Video presentation: Autonomic regulation of glucose in POTS, 2020 Cyndya Shibao

Presentation from Dr Cyndya Shibao including apparent early data from an unpublished pilot study into autonomic regulation of glucose in POTS.

Very interesting video for those of us here that experience postprandial (after eating) problems, I know these issues have been discussed a fair bit over the years here. When mild its usually just the "food coma" slowdown. When severe it can have many symptoms of a hypoglycaemic event and be very, very disabling.

I've experienced the full spectrum of this. Certainly when milder with less ANS dysfunction I didn't recognise the impact eating was having on my CFS symptoms & fatigability. Even when it insidiously became a significant issue, one that eventually eclipsed my general CFS/POTS issues, it still wasn't obvious to me until a POTS-aware endocrinologist pointed out what was happening. Much like how many of us don't realise we experience orthostatic intolerance until we are told - these weird problems just get mixed in to the confusing gamut of CFS symptoms.

A few summary slides on the study to follow but the new headlines appears to be:

- 50% of lean POTS patients have impaired glucose tolerance (IGT) with higher risk of developing Type 2 Diabetes.
- The IGT has a distinct pathophysiology that may not respond to conservative measures like weight loss.
- POTS patients have increased incretin hormone GIP that is potentially responsible for postprandial increased heart rate.
- GIP antagonist is under trial & might be a useful therapeutic.

Splanchnic pooling has been implicated in this for a long time and this incretin finding seems to reinforce that. Pleased to see controls for the gastric emptying issues that often get reported in POTS too.

 

From the video:

 

Thanks for sharing. This is what I have I think, except that it was there even when I didn't have POTS. It's likely to be partially genetic in my case.

PEM, OI, strange blood glucose regulation problems, fatigue, brain fog, low blood pressure and others might just be an expression of an autonomic nervous system problem.