ate something sweet. She had had these symptoms since infancy from the time she was weaned. She developed an aversion to sweets and followed a diet, which consisted mainly of meat and dairy products. She had a brother who had the same problem. Ten to 20 years ago she was given a “glucose tolerance test” by her family physician who gave her a glass of sweetened orange juice. She developed a severe attack of her usual symptoms, shaking, and perspiration and she almost lost consciousness. Hypoglycaemia was documented by her physician. Fortunately, she recovered spontaneously. At that time her doctor recommended that she continue with her diet. She remained well and was able to stay almost symptom-free by carefully selecting what she ate. Her review of systems and physical examination were also remarkable for excellent dental health.
- What diagnosis would account for her “sugar intolerance” and what diagnostic test would you recommend?
- How would you treat hypoglycaemia in such patients?
- What needs to be done for the patient?
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