Reactive Hypoglycemia - Can Anyone Help Please?

TMEUK

Member
Messages
12
Hi,

I'm new here so sorry if I am posting in the worng place. I am bit confused over a recent diagnoses and wondered if anyone might be able to point me in the right direction? I know any advice ofered will be of an experiance nature and not medical, but it may just help me out.

About 20 months ago I was admitted to hospital with a suspected heart attack. After investigation it was decided I was not cardiac, but needed to see the Endocrine team.

After many months of tests for just about everything from Thyroid to Carcenoid, I was told the results of a fasting blood test revealed Reactive Hypoglycemia.

My results on fasting were 13.5, followed by 4.5 after being given Glucose and then droping out an hour later to 3.5.

For the past 2 weeks I have had a blood monitor, given to me by the Diabetic Nurse. My readings are always with in the normal range or very close, with the lowest ever being 4.5. My average over 2 weeks is 6.0.

However I am still experiancing, very bad headaches, which I was told was because the sugar goes to my brain! My vison is all over the place and I am very tired and fed up.

I think my blood sugar levels are good, so am not sure if this is normal?

Can anyone suggest anything? or has anyone had experiance of this. I don't even know if Hypoglycemia is Diabetes.....

Thanks in advance

Simon
 

LittleGreyCat

Well-Known Member
Messages
4,233
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
Diet drinks - the artificial sweeteners taste vile.
Having to forswear foods I have loved all my life.
Trying to find low carb meals when eating out.
Reactive hypoglycemia, or postprandial hypoglycemia, is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring within 4 hours[1] after a high carbohydrate meal (or oral glucose load) in people who do not have diabetes. It is thought to represent a consequence of excessive insulin release triggered by the carbohydrate meal but continuing past the digestion and disposal of the glucose derived from the meal.

The prevalence of this condition is difficult to ascertain and controversial, because a number of stricter or looser definitions have been used, and because many healthy, asymptomatic people can have glucose tolerance test patterns said to be characteristic of reactive hypoglycemia.[citation needed] It has been proposed that the term reactive hypoglycemia be reserved for the pattern of postprandial hypoglycemia which meets the Whipple criteria (symptoms correspond to measurably low glucose and are relieved by raising the glucose), and that the term idiopathic postprandial syndrome be used for similar patterns of symptoms where abnormally low glucose levels at the time of symptoms cannot be documented.

For diagnosis, a doctor can administer an HbA1c test to measure the blood sugar average over the past 2-3 months. Additionally, a 6-hour glucose tolerance test will chart blood sugar during the past six hours.

According to the U.S. National Institute of Health (NIH), a blood glucose level below 70mg/dL at the time of symptoms followed by relief after eating confirms a diagnosis for reactive hypoglycemia.[2]
http://en.wikipedia.org/wiki/Reactive_hypoglycemia

I find this slightly confusing, but the description does say "in people who do not have diabetes".

However the picture this paints for me is someone having a hypo after a high carb meal because they over produce insulin, which in turn suggests that blood sugar would tend to be normal to low.

You report a high fasting blood sugar which was knocked down by giving you glucose - which sound to be a demonstration of (over)production of insulin after a high carb meal. However I can't really understand where the high fasting blood glucose came from. If you over produce insulin then I can't really see how you could have high blood sugar unless there is a mechanism beyond the normal monitoring of the blood glucose level by the body coming into play.

This is the general thing that is confusing me.
Apparently the sufferer gets a dip in blood glucose after a meal due to over production of insulin.
This is treated by giving glucose/food to bring up the blood glucose.
So why does this not trigger yet more over production of insulin?
Or is it just high carbohydrate meals or high doses of oral glucose and not small amounts of oral glucose or medium to low carbohydrate meals which trigger the over production of insulin?

Sounds like a recipe for uncontrollable weight gain to me if every time you eat all the glucose in your blood stream is flushed out to your tissues, requiring you to eat more to compensate.

Someone will no doubt come along who understands this.

Anyway, as something related to glucose control a diabetes forum is not a bad place to ask a question.

Another thing - you say that from regular testing your average blood glucose is 6.
When are you testing?

For the majority of healthy individuals, normal blood sugar levels are as follows:

The normal blood glucose level in humans is about 4 mM (4 mmol/L or 72 mg/dL)
The body, when operating normally, restores the blood sugar level to a range of about 4.4 to 6.1 mmol/L (82 to 110 mg/dL).
Shortly after eating the blood glucose level may rise temporarily up to 7.8 mmol/L (140 mg/dL) or a bit more in non-diabetics.

So an average of 6 sounds a little bit high.
A fasting BG of 13.5 sounds like full blown diabetes but then as stated above I don't really understand reactive hypoglycemia.
What were your highest readings during your testing campaign, and when (in relation to time after last meal)?

Cheers

LGC
 

TMEUK

Member
Messages
12
Hi LGC,

Thanks for the information, I'm glad I am not the only one who can't get their head around it and now I dont feel so stupid because you obviously have some experiance of these type of things and still don't get it.

OK, I wont give you the full blown 14 day account but if we consider the last few days it would be as follows:

11/08/11 - 12.54 Just before lunch 6.7
11/08/11 - 21.03 2 hrs after evening meal 7.5
12/08/11 8.53 Just before breakfast 5.9
12/08/11 10.46 2 hrs after breakfast 5.2
12/08/11 - 17.45 Just before evening meal 7.4
12/08/11 - 22.14 2 1/2 hours after evening meal 5.5
13/08/11 - 17.55 Just before evening meal 4.6
13/08/11 - 20.20 2 hours after evening meal 5.7
14/08/11 - 8.19 Just before breakfast 6.0

I havent done any further tests today as I havent eaten much as am feeling so rubbish.

Does that mean anything to anyone? Is it good, bad or neither.

Thanks again

Simon
 

LittleGreyCat

Well-Known Member
Messages
4,233
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
Diet drinks - the artificial sweeteners taste vile.
Having to forswear foods I have loved all my life.
Trying to find low carb meals when eating out.
Quick reply - not eating because you feel rubbbish isn't really going to help.
This is more likely to mess with your BG.
Try following a low carb regime and eating regular moderate size meals.

The numbers you have posted don't look too bad so I am still puzzled over your high fasting BG when you had your earlier test.

Not seeing any really low hypo style readings either.

Not seeing any trends.

O.K. - I am baffled (however this is not too hard to achieve).

So probably best to just make sure you eat regular meals but avoid high sugar and carb intake.

Cheers

LGC
 

TMEUK

Member
Messages
12
Hi LGC,

I am still trying to get my head around the whole low carb thing. I did eat yesterday during theday, just not much, I had a slice of toast (Granary bread) and peanut butter mid afternoon, with a cup of tea and 2 rich tead biscuits.

For your information, my levels yesterday were at 5.0 at 6.30 before my evening meal. I then had Lamb steaks with mashed potatoe (small amount) and caluiflower, carrots and gravy. 2 hours later i was at 7.3.

I then woke up in the night feeling very rubbish like I had low BG so tested at 2.40 am and got 6.5. This morning I am at 5.9!

Not knowing much about the condition they say I have or Diabetes in general I dont find those readings alarming or am I missing something? I am taking in to account various articles I have read about natural peaks and lows in BG regardless of your medical condition.

I am now just so confused!

Regards

Simon
 

Snodger

Well-Known Member
Messages
787
Hi there,

you are right, your blood glucose readings seem nice and steady at the moment, nothing to be alarmed about. But if you are still feeling rubbish then presumably something is still wrong somewhere, even if it isn't your blood sugar doing it. In your position I think I'd go back to the doc with the readings you've done and ask them to have another think about it... I wouldn't expect those bg readings to be causing you any problems, so maybe something else is afoot.
 

TMEUK

Member
Messages
12
Hi Snodger,

Thanks for your reply. I think I will go to the docs. The diagnosis was made at St Barts Hospital in London, but I think something must have just been a miss that day that gave strange readings. I know they also mentioned high growth hormone levels and that on a PET Sacn all sugar had gone to the brain area.

The starnge thing is all my symptoms apart from BG do point to diabetes, but I feel like im on a consant crash!
 

LittleGreyCat

Well-Known Member
Messages
4,233
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
Diet drinks - the artificial sweeteners taste vile.
Having to forswear foods I have loved all my life.
Trying to find low carb meals when eating out.
TMEUK said:
Hi LGC,

I am still trying to get my head around the whole low carb thing. I did eat yesterday during theday, just not much, I had a slice of toast (Granary bread) and peanut butter mid afternoon, with a cup of tea and 2 rich tead biscuits.

For your information, my levels yesterday were at 5.0 at 6.30 before my evening meal. I then had Lamb steaks with mashed potatoe (small amount) and caluiflower, carrots and gravy. 2 hours later i was at 7.3.

<snip>

Ummm......
If that is what you are eating during the day then this may be why you are feeling rubbish.
You don't say what you are eating for breakfast.

On the low carb front you are doing practically everything wrong!

Bread (granary or otherwise) is a major carb source.
Rich tea biscuits are packed with carbs and sugars.
Mashed potatoes are carbs processed to be rapidly absorbed.

In my view to low carb you should be eating a protein rich breakfast (quite a large one if you can manage this), protein snacks (e.g. chicken salad) and NO BREAD during the day and no potatoes, pasta, rice, bread etc. in the evening.
In dietary terms it is generally not good to load your eating towards the evening meal - your evening meal would have been much better as a mid day meal.
However people who are working are often constrained by their environment and find it difficult to have a reasonable mid day meal.

Given the blood sugar readings you report I don't think you are suffering from diabetes symptoms - you may be feeling rough because you are messing around with your diet, not eating regular meals, and generally worrying about it all or there may be some other reason.

Certainly skipping a midday meal then snacking on high carb/sugar items in the afternoon is not going to help (although I suspect that is how a lot of people 'diet').

Sorry I can't be much help.

Cheers

LGC
 

TMEUK

Member
Messages
12
Hi LGC,

Thanks again for you input, much appreciated. I think it's a valid point on the diet front. Have started a food diary today to go with BG readings so I can see what foods if any are effecting me.

I think then it's a trip back to the docs, evidence in tow and furthering discussion as to what is wrong!

Regards

Simon
 

daisy1

Legend
Messages
26,457
Type of diabetes
Type 2
Treatment type
Tablets (oral)
Dislikes
Cruelty towards animals.
Hi Simon :)

I think some basic information might help you to control your levels - you will understand better what you can and can't eat. Eating less carbs will ensure more stable levels helping to avoid the peaks and the troughs. Here is some information written by the former monitors for new members (even if not diagnosed) which I hope will help you to obtain better, more even, levels.

Here is the advice that Ken and I, as Forum Monitors, usually give to newly diagnosed Diabetics. We hope that these few ideas gained through experience help you to gain control and give you some understanding of Diabetes. This forum doesn't always follow the recommended dietary advice, you have to work out what works for you as we are all different.

It's not just 'sugars' you need to avoid, diabetes is an inability to process glucose properly. Carbohydrate converts, in the body, to glucose. So it makes sense to reduce the amount of carbohydrate that you eat which includes sugars.

For more information on CARBOHYDRATE see here:

viewtopic.php?f=3&t=20306

This is NOT a low carb diet suggestion, just a reduction in your intake of carbohydrate. You have to decide yourself how much of a reduction will keep your blood glucose levels in control.

The main carbs to avoid OR reduce are the complex or starchy carbohydrates such as bread, potatoes, pasta, rice, starchy root veg and also any flour based products. The starchy carbs all convert 100% to glucose in the body and raise the blood sugar levels significantly.

If you are on Insulin you may find that reducing the carb intake also means that you can reduce your dose of insulin. This can help you to keep weight gain down as Insulin tends to make you put on weight and eventually cause insulin resistance. This should be done slowly so as not to cause hypos.

The way to find out how different foods affect you is to do regular daily testing and keep a food diary for a couple of weeks. If you test just before eating, then two hours after eating, you will see the effect of certain foods on your blood glucose levels. Some foods, which are slow acting carbohydrates, are absorbed more slowly so you may need to test three or even four hours later to see the effect that these have on your blood glucose levels.

Buy yourself a carb counter book (you can get these on-line) and you will be able to work out how much carbs you are eating, when you test, the reading two hours after should be roughly the same as the before eating reading, if it is then that meal was fine, if it isn’t then you need to check what you have eaten and think about reducing the portion size of carbs.

When you are buying products check the total carbohydrate content, this includes the sugar content. Do not just go by the amount of sugar on the packaging as this is misleading to a diabetic.


As for a tester, try asking the nurse/doctor and explain that you want to be proactive in managing your own diabetes and therefore need to test so that you can see just how foods affect your blood sugar levels. Hopefully this will work ! Sometimes they are not keen to give Type 2’s the strips on prescription, (in the UK) but you can but try!!

For TIPS FOR STRIPS see here:

viewtopic.php?f=20&t=19002#p173253

If you are an Insulin user in theory you should have no problem getting test strips.

The latest 2011 NICE guidelines for Bg levels are as follows:
Fasting (waking and before meals).......between 4 - 7 mmol/l...(Type 1 & 2)
2 hrs after meals........................no more than 8.5 mmol/l.....( Type 2)

2hrs after meals......................... no more than 9 mmol/l ......(Type 1)

If you are able to keep the post meal numbers lower, so much the better.

It also helps if you can do at least 30 minutes moderate exercise a day, it can be split into 10 min sessions to start with. It doesn't have to be strenuous.

The above is just general advice and it is recommended that you discuss with your HCP before making any changes. You can also ask questions on the forum on anything that is not clear.

Finally a few QUESTIONS TO ASK AT DIABETES CLINIC.

viewtopic.php?f=20&t=17091



Sue/Ken.
 

TMEUK

Member
Messages
12
Thanks everyone for your advice, there are certainly some things to consider. This forum is a great source of information, so long may it continue.

Regards

Simon