Psychosomatics 39:298-299, June 1998
© 1998 The Academy of Psychosomatic Medine
Chromium-Induced Hypoglycemia
Scott P. Bunner, M.D., and
Ronald McGinnis, M.D., Medical College of Ohio, Department of Psychiatry, Richard D. Ruppert Health Center, Toledo, Ohio
Key Words:
TO THE EDITOR: The use of over-the-counter (OTC) medications and supplements has increased dramatically over the years. Our patients have resorted to the use of vitamins, herbs, and supplements to cure a myriad of conditions. We would like to report a case of hypoglycemia because of its unusual trigger and its implications in the use of OTC products.
Case Report
Mr. A. is a 29-year-old man who was referred to the outpatient neuropsychiatry clinic because he had been relieved of duty due to concerns that he was unsafe on the job. There was concern because of two episodes of unusual behavior during which he was disoriented and belligerent. After being seen by an occupational medicine specialist and a neurologist, he was sent for neuropsychiatric evaluation.
Mr. A. had been diagnosed with diabetes mellitus at 20 years of age. Since that time, he had been on insulin and was taking 9 units of Humulin-N per day. His blood sugars ranged between 90 mg/dl and 120 mg/dl. His first unusual episode occurred after a long, physically strenuous shift at work. He became weak, confused, paranoid, agitated, and ran around the office, falling and tripping. He shouted and cursed while accusing co-workers of stealing his change. Eventually, he was restrained until an emergency squad arrived. His blood sugar was found to be in the range of 30 mg/dl, and he refused intravenous glucose treatment. He begrudgingly took an oral glucose solution, after which he slowly started improving.
His family physician saw him in follow-up and learned that the patient had started using chromium picolonate 200 µcg 2 times a week and 300 µcg 3 times a week for bodybuilding. Believing that the patient's insulin had caused the episode of hypoglycemia, his family physician decided to stop the insulin. He shifted the patient to only chromium and titrated it up to 1,000 µcg/day over several weeks. On this new regimen, Mr. A.'s blood sugars were running between 90 mg/dl and 140 mg/dl.
Six months after his first episode of hypoglycemia unawareness, he had another similar episode. He was only on chromium and not using insulin. On the advice of his physician, Mr. A. stopped chromium the following day and was put on Glynase (glyburide). Since that time, he has had no further episodes.
Mr. A.'s initial laboratory evaluations, including toxicology, were normal. He also had a normal electroencephalogram and magnetic resonance imaging of the brain. His neuropsychiatric evaluation was within normal limits. We diagnosed these two episodes as delirium due to hypoglycemia.
Discussion
A recent surge of chromium use in diabetes is attributed to a report at the 56th Annual Meeting and Scientific Sessions of the American Diabetes Association (ADA).1 The study describes a group of Chinese patients with Type II diabetes who had improved glycemic control on 200 µcg/d and 1,000 µcg/day of chromium picolonate. Anderson, however, believes that chromium (Cr) is a nutrient and not a therapeutic agent.2 It cannot necessarily be concluded that all people with Type II diabetes will benefit from Cr supplementation, as in the case we described. Cr (III) may be a trigger or factor inducing hypoglycemia. Because many studies with Cr only last 2–4 months, this side effect might be missed if it is not experienced until 6–12 months after starting Cr supplementation. The ADA itself does not recommend supplementation with Cr for persons with diabetes until further testing is done.3 The estimated safe and adequate daily dietary Cr intake in adults recommended by the Food and Nutrition Board is between 50 and 200 µcg/d.4 However, when studied, daily intake in normal subjects with self-directed diets is from 13 to 48 µcg/d.5 Because of its long half-life and inconsistencies in the study of the long-term accumulation of Cr, the recommended daily dietary Cr intake of between 50 and 200 µcg/d should be approached cautiously. Cr (III) can be allergenic [although less than Cr (VI)] and mutogenic, but there is little evidence it is carcinogenic.6 Taken as a whole, the possible buildup of Cr levels from nutritional supplements and long-term allergenic or mutogenic effects are cause for concern.
This case of hypoglycemia illustrates the need for more research to determine Cr's effects in diabetes, its long-term toxicity, and safe daily requirements in a nondeficient population. This case also emphasizes the need for psychiatrists to be aware of the signs and symptoms of hypoglycemia and hypoglycemia unawareness. Finally, this case highlights the need to be aware of OTC drugs that patients may or may not mention that may affect diseases and the medications we use to treat them.
REFERENCES
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Anderson R, Cheng N, Bryden N, et al: Beneficial effects of chromium for people with type II diabetes. Diabetes 1996; 45:337A[Abstract]
-
Anderson RA: Chromium, glucose tolerance, and diabetes. Biol Trace Elem Res 1992; 32:19–24[Medline]
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American Diabetes Association: Nutrition Recommendations and Principles for People With Diabetes Mellitus (position statement). Diabetes Care 1996; 19(suppl):S16–S19
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Food and Nutrition Board: Recommended Dietary Allowances, 10th Edition. Washington, DC, National Academy of Sciences, 1989
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Anderson RA, Kozlovsky AS: Chromium intake, absorption and excretion of subjects consuming self-selected diets. Am J Clin Nutr 1985; 41:1177–1183[Abstract/Free Full Text]
-
Baruthio F: Toxic effects of chromium and its components. Biol Trace Elem Res 1992; 32:145–153[Medline]
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