Kyle Varner’s Blog

Note this well:  I am not a doctor (yet).  I am specifically not an endocrinologist.  This is not medical advice.  This is not a scientific paper or intended as such.  Do not change anything you are taking or doing on the basis of this post.  ANY AND ALL changes in medications should ALWAYS be approved and supervised by a licensed physician.  This post is pure speculation based upon my current level of knowledge and personal experience.  I cannot, and AM NOT making any scientific claims here.  If you find what I have to say interesting, DO RESEARCH, DO NOT ACT ON MY SPECULATION.

Hopefully I’ve said enough to dissuade anyone from taking doing anything based on what I say without consulting their physician.  This is very, very important.  I do NOT want to be the cause of anyone’s death, and I don’t want to mislead anyone into harming their health.  I also don’t want to get sued.  So, to reiterate:  this is not medical advice, it is speculation about biochemsitry and pharmacology.

Disclaimer  Over!

I think there may be a useful off-label use for Provigil (Modafinil), and I think I’ve been experiencing its benefits.

Among the many effects of Modafinil, one is to promote the release of norepinephrine.  Norepinephrine inhibits the production of insulin.

Here is a basic rundown of postprandial reactive hypoglycemia (the sort from which I suffer) in a sexy USMLE vignette format:

A 23 year old male patient goes to a convenience store and buys a slurpee, coca cola and snicker’s bar.  Twenty minutes after quickly consuming all three he becomes very tired.  He describes it as though he feels drunk and reports that he cannot function normally unless he naps for several hours.  The situation is repeated in the lab, and lab tests reveal a hyperactive response from the beta cells of the pancreas.  Blood glucose initially rises normally, but blood insulin levels rise drastically.  Within thirty minutes the patient’s blood glucose is much lower than normal and he feels lethargic.

Note here that in this quasi-vignette I said nothing about a hypoglycemic coma or anything of the sort.  This is because the vignette is about me (not the lab part…or the gluttony part).  All it takes is a candy bar or a sugared soda to disrupt my day.  I cannot stop myself from taking a nap.  Sometimes even a meal containing simple carbohydrates (rice, white bread or potatoes).  I often skip lunch entirely in an effort to avoid an afternoon crash.  It is really quite a problem.  Luckily it has never been a dangerous problem; it has imperiled only my day to day activities, never my life.

But…the problem isn’t as bad…when I am on Provigil.  I will be the first to say that this could well be due to its appetite suppressing effects leading me to eat less, and also due to its stimulant effects.  The latter, however, is unlikely, because I can tell from experience and from a scientific standpoint that the wakefulness promoted by Provigil is quickly overcome by a precipitous drop in blood sugar (if I really binge, i.e. the emotional eating of large quantities of cookies while on Provigil, I tend to have a problem).  I overcame my former objection with a totally unscientific and clinically useless experiment of my own.  One morning before my biochemistry class, I decided to eat three scoops of ice cream and drink two bottles of Ting (a very sugary local soda).  I then went to class.  I fully expected to leave during the first break and have to go home and sleep.  This was not the case.  I did not feel any more tired than usual, and my ability to concentrate on the boring lectures was, judging subjectively, roughly the same as any other day.

Could this be due to Provigil’s indirect inhibition of the production of insulin?  Could it be that an appropriate does of Provigil timed properly could prevent the afternoon slump that is so typical during a workday?  Could people like me, who have a hyperactive insulin response benefit from this property of Provigil?

I think its very possible.  During my short holiday break from school, I’m going to do some digging around and see if I can find any published research on the topic.  If I can’t, I’ll become very curious.  I know a number of medical students conduct some sort of research, and I wonder if I might be able to publish a paper on this topic…

Another consideration is that norepinephrine stimulates glycogenolysis, which puts glucose into the blood.

Once again, to cover my ass and yours:  THIS IS NOT MEDICAL ADVICE OR A SCIENTIFIC PAPER.  IT IS SPECULATION AND I AM NOT A DOCTOR!  DO NOT CHANGE ANYTHING YOU ARE DOING BASED ON MY SPECULATION!  If you are not a doctor, you are not going to be very successful trying to play with your own medications.  There is so much that goes into learning how and when to prescribe medications that it makes it dangerous for the lay person to go at it alone (I think that if they want to they should be legally allowed, but that is due to my political ideology, not because I think it is generally a good idea).   Why do I keep reiterating this point?  Because I want to make it CRYSTAL CLEAR that I am not giving any medical advice or making any claims.  If you read my post Dangerous Voodoo Medicine you will see why I think it is so very dangerous for non-professionals to be giving out medical advice.

I’ll make it even clearer:  I am a medical student living in a third world country.  Being a medical student means I know a thing or two about medicine, and can understand doctor-speak.  This means I can read and understand Harrison’s Principles of Internal Medicine and the prescribing information for any drugs.  It also means that I can pretty easily bribe a pharmacist to sell me whatever drugs I want without a prescription.  Guess what:  I don’t do it!  If I am ill, I either call my physician in the United States or visit a physician here and obtain a legal prescription, preferably from a pharmacy in the United States.  Just a few months ago I requested a particular medication from my family physician, and he agreed and wrote the prescription.  There was a rare drug interaction that 99.9% of doctors would never think about, and he didn’t think about.  Guess what?!  The pharmacy caught it, and alerted both my physician and I.  There are really good reasons to go through professionals and not just play with drugs like they are candy.

I know this post is getting long-winded, so I’ll wrap up:  I wrote this post to speculate about a potential off-label use of medicine.  It reminded me of my post yesterday, Dangerous Voodoo Medicine, and I am still quite angry about the email that was sent to my mother and her colleagues.  Don’t try to be your own doctor. Even doctors don’t prescribe their own medications (generally).  Don’t take your life into your own hands by following some random guy’s advice on the internet (except this advice!).  Your life is too precious.  There is no God, no Jesus and no Heaven (or Hell).  When you’re dead, your body rots and it’s over.  Don’t hasten that time.  Enjoy your life and do whatever you can to make it a long and healthy one because it is the only one you’ve got.  There are professionals out there who dedicate their lives to the hard science of alleviating suffering and extending life.  Their services are the most useful services you could ever access.  You can cut corners on a lot of things, but don’t EVER CUT CORNERS ON YOUR LIFE!  It is far too precious.

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