Does a normal HBA1C result rule out Reactive Hypo?

[PraxxtorCruel]

I've been trying to get a referral to Endocrinology but since I've been tested twice for HBA1C test, several months apart my GP basically has reassured me it's not a blood sugar issue. My symptoms always come on with food but are nonexistent when I fast for 12+ hours.

Regular meal symptoms:

Sweating
Anxiety/Nervousness
Palpitations
Blurred vision
Fatigue/Weakness
Sleep problems
Poor concentration
Extreme hunger shortly after eating
Muscle twitches
Cold extremities
Desire to sleep after meals
Pale face

I've tried low carb / keto dieting and noticed reduction in adrenergic symptoms but am left feeling lethargic mentally and physically(still desire to lay down after meals), lack of concentration and continued ravenous hunger, plus feeling overly warm and struggling to fall off to sleep or stay asleep(waking up sweating and feeling full of energy) for more than 3 hours. So ideally I'd want to get a mixed meal tolerance test to see how my body responds to food.

 

[JoKalsbeek]

I've been trying to get a referral to Endocrinology but since I've been tested twice for HBA1C test, several months apart my GP basically has reassured me it's not a blood sugar issue. My symptoms always come on with food but are nonexistent when I fast for 12+ hours.

Regular meal symptoms:

Sweating
Anxiety/Nervousness
Palpitations
Blurred vision
Fatigue/Weakness
Sleep problems
Poor concentration
Extreme hunger shortly after eating
Muscle twitches
Cold extremities
Desire to sleep after meals
Pale face

I've tried low carb / keto dieting and noticed reduction in adrenergic symptoms but am left feeling lethargic mentally and physically(still desire to lay down after meals), lack of concentration and continued ravenous hunger, plus feeling overly warm and struggling to fall off to sleep or stay asleep(waking up sweating and feeling full of energy) for more than 3 hours. So ideally I'd want to get a mixed meal tolerance test to see how my body responds to food.

A HbA1c can't rule RH in or out, an *Extended* Oral Glucose Tolerance Test would, which, alas, most GP's don't know about because RH isn't on their radar either, as it's relatively rare. For now, if you think this is blood-sugar related, just get yourself a meter and see what your blood sugars are doing when you feel like this. Having those results might make a doc more willing to order tests they might not have previously heard of, but only if you actually do go hypo... You feel off, but without the test numbers to back it up, and maybe additional blood tests for thyroid issues and the like (I mean, a full MOT might be a good idea, as a lot of what you mention could come from dozens of other causes, like hypothyroidism, which is relatively easy fixed with a supplementation of hormones), there's no way to tell what causes them. Get a good once-over, test what you can test yourself if you feel you need something to back you up, and go from there.

As for keto making you feel lethargic, I don't know how long you tried it, but that's a common symptom of carb-flu... Lasts for about two weeks, then your body should find a new equilibrium and the feeling-blech should go. Some people don't give it that long, some need to give it a bit longer. And if you're constantly hungry you might want to look at whether you're replacing the carbs with enough protein and fats to fill you up. Lettuce is keto, but it doesn't quell hunger like a sausage or strips of bacon can.

So, it's all still up in the air and you do need a doc to go over all this with. Bring that list of symptoms, and if you can, a list of blood sugar measurements, which should help your GP along when deciding what sort of help you need.

Good luck!
Jo

 

[searley]

No, a hba1c is only a glimpse of control over the last 3 months or so.. the time period of a single high or low would have no effect.. even multiple occurrences would have a small effect that it would probably appear all ok

I would think this is something you could get an idea about your self with a glucose monitor then discuss the results with your GP if you find you are actually hypo. Something like the libre would give an accurate picture over 10 days

 

[Lamont D]

I've been trying to get a referral to Endocrinology but since I've been tested twice for HBA1C test, several months apart my GP basically has reassured me it's not a blood sugar issue. My symptoms always come on with food but are nonexistent when I fast for 12+ hours.

Regular meal symptoms:

Sweating
Anxiety/Nervousness
Palpitations
Blurred vision
Fatigue/Weakness
Sleep problems
Poor concentration
Extreme hunger shortly after eating
Muscle twitches
Cold extremities
Desire to sleep after meals
Pale face

I've tried low carb / keto dieting and noticed reduction in adrenergic symptoms but am left feeling lethargic mentally and physically(still desire to lay down after meals), lack of concentration and continued ravenous hunger, plus feeling overly warm and struggling to fall off to sleep or stay asleep(waking up sweating and feeling full of energy) for more than 3 hours. So ideally I'd want to get a mixed meal tolerance test to see how my body responds to food.

Do you get a headache behind the eyes or low on your temple as your eyes blur?
Because that is very similar line up of symptoms that I have had before diagnosis and when I have fell off the wagon........
However, that may not be the whole story, as there are symptoms you may not be aware about.
And again it could be one of those nasty hormonal imbalances.
But it could be RH.
And I agree you need an endocrinologist, because, you need the tests.
Hba1c with RH, should be normal. But then again just to complicate things, If your hba1c levels are in diabetic range, then either prediabetic, T2 and RH or a form of hypoglycaemia could be happening.
But we don't know, and we would struggle to help or advise.

Could you go private?
Could you annoy your GP enough to get a referral?
Are you in the U.K.?

In the meantime, as has already been suggested, a CGM would indeed help with tracking your BG levels.
A food diary is always a good idea, a resource to produce to your doctor.
With a lot of detail.

In the meantime (again) reduce your carbs, your sugars, and be careful with food.
If it is hypoglycaemia, (a few types) then there are many reasons for only eating fresh food.
Low carb does not work straight away, it is a gradual process as your body has to adjust to the reduction of carbs.
If you can fast, do the symptoms relapse and you feel better?

A extended oral glucose tolerance test (5 hours (ish)) is the best method for someone without T1, to see the hypo develop.
A mixed meal test is useful but can be distorted by other conditions or hormonal imbalance.
The tests which follow are those to eliminate other conditions, rather than a definite diagnosis.
But you need the referral.
And I would presume, a more involved blood test, which would include c-peptide, GAD. And other checks.

Hope this helps. Keep asking. Keep battling for that referral.
Best wishes.

 

[Giraffe 95]

I have a normal HBA1C and diagnosed with reactive hypoglycaemia. A CGM will show it best, my blood sugar is rarely flat, constant up and down, unless fasting. While when my partner wore a CGM it was often a nice stable horizontal line.
I also have not been able to go keto/ very low carb, I feel awful and have no energy. I think there is a lot more to this condition.
Biggest struggle is physical activity. I eat much lower carb than I used to, and try to have a good balance of fats and protein with some carbs. Triggers are apples, bananas, pasta, alcohol

 

[Catkysydney]

I've been trying to get a referral to Endocrinology but since I've been tested twice for HBA1C test, several months apart my GP basically has reassured me it's not a blood sugar issue. My symptoms always come on with food but are nonexistent when I fast for 12+ hours.

Regular meal symptoms:

Sweating
Anxiety/Nervousness
Palpitations
Blurred vision
Fatigue/Weakness
Sleep problems
Poor concentration
Extreme hunger shortly after eating
Muscle twitches
Cold extremities
Desire to sleep after meals
Pale face

I've tried low carb / keto dieting and noticed reduction in adrenergic symptoms but am left feeling lethargic mentally and physically(still desire to lay down after meals), lack of concentration and continued ravenous hunger, plus feeling overly warm and struggling to fall off to sleep or stay asleep(waking up sweating and feeling full of energy) for more than 3 hours. So ideally I'd want to get a mixed meal tolerance test to see how my body responds to food.

HbA1c is showing the average blood glucose level for last 3 months.. so we cannot tell whether we have reactive hypoglycemia or not. Please ask your doctor to do Oral Glucose Tolerance Teat with insulin level. This can show you that you have reactive hypoglycemia .
But in my case , my doctor completely ignored my hypo and diagnosed me with type 2 diabetes.. for hypo doctors are not so helpful .. this is sad.. ( I have a new doctor now )

 

[Lamont D]

I have a normal HBA1C and diagnosed with reactive hypoglycaemia. A CGM will show it best, my blood sugar is rarely flat, constant up and down, unless fasting. While when my partner wore a CGM it was often a nice stable horizontal line.
I also have not been able to go keto/ very low carb, I feel awful and have no energy. I think there is a lot more to this condition.
Biggest struggle is physical activity. I eat much lower carb than I used to, and try to have a good balance of fats and protein with some carbs. Triggers are apples, bananas, pasta, alcohol

I have small apples, but stay away from pasta and alcohol, if it is RH, that is why you can't get control of your BG levels. Bananas should be a big no, unless you know they won't effect you. This is why you have no energy, it's the carbs!
When you don't put glucose from food that triggers your reaction, (fasting) you are fine and don't get the symptoms as such.
You might have a condition that your digestive system does not like high glucose levels (spikes).
That you are intolerant to those foods that triggers the symptoms, just like my lactose intolerance and with RH, it is all those like glucose, lactose, sucrose, fructose, starch that you are intolerant to.

Until you know, for sure, you do need in the short term to avoid, and fasting will help.
It will take time, but the longer you are in normal levels, the symptoms will decrease..

I do hope that, you will try to lower your carbs enough to get control.
Best wishes.