Diet controlled dropping during exercise

Lemonie said:

I've recently lost a fair bit of weight and have just started exercising at the gym. I am diet controlled with lchf diet (30g carbs) and am usually around the low 4's. I was 3.8 before exercise today and had a smoothie with 19g of carbs .. coconut water, coconut milk, frozen raspberries, 1/2 avocado, water. After 1hr workout was 2.9. I felt fine but that seems low to me. Last time I was that low was after a vodka incident (blush) and my nails went blue! Any advice on what to eat when gratefully received.

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Eat some carbs before you exercise. 2.9 is too low.

Is this the only time it has happened?
Do you know if you are consistently in ketosis?

For me, in ketosis, hypos feel very different. I am still aware of them, but they feel very different.

Also, with a low reading like that, maybe test again? Could have been a rogue reading, or a rogue strip.

I appreciate that my situation (reactive hypoglycaemia) is probably very different from yours, but for me, taking 19g of fast acting carbs before rapidly burning them off would be more likely to provoke a hypo than if I ate a decent low carb meal of fat, protein and veg 3 hours before the workout. The meal would give me a lovely long, slow reliable burn, and my bg would drop a bit, then run steady for the workout - in ketosis, using fat and maybe protein as fuel.

Mind you, the type of exercise will also be a factor.

Lemonie said:

I've recently lost a fair bit of weight and have just started exercising at the gym. I am diet controlled with lchf diet (30g carbs) and am usually around the low 4's. I was 3.8 before exercise today and had a smoothie with 19g of carbs .. coconut water, coconut milk, frozen raspberries, 1/2 avocado, water. After 1hr workout was 2.9. I felt fine but that seems low to me. Last time I was that low was after a vodka incident (blush) and my nails went blue! Any advice on what to eat when gratefully received.

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That is a low reading, but then if you are in ketosis blood glucose levels can be lower than what you might normally expect. The fact that you are diet and exercise controlled, there isn't any obvious prescription related cause, so I would mention it to your doctor just in case. @Brunneria is right to suggest that it could also be a false reading.
Sounds as though you're doing an amazing job at managing the condition, but you might want to consider upping your carb intake a little once you start exercising regularly. (Unless you have other reasons for staying super low carb)

If you aren't getting hypo symptoms, then I don't think levels even this low would be an issue for a Type 2 not on medication. There seems to be evidence that ketosis is protective against hypos. If your body is working the way it should, your liver will dump glucose if it feels you need it. It would be a really interesting exercise to track your levels with a Libre to see how low you go before that happens.

Sounds like you're doing a wonderful job of controlling your diabetes

Have you considered asking your Doctor for an oral glucose tolerance test, your figures and response are so good.

Exercise is very good at reducing insulin resistance - which means that when you exercise enough to trigger that effect, the insulin you have floating about (everyone has background insulin all the time, not just T1s, it is just that the non-T1s generate it themselves) is actually working, like it is supposed to work - so the glucose in your blood finds it easier to get into the cells.

I find that enough exercise, of the right type will effectively drop my bg by at least 1mmol/l, often more. It all depends on how high my insulin resistance was before I started exercise.

When we were on holiday, I would start one of our long, strenuous dog walks at around 5.5mmol, and within half an hour it would have dropped to 4.0mmol. It would stay there for the next few hours I was walking. Steady as a rock, and for a few hours after. No sign of a hypo - no danger of a hypo. Felt great, actually.

Then it would slowly drift back upwards as the day continued. Especially if I ate carbs.

Now, I have a LOT of insulin resistance. The only things that break down IR for me are exercise and prolonged fasting. Since you have lost weight, maybe you have lowered your IR? Plus the effect of exercising may be reducing your IR further, to hitherto unexperienced levels.

But are you feeling bad? Are you actually hypoing if you don't eat those carbs? I don't mean assuming it is a hypo according to your meter and deciding to eat carbs to bring it back up, I mean actually feeling grotty and having a hypo experience? Because if your body is exercising its way to a healthy, normal, non-IR blood glucose level, then that could easily be in the 3s. There are a lot of non-diabetics out there, without insulin resistance, who spend a lot of their time in the 3s. And if you are keto adapted (running dual fuel on fat as well as glucose), then blood glucose in the 3s doesn't necessarily mean you are in trouble. It may just mean that you switch to ketones for muscles and brain, and function perfectly OK.

And if your body, minus insulin resistance, likes to be in the 3s and 4s, when active, and you are feeding it carbs to force the blood glucose back up, then you are also forcing your insulin resistance back up too...

Please note: I am NOT suggesting that you push the boundaries of this, and try to force a hypo, or to see how low you can go, or anything. I am just suggesting that maybe, just maybe, when your body is functioning without insulin resistance, it chooses to run in the 3s, efficiently tucking that glucose into the cells like it is supposed to, and not leaving it in the blood, like happens with a diabetic.

Hope that helps.

Lemonie said:

I've recently lost a fair bit of weight and have just started exercising at the gym. I am diet controlled with lchf diet (30g carbs) and am usually around the low 4's. I was 3.8 before exercise today and had a smoothie with 19g of carbs .. coconut water, coconut milk, frozen raspberries, 1/2 avocado, water. After 1hr workout was 2.9. I felt fine but that seems low to me. Last time I was that low was after a vodka incident (blush) and my nails went blue! Any advice on what to eat when gratefully received.

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Did you retest the 2.9?

Personally, I have never knowingly had a hypo affecting my physical or mental acuity, although I have had exceptionally low scores. I have never taken any medication.

Often when I'm very low, I'm either asleep or hungry, so if I'm hungry, I'll have something to eat. I have something to eat, but that will usually be my meal and certainly not glucose tablets, biscuits, jelly babies or Lucozade.

If you have a pretty low number you feel a bit uncomfortable or disturbed by, please do retest. All sorts can affect the results, including perspiration on your hands. If you felt unwell, then best to have a little something to eat.

Lemonie said:

Thanks Brunneria. that makes a lot of sense. I had/have IR as when I was on insulin I was on stupid doses. I don't feel any different when I am low. When I have felt hypo before I get the shakes and feel light headed and sweaty. I'm going to try exercising fasted see if that makes a difference to how my bg reacts. My gym is nice and quiet so can take my testing kit with me. Don't test very often now but will start again with this. Might stick a glucose tab in my pocket just in case

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Sounds like an excellent plan - but DO have that glucose tab handy, just in case.
I really don't want to sound like I am encouraging you to dive into hypo-land! lol.

Edited to add:
I might be wary of exercising fasted, just because of my experiences. Yours may be different.
But I would totally suggest exercising several hours after a decent meal (meat and veg with butter on the veg, say), because that is going to be slow release, with maybe some gluconeogenesis going on, to drip feed your bg. Hope that makes sense.