Diabetes type 2/reactive hypoglycemia

Pegging @Lamont D ...

Our resident RH expert - any more details you would feel comfortable sharing? it does sound very unusual.

Bumble1510 said:

Hi Pegging thank you for your reply.

Well this morning when I woke up at 7am my BM was 4.1 I ate breakfast. Which was 40gm of shreddies. I rechecked my BM at 7.45am and it was 7.9. I have to check my BM and eat every 2 hours. I rechecked my BM at 9am and it was 4.8.
I am taking Acarbose for the reactive hypoglycaemia. This has seemed to of stopped me from crashing into the 1's and 2's I have more good days than bad days these days. I also take metformin to stop my sugars from spiking too quickly as I can go up to 13's and the next hour I'll be back down to 4.1
I was diagnosed 5 years ago after having a glucose tolerance test. On the 2nd hour my bm's had risen. The bm an hour later had risen again to 10.6. Half hour later they were 3.6. Within 20 mins they were 2.2

My endocrinologist says it's my pancreas miss-firing as my c-peptide came back as borderline insulinoma. Because of this I was scanned. The results showed no insulinoma.

Click to expand...

@Bumble1510 - has anyone every explained to you why your numbers crash so quickly, and what lifestyle changes you might be able to make to make your life a bit more comfortable?

From what I have read and observed, whilst the Acarbose can be helpful, the most powerful too in your personal toolbox is managing what you eat and when.

Are you under instruction to have snacks regularly?

Ok - I don't think I should say another word - we need someone with experience of RH to comment.

Bumble1510 said:

I have a very strict diet of 30gm of carbs, 4 gms sugar for main meals and 10-15gms of carbs for my 2 hourly snacks. I exercise, but only walking my dog for 20 mins. I also have Epilepsy. My endocrinologist says that my pancreas is releasing insulin whenever, it wants to and not when it needs to. He also said that in the end it will stop firing and I will need insulin injections. However, he is trying to slow that process down as it can cause complications.

Click to expand...

What does that add up to in an average day, @Bumble1510 ?

Bumble1510 said:

Roughly I have 120grams of carbs. I'm very sensitive to carbs and glucose. My body tries to reject them.

Click to expand...

For someone with RH, that might still be too many, but I don't know the meds you're on. @Chris24Main has a point, as our resident RH expert can fill you in on all sorts, and in great detail, but to keep it simple for now... The clue is in the name: *Reactive* hypoglycemia. Your pancreas overreacts to carbs. You spike, it releases too much insulin, you hypo, you take more carbs, spike again, more insulin, hello, hypo. It's a vicious circle. So... Take out the thing your body freaks out to, is the simple answer, more often than not... Now you're just going from spike to low to spike to low. If you eliminate the spikes, there are no more lows. Should get your T2 sorted as well, if at all possible. (I can't get away with 120 grams of carbs as a T2... I'm more at around 20 to 30 grams of carbs a day, total.).

Also, type 2 diabetes is a problem of becoming insensitive to your own insulin, because there's so much going around, it doesn't work adequately anymore. It's not entirely uncommon/illogical for RH to precede T2, as both are a mater of too much of a good thing.

Personally, I'd say try a ketogenic diet, (20 grams a day or thereabouts), but I have absolutely NO IDEA whether that is a possiblity with the medication you're on, and your doc would likely have me shot for saying so. But maybe just dial down the carbs a little, gradually, carefully...? Preferably while wearing a CGM to see what goes on? Might be an idea. It would be a way to find out what works for you and give you some answers. Also, when I was just diagnosed I was eating every three hours on the mark, and that got old, really fast, because three hours is nothing. Snacking and main meals even more often? You're eating all the time! Must interrupt your day-to-day life horribly, I know mine was a wreck on less.

Anyway... It's something to mull over until @Lamont D gets on here with more specifics on what happens in your metabolism.

Hang in there. It can get better.
Jo

Bumble1510 said:

Thank you. I have to be careful with my Epilepsy as well. I've had seizures that have caused MI's in the past.

My blood sugars are much better than they were as they were crashing down into the 1's and 2's now I occasionally crash into the 3's

I tried a Libre 2 for a few months under my endocrinologists say so as you're not allowed them for type 2 in uk. However, my consultant said that it wasn't catching my blood sugars quick enough. Which is why I was ending up going far too low most of the time.

Click to expand...

The keto diet (20gr carb a day, or lower) is a treatment for epilepsy - especially drug resistant epilepsy.
For many living with T2, 120gr a day could be a bit much. In RH the hypo is a reaction to elevated blood sugars, so keep the blood sugar in a lower place, there's less chance of the reactive hypo.

I think of it a bit like throwing a tennis ball up gently, towards the ceiling. Generally, you can develop a routine where you catch the ball on the way down. In RH, the blood sugar shoots up (like the ball going towards the ceiling) with a bit more gusto. When it hits the ceiling it tends to come down quickly - being much harder to catch. The secret is to find a way to smooth out the highs and lows. For many that means modifying the way they eat and drink.

If you want to try reducing your carbs further, please do so steadily, rather in large jumps.

I have reactive hypoglycaemia and borderline T2.
I do not have epilepsy.

I was diagnosed over a decade ago, nearly 13 years now.
Firstly the reason why you have T2, is probably the amount of time you have eaten carbs.
As you say, carbs don't like you. They certainly don't like me.
I have talked to a lot of doctors and describe RH as carb intolerant.
I also have an intolerance to most sugars or anything ending in ose, such as lactose, not had dairy, since discovered young. The rest followed in late forties to fifties.

I can go through the science with you, as it does tell the story of how your system reacts to those foods.
A question?
How can a doctor ask you to eat carbs, when the doctor knows how it can impact on your day?
Eating spuds is starch which is high in carbs...... It doesn't make sense.

My endocrinologist stopped my taking of metformin. Because of the effect it has on by BG levels if going into hypoglycaemia. It can prevent the natural action of glucogenisis, which is vital when going low.
Other meds, diabetic meds such as acerbose, are to slow down carb digestion. But if you don't eat regularly through the day, once you stop, you still go hypo. ***?

Another question? If you don't mind....
If you were told that carbs were an allergy, similar to a nut allergy, your doctor would advise what?
Having an intolerance, is not as clinically bad, but going hypoglycaemic is also dangerous, isn't it?
You could be really ill, with a very low hypo, and you have described that.

Others above have given good advice about how food will help with the RH and the T2. The body responds to food producing a spike, that the pancreas responds with more insulin, in fact it floods the blood, it anything like mine does. It is called an overshoot. This is why you go hyp.
The high abnormal spike, triggers the overshoot, you go hypo.
So logically think, that no carbs means no spike, no spike, no trigger, no overshoot, no hypo.
It's not easy, in fact it's bloody horrible!
But because there is no cure, no magic pil , no course of treatments. Just dietary control.
This is what I do.
I have a balanced diet of protein, good saturated fats, good low carb vegetables and and I assure you, this is what you need.
I don't eat carbs.
I use fasting and intermittent fasting.
My body actually, prefers me not to eat, but you do for the nutrition.
I feel better without food, my brain is better fasting.
I have really good energy levels.
It is the carbs and sugars that make me ill.

Finally, I get the rarity of RH, and having RH with T2. But the majority of doctors don't understand why it happens.
They just don't understand the science of it all.
I was very lucky to get my endocrinologist and having had the diagnostic tests to get a true diagnosis, we went on to understand the science behind it.

Keep asking, I have had to spend time away from the frum. But I will catch up.
Do have a read of the RH sub forum, lots of information there.

Best wishes.

Bumble1510 said:

Hi Lamont
Thank you for your very informative reply. I've got an appointment with my endocrinologist in about a weeks time. I am also better at fasting than I am once I've eaten. I've found that if I don't have my regular 2 hourly snacks my glucose levels still drop. Since I've had this problem, before any meds I don't seem to have any kick back to get my blood sugars up when they go low. The only thing that seems to get them back up again is slow release carbs.
As you have already said in your reply. The doctors don't know enough about this. I will take a look on the RH forum.
Thank you

Click to expand...

If you don't have your snack, what numbers do you see?