Questions about RH and suggestions

[Auto E]

I was diagnosed with prediabetes and chronic kidney disease about 18 months ago and so I decided to eat low carb. I lost over 20 pounds/9kg . I'm now BMI 22. My fasting blood glucose remains stubbornly pre-diabetic although my post-prandial blood sugars are now well under control. I have been wearing a CGM for 1 week and I've already learned so much. First, I stay around 110 (6.1mmol/L) all night long. Stable, but slightly high. Does anyone else experience this? Second, when I eat low-carb I stay between 95 (4.1) and 120 (6.7) all day long, with the exception of learning that during exercise I go a bit low (60mg/dL/3.3mmol/L) - before my CGM I never saw these exercise lows. But the biggest surprise (to a frequent finger-sticker like me) is that, when I cheat (I had french fries), I have reactive hypoglycemia!!!! I had NO IDEA.

I had french fries Saturday night as a splurge (not even a whole serving). To try and blunt the effect, I had them with cheese and bacon. Nevertheless, within 30 minutes I was up to 160mg/dL (8.9). Then I crashed within the next 30 minutes all the way down to 42mg/dL (2.3). 30 minutes after that, back up to 125mg/dL (5.8). 30 minutes after that, back down to 60mg/dL (3.3). At that point I had a little bit of milk, which stabilized me for the rest of the evening. Slept like **** after that roller coaster, though. Splurging isn't worth it!

Here's the other major thing - if not for the CGM, I was completely unaware that my blood glucose was so low. In hindsight, I have had these symptoms SO MANY TIMES over my life: lethargic, poor fine motor control (writing/typing difficult), headache, palpitations, and a floaty feeling. I have always just assumed this meant I was tired and I needed to go to bed.

Here's the thing that I'm now wondering about: for years, some nights I wake up nauseated and with diarrhea. I have assumed this is a digestion problem or a blood pressure issue, but I am wondering if any of you have experienced vomiting and diarrhea during a hypoglycemic episode? Now that I'm wearing the CGM, I'll catch it if this happens, but luckily it is not frequent (maybe 1 time/month).

Also, I guess I'm just looking for some dietary reassurance. Here are my current meals:
B: coffee w/cream, walnuts, eggs if particularly hungry
L: high-fat yogurt w/berries
D: meat + salad
decaf coffee w/cream

This is what I eat, Monday through Friday. I try to be more relaxed on the weekends. I'll have something like peanut butter w/banana slices for a dessert.

Do you have dietary suggestions or ideas for me moving forward? I would love to keep my blood sugar stable (the diet I have DOES accomplish this, assuming I don't splurge and have french fries!!!), but I also WOULD LOVE to bring my fasting glucose down. My liver seems to be a glucose making machine, keeping my blood glucose slightly elevated 24 hours a day, except on the rare occasion when my pancreas goes into hyperdrive and overwhelms my liver's sugar-making capacity. I'm paranoid that my low-carb diet is just making me MORE intolerant of carbs. Am I making myself worse? Reassurance anyone.....?

 

[Lamont D]

Hi @Auto E
Wow!
Thanks for the post, some useful information.
It does seem that you have already got a handle on how RH can effect what you eat.

Because, you still have prediabetic levels, it could possibly not be either, RH or diabetes related, it could be any number of Hypoglycaemic related conditions.
You can have T2 and RH!
You can have T2 and RH symptoms!
You can have RH and be non diabetic, like me.
Until your body adjusts to having normal blood sugar levels pre meal, (not fasting because of what is known as dawn phenomenon.)
If you have normal levels (between 4-6 mmols) pre meal after not eating for about four hours, then your blood sugar levels go quickly high, then an overshoot of insulin happens, then you go below normal levels into a hypoglycaemic episode. That could possibly be RH.
Because you are still getting higher readings, it is because of insulin resistance, high circulating insulin, or what is known as glucose dumping. The imbalance in insulin/glucose depending on what you eat is the cause, there probably is more hormones at work, but if the resulting reaction is too much insulin, you will certainly have a hypo.
I too have problems exercising, too much, and I have a liver dump.
I have probably had both vomiting and diarrhoea, but not at the same time, whilst going hypo, but I never attributed it to RH, my symptoms will certainly be different to yours.
Your daily intake is not bad but not diverse enough, you need more variation.
Depending on your tastes, your location, your nutritional needs, and the most important is what you can tolerate to stay in normal levels. The more you stay in normal levels the better you will feel and the symptoms will ease.
Because your body can cope with very lower carb, your insulin resistance etc. will respond and the trigger for the overshoot of insulin won't happen.
It's down to what portion size you have. You mention fries, I could possibly eat one or two and it won't trigger the reaction, but if I had another two, it would almost certainly trigger it.
Eating small very low carb meals every three to four hours is important at the start, then you could progress to having less food, less often. Doing set meals is something I found hard to stick to. I only eat (very low carb of course) when i want or I use intermittent fasting, because I know what limits to keep to, through trial and error.
Using your cgm, is a tool I never had, I wish! That is so useful, I kept a food diary and still do to see readings post prandial.
Control is so important to Hypoglycaemia.
Because these types of endocrine conditions are food related and it is the usual suspects, carbs and sugars!

Let us know how you get on.

Best wishes and welcome to our forum.

 

[Auto E]

Lamont, I've realized that I have to eat even lower carb than I was doing. I'm working to find more variety and lower carb lunch options. Today I had tuna fish with walnuts, cheese, and pickles. Not only did my blood sugar stay more stable after eating, but when I went running in the afternoon I didn't get the usual (mild) hypo! So, I'm sad to remove so much yogurt from my life, but I'm pleased that I can still tinker and see improvements to my symptoms.

 

[Damtov8]

I would ditch the banana as it is very high carb and stick with berries in small quantities.

 

[Lamont D]

Lamont, I've realized that I have to eat even lower carb than I was doing. I'm working to find more variety and lower carb lunch options. Today I had tuna fish with walnuts, cheese, and pickles. Not only did my blood sugar stay more stable after eating, but when I went running in the afternoon I didn't get the usual (mild) hypo! So, I'm sad to remove so much yogurt from my life, but I'm pleased that I can still tinker and see improvements to my symptoms.

It is a lot to do with personal taste, how you approach very low carb, I'm more of a meat eater, without this, I would really struggle.
I couldn't go vegetarian, vegan, simply because my body has told me not to eat certain vegetables particular cooked greens. Trying to force me not to eat meat is a waste of time. I couldn't do it!
I have given up an awful lot of carbs that I really enjoyed and was part of my staple diet prior to diagnosis.
I agree about bananas, you have to be careful with certain fruits, especially those from warmer climate, they tend to have more fructose than the likes of apples, pears, berries.
If I run too much, if I intentionally exercise too strenuously, if I do too much in work, I'm liable to trigger a liver dump, which is the last thing I need, because that would trigger the overshoot of insulin, I would need to counter the glucose. Hyper then hypo.

Keep thinking about what your carb intake is, could you go lower?Knowledge about carb counting is useful, there are hidden carbs everywhere especially in food that is processed, prepared or not fresh. It is a minefield out there! Having hypo awareness is part of knowing the symptoms you get when your blood glucose levels rise too much, too quickly.

Best wishes

 

[Brunneria]

Lamont, I've realized that I have to eat even lower carb than I was doing. I'm working to find more variety and lower carb lunch options. Today I had tuna fish with walnuts, cheese, and pickles. Not only did my blood sugar stay more stable after eating, but when I went running in the afternoon I didn't get the usual (mild) hypo! So, I'm sad to remove so much yogurt from my life, but I'm pleased that I can still tinker and see improvements to my symptoms.

Well done!
I find that cows milk raises my blood glucose, whereas goatsmilk and sheepsmilk doesn’t. This applies to yogurt too.
Also, a trick that many low carbers use is to have the Greek yogurt, 5-10% fat. The fat is more filling, which means you can feel just as full with a smaller portion.
Adding cream to a low fat yogurt achieves the same result, of course.

we are all v different, but it is worth trying out a few different things to see what works for you.

In my case, I sometimes have some goatsmilk yog (full fat) with a dash of double cream and a dollop of nut butter stirred in.
Delicious! If you want to stir a few crushed berries in too, you get a kind of PB&J yog.

 

[Auto E]

Well done!
I find that cows milk raises my blood glucose, whereas goatsmilk and sheepsmilk doesn’t. This applies to yogurt too.
Also, a trick that many low carbers use is to have the Greek yogurt, 5-10% fat. The fat is more filling, which means you can feel just as full with a smaller portion.
Adding cream to a low fat yogurt achieves the same result, of course.

we are all v different, but it is worth trying out a few different things to see what works for you.

In my case, I sometimes have some goatsmilk yog (full fat) with a dash of double cream and a dollop of nut butter stirred in.
Delicious! If you want to stir a few crushed berries in too, you get a kind of PB&J yog.

Sadly - I use Zoi, which has 18 grams fat per se

Well done!
I find that cows milk raises my blood glucose, whereas goatsmilk and sheepsmilk doesn’t. This applies to yogurt too.
Also, a trick that many low carbers use is to have the Greek yogurt, 5-10% fat. The fat is more filling, which means you can feel just as full with a smaller portion.
Adding cream to a low fat yogurt achieves the same result, of course.

we are all v different, but it is worth trying out a few different things to see what works for you.

In my case, I sometimes have some goatsmilk yog (full fat) with a dash of double cream and a dollop of nut butter stirred in.
Delicious! If you want to stir a few crushed berries in too, you get a kind of PB&J yog.

I definitely only eat high-fat yogurt (Zoi - it has 18 g fat!), and the thing is, I don't go more than 1.25mmol/L above my fasting when I eat it, but because my fasting glucose is often about 5.8mmol/L, it doesn't take much for me to bump up above 6.6mmol/L (which is my personal goal). Since my A1C is 42mmol/L right now, I'm becoming super strict with my foods. I hope I'm not veering into the "obsessive" range.
Thanks for the tip about the goatsmilk. I tried some the other day and was shocked how different it tasted. I um... didn't love it.
And, for what it's worth, if I have 1/2 a banana and peanut butter for a dessert (so this is not an everyday thing - it's a Saturday or Sunday food), my BG only raises .5mmol/L. Go figure. But eat to the meter!

 

[Auto E]

I would ditch the banana as it is very high carb and stick with berries in small quantities.

The 1/2 banana is only a rare (once a week, if that) treat - I dip the slices in peanut butter. Believe it or not, I only raise 0.5mmoL/L after this dessert.
But in general I agree with you - bananas are not part of my everyday foods.

 

[Auto E]

It is a lot to do with personal taste, how you approach very low carb, I'm more of a meat eater, without this, I would really struggle.
I couldn't go vegetarian, vegan, simply because my body has told me not to eat certain vegetables particular cooked greens. Trying to force me not to eat meat is a waste of time. I couldn't do it!
I have given up an awful lot of carbs that I really enjoyed and was part of my staple diet prior to diagnosis.
I agree about bananas, you have to be careful with certain fruits, especially those from warmer climate, they tend to have more fructose than the likes of apples, pears, berries.
If I run too much, if I intentionally exercise too strenuously, if I do too much in work, I'm liable to trigger a liver dump, which is the last thing I need, because that would trigger the overshoot of insulin, I would need to counter the glucose. Hyper then hypo.

Keep thinking about what your carb intake is, could you go lower?Knowledge about carb counting is useful, there are hidden carbs everywhere especially in food that is processed, prepared or not fresh. It is a minefield out there! Having hypo awareness is part of knowing the symptoms you get when your blood glucose levels rise too much, too quickly.

Best wishes

Thanks Lamont. It really does feel like a dance to find foods I like, don't spike or hypo me, and meet all my nutrition needs. But I'm in this for the long haul