Startled at low numbers on VLCD I can't hypo can I?

[Geminigirl]

Hi all.

Looking for advice.

I started a VLCD 3 weeks ago with support from GP. He has been great.
When I started he took me off the Glimeperimide so no fear of hypo, also took me off my Jardiance as he voiced concern at possibility of DKA.

I had been checking keytones and they show I am in Ketosis and I feel very well.

I have lost 10lbs and my BG has drastically reduced in last week which is good. My eyes are also much better.

I am keeping a BG record for the GP....he gave me tons of strips so that even though I am on NIL meds I can show him progress in 1 months time.

However, before tea (meal replacement) today when I took my BG it was 4.5. Now I haven't seen that in months. I feel fine but am worried about hypos? Surely I shouldn't have any?

Any advice would be appreciated as I am chuffed but startled at the same time!

Thanks, Chris

 

[Goonergal]

@Geminigirl 4.5 isn’t hypo territory, but if you’re used to running higher, you might feel a bit odd. If you’re not on any diabetes med then it’s very unlikely you will have a hypo.

Great that your numbers are coming down.

 

[NicoleC1971]

Hi all.

Looking for advice.

I started a VLCD 3 weeks ago with support from GP. He has been great.
When I started he took me off the Glimeperimide so no fear of hypo, also took me off my Jardiance as he voiced concern at possibility of DKA.

I had been checking keytones and they show I am in Ketosis and I feel very well.

I have lost 10lbs and my BG has drastically reduced in last week which is good. My eyes are also much better.

I am keeping a BG record for the GP....he gave me tons of strips so that even though I am on NIL meds I can show him progress in 1 months time.

However, before tea (meal replacement) today when I took my BG it was 4.5. Now I haven't seen that in months. I feel fine but am worried about hypos? Surely I shouldn't have any?

Any advice would be appreciated as I am chuffed but startled at the same time!

Thanks, Chris

Wow. It sounds as if you are doing very well and kudos to your GP for being supportive o f this approach.
Technically you would go below 4 to be considered 'hypo' so you are not hypo. You are simply losing insulin resistance as you have lost your liver fat via your VLCD (are you on the Direct trial BTW?) This is what is supposed to happen. You should continue to get good bgs even though you won't have lost all your weight yet.
Ketones are a sign that your body is burning fat (NOTE that if you are peeing on a stick then those ketones may not show up once your body gets used to them and does not excrete them but you will likely still be burning fat if on the VLCD)
Unless you had high blood sugars at the same time or were taking certain diabetes meds (SGLT 2) there should be no concern for DKA which is normally only a problem for a type 1 with not enough insulin to deal with high bgs.

 

[Geminigirl]

@Geminigirl 4.5 isn’t hypo territory, but if you’re used to running higher, you might feel a bit odd. If you’re not on any diabetes med then it’s very unlikely you will have a hypo.

Great that your numbers are coming down.

Hi. Thanks, no I am not on any other diabetic meds. Just diet. I did feel a bit off the 2nd week but this last week I feel fine.
Am also monitoring my BP as am on a med for that.

 

[Geminigirl]

Wow. It sounds as if you are doing very well and kudos to your GP for being supportive o f this approach.
Technically you would go below 4 to be considered 'hypo' so you are not hypo. You are simply losing insulin resistance as you have lost your liver fat via your VLCD (are you on the Direct trial BTW?) This is what is supposed to happen. You should continue to get good bgs even though you won't have lost all your weight yet.
Ketones are a sign that your body is burning fat (NOTE that if you are peeing on a stick then those ketones may not show up once your body gets used to them and does not excrete them but you will likely still be burning fat if on the VLCD)
Unless you had high blood sugars at the same time or were taking certain diabetes meds (SGLT 2) there should be no concern for DKA which is normally only a problem for a type 1 with not enough insulin to deal with high bgs.

 

[Geminigirl]

Thanks. Yes, he has been very helpful amd encouraging (unlike the DN! )
No I am not on a trial. Am following Newcastle type plan with Tesco's shakes/bars plus the 200 cal veg a day.
I am taking my BP as well and send him the reafings weekly incase my med needs reducing.

 

[Geminigirl]

Wow. It sounds as if you are doing very well and kudos to your GP for being supportive o f this approach.
Technically you would go below 4 to be considered 'hypo' so you are not hypo. You are simply losing insulin resistance as you have lost your liver fat via your VLCD (are you on the Direct trial BTW?) This is what is supposed to happen. You should continue to get good bgs even though you won't have lost all your weight yet.
Ketones are a sign that your body is burning fat (NOTE that if you are peeing on a stick then those ketones may not show up once your body gets used to them and does not excrete them but you will likely still be burning fat if on the VLCD)
Unless you had high blood sugars at the same time or were taking certain diabetes meds (SGLT 2) there should be no concern for DKA which is normally only a problem for a type 1 with not enough insulin to deal with high bgs.

 

[Geminigirl]

Jardiance comes into that group.

 

[Spl@]

No you won't hypo without meds. I'm on quite a low carb count. Probably 20 a day. Some days much less. Also OMAD.

I have only seen 2 readings under 4. Your liver will kick in to stop it going lower and you may find yourself getting hungry. Like throat cut hungry the first few times. As you adjust that will pass.

Once your used to being in the 4's on a regular basis. Higher numbers will feel wierd.

 

[DCUKMod]

Geminigirl, you're doing very well, and your GP is to be applauded for his supportive approach.

I didn't do ND, but when I started low carbing, I got skinny fast, and my blood glucose numbers plummetted.

These days I run around your 4.5 and aften lower. Often 4.5 will be my after meal reading. I feel absolutely fine and all my health markers are in a good place.

Two comments I would make are:

Keep an eye on your BP; it may well naturally drop a bit on the VLCD, so your meds could need a bit of a tweak along the way. That's a maybe, not a certaintly. Secondly, You may also find your Levothyroxine needs tweaked a bit along the way too.

Were I in your shoes, I'd be hoping for regular blood work, to include my thyroid function - not just the TSH, but also measuing the T4 and ideally T3, although I wouldn't hold your breeath for the T3!

Keep going, but please don't be fearful of smaller numbers - provded you feel well. If you feel dire, have a cup of tea and see how you feel in a few minutes. Often whilst blood glucose numbers are coming down fols experience the odd rogue hypo-style feelings. It's usually just our body's way of keeping us it it's comfort zone, when we are trying to break it out of that comfort zone.

If you have real concerns 111 is always there, of I'm sure your stellar GP or Practise Nurse could be able to advise. Although if you are their first VLCD patient they may not have muc experience. (That last part is speculation, not an insult!)

Good luck with it all, and welcome to the little numbers club.

 

[JohnEGreen]

No you won't hypo without meds. I'm on quite a low carb count. Probably 20 a day. Some days much less. Also OMAD.

I have only seen 2 readings under 4. Your liver will kick in to stop it going lower and you may find yourself getting hungry. Like throat cut hungry the first few times. As you adjust that will pass.

Once your used to being in the 4's on a regular basis. Higher numbers will feel wierd.

I have unless you consider levels well under three as normal.
You cannot say definitively that it is not possible to hypo in such circumstances though unlikely it is best to be aware of the possibility and take precautions.

 

[DCUKMod]

I have unless you consider levels well under three as normal.
You cannot say definitively that it is not possible to hypo in such circumstances though unlikely it is best to be aware of the possibility and take precautions.

Whilst I agree it is tecnically possible to hypo, I think the difference is it is unlikely to be a medically concerning hypo. A cup of tea, or the like, with a bit of milk (no sugar) would just nudge up i nto the comfort zone.

That's my view anyway, but clearly does not apply to anyone with T1.

 

[JohnEGreen]

Whilst I agree it is tecnically possible to hypo, I think the difference is it is unlikely to be a medically concerning hypo. A cup of tea, or the like, with a bit of milk (no sugar) would just nudge up i nto the comfort zone.

That's my view anyway, but clearly does not apply to anyone with T1.

I beg to differ my three experiences involved unexpected contact with the floor and sharp corners of furniture coming round with family trying to get me up off the floor and once coming round in a pool of my own urine and excreta I have had blood sugar levels as low as 2.2 on occasion.

So my experience differs from yours this is why I say you cannot discount out of hand the possibility and the seriousness.

 

[DCUKMod]

I beg to differ my three experiences involved unexpected contact with the floor and sharp corners of furniture coming round with family trying to get me up off the floor and once coming round in a pool of my own urine and excreta I have had blood sugar levels as low as 2.2 on occasion.

So my experience differs from yours this is why I say you cannot discount out of hand the possibility and the seriousness.

That would account for my use of the word, "unlikely".

John, in my world, there are exceptions to every "rule" the more hard and fast; the more exceptions it seems.

 

[JohnEGreen]

@DCUKMod Point conceded it is somewhat unlikely if not on meds. I suppose my experience makes me a little paranoid and lack of sleep lately is making me a little irascible.

 

[DCUKMod]

@DCUKMod Point conceded it is somewhat unlikely if not on meds. I suppose my experience makes me a little paranoid and lack of sleep lately is making me a little irascible.

John - I totally accept that you had very unpleasant experiences (how could I not), but you do have some other conditions which also could be in the mix.

We're in another example of how we're all different, and the message, to me anyway, if when making changes, or eperiencing new things, we should be body-aware and do and go wherever we feel safest.

 

[Spl@]

I have unless you consider levels well under three as normal.
You cannot say definitively that it is not possible to hypo in such circumstances though unlikely it is best to be aware of the possibility and take precautions.

While there are exceptions to every rule as said. When I read the op I see someone after reassurance.

It may be there is a secondary issue. It's is far more likely there is not and worry especially with paranoia can be far more problematic. Especially where eating is concernd.

The lowest figure seen by the op is 4.5. In keto, with gp help (lottery win there) I think she is in really good shape.