Fasting and reactive hypoglycemia

Hi @rivamira and welcome to our forum.

Other than the diabetes tests, for example, hba1c test.
What other tests have you had to get the RH diagnosis?
I say this because, RH is directly a food intolerance condition.
And only after a series of tests to eliminate other conditions such as insulinoma or other pancreatic conditions can a true diagnosis can be reached.
There are other conditions that describe your symptoms but I would be guessing what it is.
I'm not ruling it out however, the main thing is, if you are going hypo not eating or fasting that does not correspond with what I have learned about RH.
My advice would be to monitor your blood glucose levels in a structured approach, using a food diary to log everything you have and record your pre meal and subsequent hours after. You can also fast and monitor your blood glucose levels. And write down results. This will help your doctor and endo to understand what is going on. Record your hypos, your food intake, your amount of carbs, increase your natural saturated fats. Be wary of low fat and spreads, vegetable oils, manufactured food. Dairy is okay as long as it's full fat.
You may not have high blood glucose levels but your insulin levels or your hormonal response is the cause of the lows.
Also 3.5 is classed as normal but these conditions, it can still be called a hypo depending on your symptoms.
Until you are diagnosed properly, a very low carb diet avoiding high carbs, sugars, starchy foods and testing will show which foods you are intolerant to.

If you have more questions, do ask.

Stay safe.

Thank you Lamont I have read your posts in the past. I have been hypoglycaemic for about 50 years. I have had symptoms after exercise and when fasting, skipping a meal, delaying breakfast after early dinner, or before an operation. I was diagnosed RH by an endocrinologist on the basis of a glucose tolerance test in hospital. A heart rate monitor worn for 24 hours indicated not a heart problem. It has been easy to control most of life by avoiding sugar and white flour, regular exercise, eating before exercise etc. It became much worse after a knee replacement ( fasting, stress no exercise). I did the Zoe app tests which included a 14 day CGM. The Zoe tests show very poor blood sugar and blood fat control. I’ve been following the suggested Zoe eating pattern (low glycemic, high fibre, natural saturated fats etc for four months. I record everything. Carbs usually about 80, protein 60+, fat 70g. Lost weight ( I’m not overweight, Hb1ac around 38) but hypos are shown on my libre GCM (as low as 3.1) They are very quick and I don’t usually notice symptoms. Respond to 1 dextrose tablet. I Can’t find an endocrinologist who knows about hypoglycaemia. Do you know anyone?

rivamira said:

Thank you Lamont I have read your posts in the past. I have been hypoglycaemic for about 50 years. I have had symptoms after exercise and when fasting, skipping a meal, delaying breakfast after early dinner, or before an operation. I was diagnosed RH by an endocrinologist on the basis of a glucose tolerance test in hospital. A heart rate monitor worn for 24 hours indicated not a heart problem. It has been easy to control most of life by avoiding sugar and white flour, regular exercise, eating before exercise etc. It became much worse after a knee replacement ( fasting, stress no exercise). I did the Zoe app tests which included a 14 day CGM. The Zoe tests show very poor blood sugar and blood fat control. I’ve been following the suggested Zoe eating pattern (low glycemic, high fibre, natural saturated fats etc for four months. I record everything. Carbs usually about 80, protein 60+, fat 70g. Lost weight ( I’m not overweight, Hb1ac around 38) but hypos are shown on my libre GCM (as low as 3.1) They are very quick and I don’t usually notice symptoms. Respond to 1 dextrose tablet. I Can’t find an endocrinologist who knows about hypoglycaemia. Do you know anyone?

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hi again.
Wow, fifty years! I should be getting advice from you!
Have you only had one eOGTT? How long was it? How long after the glucose did you go hypo?
Did they test your insulin levels?
Exercise if overdone causes a liver dump, glucagon you don't want!
The essential part of my RH, is that I can fast for more than four days, I intermittent fast overnight till mid afternoon and my window is about four hours, so I know that going to bed, I'm not going hypo.
Fasting does not cause hypos for me.
Using the knowledge I have gleaned from my experience, my endocrinologist, my research, my experimentation, my food diary, to find my balance of food that will not trigger the reaction.

I will not say that the result of your tests for diagnosis, is not right, but it does seem to me me like a pancreatic problem, yes, it is the insulin overproduction that causes the hypo, but reading through your food intake and going hypo either fasting or through the night, What is triggering the excess insulin?

I cannot say on the open forum, the name of my specialist endocrinologist, who I have recommended before to posters. I will use the private message system, when I get permission, because at this moment you have not posted enough posts to gain that privilege.

keep asking, I will pm you soon.

Hi, I have sent you a pm.
There is an envelope sign on the top of the page.
Let me know if you don't get it.

Best wishes

Lamont D said:

hi again.
Wow, fifty years! I should be getting advice from you!
Have you only had one eOGTT? How long was it? How long after the glucose did you go hypo?
Did they test your insulin levels?
Exercise if overdone causes a liver dump, glucagon you don't want!
The essential part of my RH, is that I can fast for more than four days, I intermittent fast overnight till mid afternoon and my window is about four hours, so I know that going to bed, I'm not going hypo.
Fasting does not cause hypos for me.
Using the knowledge I have gleaned from my experience, my endocrinologist, my research, my experimentation, my food diary, to find my balance of food that will not trigger the reaction.

I will not say that the result of your tests for diagnosis, is not right, but it does seem to me me like a pancreatic problem, yes, it is the insulin overproduction that causes the hypo, but reading through your food intake and going hypo either fasting or through the night, What is triggering the excess insulin?

I cannot say on the open forum, the name of my specialist endocrinologist, who I have recommended before to posters. I will use the private message system, when I get permission, because at this moment you have not posted enough posts to gain that privilege.

keep asking, I will pm you soon.

Click to expand...

Actually I had two but one I did myself. The GP agreed to do the glucose but only tested for two hours. I continued testing on my own and had a hypo at three hours. The consultant confirmed my graph showed hypoglycaemia. Zoe app gave me a CGM through which it was obvious that I go high after anything with refined grain or sugar. Even oats which the diabetic consultant had recommended. Last week I had a moderate high (7.8) after cough syrup. I’m ok with milk and yogurt. Small amounts of fruit at the end of a meal. Some questions on Rh Can an infection make you more likely to hypo? Last two weeks were post covid and I had about 4 brief hypos a day. I started to eat a bit more and now blood sugar has been stable all night at about 5.

rivamira said:

Actually I had two but one I did myself. The GP agreed to do the glucose but only tested for two hours. I continued testing on my own and had a hypo at three hours. The consultant confirmed my graph showed hypoglycaemia. Zoe app gave me a CGM through which it was obvious that I go high after anything with refined grain or sugar. Even oats which the diabetic consultant had recommended. Last week I had a moderate high (7.8) after cough syrup. I’m ok with milk and yogurt. Small amounts of fruit at the end of a meal. Some questions on Rh Can an infection make you more likely to hypo? Last two weeks were post covid and I had about 4 brief hypos a day. I started to eat a bit more and now blood sugar has been stable all night at about 5.

Click to expand...

That was similar to my tests, but I had my blood screened and sent to a lab, to see if I deficient in all the different aspects and the levels of all my blood. Do you follow? It was also c-peptide and GAD tests for other glycaemic and diabetic conditions.
Oats (porridge) are the reason how and why I was eventually diagnosed. I used to have porridge for my breakfast every day, with water, no sugar, no milk (lactose intolerant) and my appointment was usually in the late morning, it was found by my GP who referred me, cos she didn't understand what was going on, then on my first and subsequent appointment with my endocrinologist, I had a hypo each time and it could only be the porridge.
Yes, but not as simple as that, the infection, illness can and does raise blood glucose levels, depending on temperature and hormonal response to it, if it goes high enough, it will trigger the overshoot. Meds are usually full of sugars, to make you believe you are better, but if it raises levels, that is not recommended. I was told only paracetamol for pain, temperature and if you need other meds, that should be sugars free and in my case, no lactose, that does upset the doctors! (Ha!)
Glad you are feeling better and in control, which is so important.
Did you Google my endo?
If I remember rightly, there is a way to get in touch through email with him. And of course there is zoom calls.
I had to travel just over an hour to see him. And it was well worth it. I even got to talk about my diagnosis and tests and my dietary regime in front of junior doctors who had chosen endocrinology as their specialty.
I did it quite well, but I must admit I became nervous, I was praised by my endocrinologist for the knowledge, he then started talking science, which lost me. It was like listening to a different language with some English words.

keep asking.

Thank you. If he does zoom I’ll definitely contact him. I did Google him and looked at some of his papers. Wanted to ask you are there any YouTube videos or google links you recommend? I think I understand that probably either I make too much insulin or my cells are insulin resistant and don’t take up the glucose. I think the latter because exercise is essential for me

I am not aware of any videos of YouTube stuff or Google.
If you have been on a low carb diet for a few years, I would have thought that your insulin resistance should not be a problem.
how will I explain this. When I asked my endocrinologist about this, he stated that the reason I am so intolerant to carbs.... Is not insulin resistance but the background insulin which is needed for insulin response is not enough for a low level of carbs. That is why the glucose levels are higher and quicker in a oral glucose tolerance test. The brain tells the pancreas to get into gear and it is like a bucket of water to put out a match.

Exercise is tricky because of liver dumps if you do too much, I used t be on my feet all day without needing food, and my energy levels were great. Walking is great, swimming, light gym work. But other than that at our age is tough on our bones. The brain is willing but the body says...........!
Again it is individual, how much you tolerate before the feeling that a hypo is on its way.
Have I mentioned the rebound effect. This is when you take too much carbs or fast sugar to get your blood glucose levels up, if you are having a hypo, but what happened is the same thing that triggers the spike, the overshoot of insulin, the hypo in the first place. That just causes a rollercoaster ride of blood glucose levels all day.

Best