EIH Issues

SoKal · Jul 18, 2024

Exercise induced hypoglycemia. I have been on a very low carb diet for 10 mo keto before that, I have lost pounds and inches. Been Cycling for many years and enjoyed the benefits from being fat adapted no need for carbs before or during a 4-5 hour ride. As I get stronger and faster I have a new problem if I go hard from the start of a club ride my BG drops from 7.2 to 5.0 in the first 30 min if I don't back off it will drop to 3.2. If I go easy like zone 2 for the first 1 hour I have not noticed the sudden drop for the rest of a 4 hour ride. This has happened 6 hour fasted or 1 hour after zero carb meal. 30 years T2 was on insulin have stopped all meds 10 mo ago the easy answer is to have a gel shot and ride on, not part of my plan to put diabetes in full remission. I'm 62yo male BMI 23.2 .

So is this something to work through like keto flu or is there some other new aliment I have now. Anyone else have similar issues let me know

Lamont D · Jul 18, 2024

Hi @SoKal

SoKal said:
Exercise induced hypoglycemia. I have been on a very low carb diet for 10 mo keto before that, I have lost pounds and inches. Been Cycling for many years and enjoyed the benefits from being fat adapted no need for carbs before or during a 4-5 hour ride. As I get stronger and faster I have a new problem if I go hard from the start of a club ride my BG drops from 7.2 to 5.0 in the first 30 min if I don't back off it will drop to 3.2. If I go easy like zone 2 for the first 1 hour I have not noticed the sudden drop for the rest of a 4 hour ride. This has happened 6 hour fasted or 1 hour after zero carb meal. 30 years T2 was on insulin have stopped all meds 10 mo ago the easy answer is to have a gel shot and ride on, not part of my plan to put diabetes in full remission. I'm 62yo male BMI 23.2 .

So is this something to work through like keto flu or is there some other new aliment I have now. Anyone else have similar issues let me know

I have never known it as EIH. But it does summarise something that does happen to me if I do any kind of strenuous exercise.
And it is possible for others with metabolic conditions such as T2 to have the similar symptoms, as in false hypos or actual hypos. Some don't feel it, others do. Some feel dreadful even having carbs before or fasting.

What happens to me, if I eat as a non diabetic, I am, but you get it, is my brain tells my liver to give me a liver dump, glucogenisis. That response triggers my pancreas to respond, and it overproduces insulin.
And my liver doesn't respond enough to stop me going hypo.

Over exercising, can be an issue that could be, is just showing up.
As with all those of metabolic conditions, it is individual and I do believe that you are sensible enough to not overdo it too much. Learn from it, and implement a new strategy for your exercise.

If you have repeat episodes of hypoglycaemia for any reason you must get the tests to discover what is causing it.

Best wishes..

Melgar · Jul 19, 2024

@SoKal I‘m a bit of an exercise junkie. I really enjoy pushing my body and getting into that zone. Up until a few years ago I was a competitive long distance runner. I don’t run long distances anymore, in fact I don’t run, but I do exercise. I do strenuous mountain hikes pushing my heart rate up.
During these strenuous hikes I can easily use up all my liver’s glycogen stores and go very low. It doesn't have to be immediate it can happen an hour or so later. Now I’m not on a keto diet, nor am I on a very low diet. I carry fast acting sugar with me, in case I should go low. So Diminished glycogen stores is one reason.

Another reason May be down to the release of Pyruvate. Pyruvic acid is produced at the end of the glycolysis process. In short pyruvate is the product of the metabolization of glucose .
When you push hard the demands on your metabolic system increases dramatically, but you likely know that being a club cyclist. In an anaerobic state your body needs a lot of energy fast. While in this anaerobic state your body produces pyruvate this is then converted to lactate. As you are anaerobic, that is you are not getting enough oxygen , your body will then use this lactic acid as energy. Lactate can be used for energy without the need for oxygen.

Now some people, with a particular genetic variant, will respond to the release of pyruvate with insulin. Their bodies start secreting insulin in response to pyruvate. At some point your blood sugar will drop and you will become hypoglycaemic.
There may be other reasons , but these are two of them.

I’m not suggesting you have either of these, simply these are two reasons for EIHI- Exercise-Induced hyperinsulinism.
Sorry it’s a bit wordy.

SoKal · Jul 19, 2024

Melgar said:
@SoKal I‘m a bit of an exercise junkie. I really enjoy pushing my body and getting into that zone. Up until a few years ago I was a competitive long distance runner. I don’t run long distances anymore, in fact I don’t run, but I do exercise. I do strenuous mountain hikes pushing my heart rate up.
During these strenuous hikes I can easily use up all my liver’s glycogen stores and go very low. It doesn't have to be immediate it can happen an hour or so later. Now I’m not on a keto diet, nor am I on a very low diet. I carry fast acting sugar with me, in case I should go low. So Diminished glycogen stores is one reason.

Another reason May be down to the release of Pyruvate. Pyruvic acid is produced at the end of the glycolysis process. In short pyruvate is the product of the metabolization of glucose .
When you push hard the demands on your metabolic system increases dramatically, but you likely know that being a club cyclist. In an anaerobic state your body needs a lot of energy fast. While in this anaerobic state your body produces pyruvate this is then converted to lactate. As you are anaerobic, that is you are not getting enough oxygen , your body will then use this lactic acid as energy. Lactate can be used for energy without the need for oxygen.

Now some people, with a particular genetic variant, will respond to the release of pyruvate with insulin. Their bodies start secreting insulin in response to pyruvate. At some point your blood sugar will drop and you will become hypoglycaemic.
There may be other reasons , but these are two of them.

I’m not suggesting you have either of these, simply these are two reasons for EIHI- Exercise-Induced hyperinsulinism.
Sorry it’s a bit wordy.

Thank You, I had started to look into the glycogen stores issue. I have not heard of Pyruvate acid, more things to look into.

EIH Issues

SoKal

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Lamont D

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Melgar

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SoKal

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EIH Issues

SoKal

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Lamont D

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Melgar

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SoKal

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