Question: I begin to perspire when I eat, and stop within a couple of minutes after I finish. I have diabetes, and I take Metformin and give myself an insulin injection when I go to bed. I also take Ramipril. This has been happening to me for about four months now. What could be the cause?

Dr. Hibberd's Answer:

Hyperhidrosis (excess sweating) related specifically to meals may be related to the stress hormone system (cortisol) becoming activated in response to a sudden drop in your glucose. You may need to consider modifying how you give yourself insulin. You may actually be having a response to excess insulin characterized by wild swings in blood glucose values (called a "symogyi effect").

I wonder just how high or low your baseline blood glucose levels are, and how much of a peak you are experiencing. You may consider interrupting your insulin to see if these spells are more or less prominent then. It is highly likely that your blood glucose is responsible for your symptoms ... is it dipping slightly before your meal has been absorbed enough to affect your serum glucose? Less likely is a response to elevated glucoses.

Definitely see your doctor for evaluation for other causes of meal-induced stress. Conditions of the pancreas such as an insulinoma (tumor) may need to be considered. If unsure, a supervised glucose challenge test will uncover how your body is responding to a glucose load, and may assist your doctors in evaluating your situation.