When diet doesn’t improve RH

[RobbieRob]

Hi kids, I was diagnosed with RH about a year ago and subsequently cut out sugar and simple carbs from my diet. However, nothing has changed. I still have the same hypos at the same time each day (10:30am, 3:30pm and 5:30pm occasionally), more often with simple physical activity.

My warning for the impending hypo is blurred vision, followed by confusion, the consumption of sugar tends to be a fix, followed by a meal or snack.

I’m finding that I’m no longer able to function normally. My BS is always low(ish) and I’m finding it difficult.

Any guidance would be greatly appreciated.

Robbie.

 

[EllieM]

This is probably a stupid question, but have you had all the tests to confirm it is actually reactive hypoglycemia rather than one of the other causes for hypos?

I believe you need an endocrinologist to do all the (many) tests.

Edited to add and welcome to the forums @RobbieRob

 

[Antje77]

Hi @RobbieRob , welcome to the forum.

I was diagnosed with RH about a year ago and subsequently cut out sugar and simple carbs from my diet. However, nothing has changed.

Would you like to share what you usually eat in a day, and at what times?
Complex carbs are carbs too, and as a T1 who needs insulin to deal with carbs, I need the same amount for simple carbs as for so called healthy carbs.

My BS is always low(ish)

What is your BG like during the day, so both when feeling ok and when going hypo?
Do you use fingerpricks to test or a CGM?

 

[RobbieRob]

This is probably a stupid question, but have you had all the tests to confirm it is actually reactive hypoglycemia rather than one of the other causes for hypos?

I believe you need an endocrinologist to do all the (many) tests.

Edited to add and welcome to the forums @RobbieRob

Hi Ellie, yes I have a specialist Endo who tortured me with the 72hour fasting test. That was fun.

 

[RobbieRob]

Hi @RobbieRob , welcome to the forum.

Would you like to share what you usually eat in a day, and at what times?
Complex carbs are carbs too, and as a T1 who needs insulin to deal with carbs, I need the same amount for simple carbs as for so called healthy carbs.

What is your BG like during the day, so both when feeling ok and when going hypo?
Do you use fingerpricks to test or a CGM?

Of course I don’t mind. Breakfast (7:30) is usually whole grain toast with avocado, feta, baby spinach and tomato. Morning tea (10:30) is a unsweetened seed bar with fresh fruit. Lunch (12:30) is always a super sized salad with avocado, chicken breast for protein and the usual salad fare. Arvo tea (3:00) is seeded no carb crackers and peanut butter and dinner (6:00) varies each day but always protein, veggies and the occasional potato or sweet potato mashed or roasted.

I test my BS all day, before and after meals and I’ve never seen it above 7.0 mmol, symptoms begin around 5.0 or below depending on the speed of the crash, the lowest I’ve tested at home is 3.4.

 

[RobbieRob]

Hi @RobbieRob , welcome to the forum.

Would you like to share what you usually eat in a day, and at what times?
Complex carbs are carbs too, and as a T1 who needs insulin to deal with carbs, I need the same amount for simple carbs as for so called healthy carbs.

What is your BG like during the day, so both when feeling ok and when going hypo?
Do you use fingerpricks to test or a CGM?

Fingerprick tests.

Hi @RobbieRob , welcome to the forum.

Would you like to share what you usually eat in a day, and at what times?
Complex carbs are carbs too, and as a T1 who needs insulin to deal with carbs, I need the same amount for simple carbs as for so called healthy carbs.

What is your BG like during the day, so both when feeling ok and when going hypo?
Do you use fingerpricks to test or a CGM?

I feel perfectly fine with anything above 5.0 mmol, but I’ve never seen it higher than 7.0.

Symptoms start with kaleidoscope or blurred vision anywhere from 5.0 or below but it depends on how quickly the crash comes on.

 

[Antje77]

From what I understand (I don't have RH and I'm tagging @Lamont D and @Brunneria who can speak from experience, hopefully they'll correct me if I'm wrong), RH is usually caused by the body reacting to carbs by producing too much insulin in rection to those carbs, hence the reactive hypoglyceamia.

Most meals you mention hold a significant amount of carbs: whole grain toast, fresh fruit, salad fare(?), potato or sweet potato.
It's possible that those carbs trigger the reactive hypo.
Have you experimented with having a couple of very low carb meals to see if you still get the hypos some 3 or 4 hours later?
Might be worth having bacon and eggs for breakfast tomorrow, no toast, and see if your 10:30 hypo still happens.

I feel perfectly fine with anything above 5.0 mmol, but I’ve never seen it higher than 7.0.

Symptoms start with kaleidoscope or blurred vision anywhere from 5.0 or below but it depends on how quickly the crash comes on.

Getting hypo symptoms at 5 is unusual, unless coming from a much higher number in general (not the case for you), or dropping very quick from a short spike, which might be happening for you, or not, those very short spikes are hard to catch with a meter.
Non diabetics are often regularly cruising in the lower 4's or even higher 3's without issue except maybe an irritable type of hunger and the feeling of needing to eat something.
I have abslolutely no idea how this relates to your symptoms at 5, sorry!

 

[RobbieRob]

From what I understand (I don't have RH and I'm tagging @Lamont D and @Brunneria who can speak from experience, hopefully they'll correct me if I'm wrong), RH is usually caused by the body reacting to carbs by producing too much insulin in rection to those carbs, hence the reactive hypoglyceamia.

Most meals you mention hold a significant amount of carbs: whole grain toast, fresh fruit, salad fare(?), potato or sweet potato.
It's possible that those carbs trigger the reactive hypo.
Have you experimented with having a couple of very low carb meals to see if you still get the hypos some 3 or 4 hours later?
Might be worth having bacon and eggs for breakfast tomorrow, no toast, and see if your 10:30 hypo still happens.

Getting hypo symptoms at 5 is unusual, unless coming from a much higher number in general (not the case for you), or dropping very quick from a short spike, which might be happening for you, or not, those very short spikes are hard to catch with a meter.
Non diabetics are often regularly cruising in the lower 4's or even higher 3's without issue except maybe an irritable type of hunger and the feeling of needing to eat something.
I have abslolutely no idea how this relates to your symptoms at 5, sorry!

Thank you @Antje77 I appreciate your comments. Dropping from a short spike sounds logical. I understand the implications of eating simple carbs and starchy foods like potato rice and pasta, but was informed that complex carbs (taking longer to digest) when consumed with protein or healthy fats would be the most appropriate option. Even fruit, I understand can be triggering, but whole fruits less so. My specialists suggestion of having a tablespoon of olive oil before each meal… well, it didn’t end well.

 

[AndBreathe]

Personally, in your shoes, I’d consider those complex carbs, and run an experiment for myself.

Again, personally, I would can ALL carbs, except some salad and green, frown above ground veg. I’d up my protein portions to compensate for the carbs. It is important you eat enough, but those carbs are creating like a bouncing ball you can’t catch.

eating,, in my imagination it a bit like throwing a tennis ball towards the ceiling. You thrown the ball up, it peaks then comes drown again. Eating more carbs than we can handle, for whatever reason, with Rh is like throwing the ball up with some enthusiasm, only it hits the ceiling and shoots down faster than we can catch it. That inability to catch is where RH is.

By cutting out or down carbs the energy of the up and down may become more gentle, allowing your body’s insulin response to handle it better.

Edited to add: if you take any blood glucose lowering meds, please check with your doc if they need to be adjusted prior to any major dietary changes.

 

[Antje77]

was informed that complex carbs (taking longer to digest) when consumed with protein or healthy fats would be the most appropriate option.

Like @AndBreathe said, it only takes a very quick and simple experiment to find out if those complex carbs are an issue for your body or not.
The person who informed you is not you, and hasn't tried to see how your body reacts.

Let us know how it goes!

 

[Giraffe 95]

Hi RobbieRob, I have RH too. My thoughts on your diet were, not enough protein for breakfast and cut out fruit. Apples cause a hypo for me about 1.5-2 hours later. Used to have one a day, not realising 20g of sugar.
Meat stabilised my BS, I am concerned that I now eat too much meat. I read that eating a very high protein breakfast helps for the rest of the day. Yesterday I had 4 slices of bacon, 2 eggs, spinach and half a slice of sourdough. Had good bs all day.
But I’m not sure this is good advice to eat so much meat. I’m trying to balance it with lots of vegetables, hummus, yogurt.
Exercise gives me hypos, can’t seem
To solve that one.

 

[MrsA2]

If carbs and/or bg don't prove to be the problem, then you could look at hydration and electrolytes such as salt.
Blurry eyes and confusion can be prewarnings of migraine in me, and I can prevent it with a pinch of salt under my tongue and an extra drink

 

[Lamont D]

Hi kids, I was diagnosed with RH about a year ago and subsequently cut out sugar and simple carbs from my diet. However, nothing has changed. I still have the same hypos at the same time each day (10:30am, 3:30pm and 5:30pm occasionally), more often with simple physical activity.

My warning for the impending hypo is blurred vision, followed by confusion, the consumption of sugar tends to be a fix, followed by a meal or snack.

I’m finding that I’m no longer able to function normally. My BS is always low(ish) and I’m finding it difficult.

Any guidance would be greatly appreciated.

Robbie.

Hi @RobbieRob I have RH and the symptoms you are having are classic RH.

You may have to start testing your BG levels before and after food, just to discover which carbs or sugars are causing the symptoms, hypoglycaemia and the impact they have.
A food diary and a dietary change is so important to managing the condition.
The majority of those giving dietary advice for RH, are so completely wrong and don't understand the science behind the reasons why our bodies react to food.
For example, I was diagnosed with lactose intolerance when very young.
My doctor and the others that followed, told me to avoid dairy. Which I do. So no reaction to the intolerance.
However, when my doctors told me that I was diagnosed with RH. My first question was about carb intolerance?
And why is all medical advice insist on carbs. When all carbs are bad for me. (Ish,) (very, very, very low)
He finally came around to my reasoning, when he was the results and not having the hypos.

Read the RH forums. There is plenty of good advice shout low carb, and walking is good exercise.

And the 72 (80) hours fasting test was fun. I hope you learned a lot about fasting and not going hypo for a few days. I had my first clear head after a day or so, on the fast, it was really the first time in years, I had so much energy, not tired, and felt really good.
I still use intermittent fasting, for a good few reasons.
I hope this helps.

Keep asking.

Best wishes.