Barbell Medicine Podcast

Episode 344: Man Has A Seizure While Lifting (Mystery Case)

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Apr 18, 2025
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INSIGHT

Complex Hormonal Control of Blood Sugar

  • Blood sugar regulation involves a complex, choreographed interplay of hormones like insulin, glucagon, and cortisol.
  • Hypoglycemia can result from multiple physiological failures including insulin dysregulation and glycogen storage or breakdown issues.
INSIGHT

Insulin-Mediated Hypoglycemia Diagnosed

  • This patient experienced insulin-dependent hypoglycemia during a 72-hour fast and exercise, confirmed by high insulin and C-peptide levels.
  • Insulin release inappropriate to blood sugar levels points to endogenous sources like insulinoma or pathological hyperinsulinism.
INSIGHT

MCT1 Mutation Causes Exercise Hypoglycemia

  • The patient's mutation in the monocarboxylate transporter 1 (MCT1) gene causes abnormal lactate and pyruvate uptake by pancreatic beta cells.
  • This triggers exercise-induced inappropriate insulin secretion and consequent hypoglycemia during anaerobic exercise.
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