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Few clarification on RH management

Discussion in 'Reactive Hypoglycemia' started by jebin, Jun 21, 2020.

  1. jebin

    jebin · Member

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    I have been identified with Reactive hypoglycemia for last 1.5 years. I have consulted many doctors, but most of them didn't really understood the issue.
    Only one doctor has told that ,my issue could be RH. Most of the doctors will not identify this problem and they don't have a correct method to manage this
    I have been watching this forum for a while and I could see that, this forum and members have more information about RH and its management

    I will give details about my conditions,

    This is my usual BGL readings
    Fasting : 4.8-5.2
    Normal food including carb,fat and protein
    1 hour : Around 8.3
    2 hour : 4.9-5.1
    3 hour : 4.2-4.6

    Somedays, the BGL will be as below
    Fasting : 4.8-5.2
    Normal food including carb,fat and protein
    1 hour : Around 8.3
    2 hour : 3.9-4.4
    3 hour : 2.8-3.9 (too low)
    The lowest till now is 2.8. This happened very recently

    I have undergone 3 hour Glucose tolerance test
    In 3rd hour, BGL was 3.7

    I have undergone 5 hour Mixed meal tolerance test
    In 3rd hour, BGL was 4 . After that, the BGL increased and in 5th hour , BGL was 4.6
    During 5 hour Mixed meal tolerance test and 3 hour GTT , my insulin level was double than the normal value in each hour.
    Also, by 5th hour, the insulin was still available in blood than normal value. As per doctors, by 5th hour, insulin level should be less than 10 units

    I also undergone 72 hour fasting test to check insulinoma. It came normal. During 72 hour fasting, the low BGL recorded was 3.1.The doctor told that, I have more insulin produced and its impacting BGL to low. They advised to take more proteins and fat along with complex carbs and take food in 3 hour intervals.

    Along with this issue, I have mild gastritis and taking Omeprazole for this. Also I am taking Blood pressure medicine to control slight high BP.
    My RH symptoms mainly include, feeling hungry by 2-3 hour after food. Then, sometime feel slightly shivering and slightly sweat. Also fee too tired by that time

    I would like to clarify few things

    Members in this forum has more knowledge about RH.
    I usually have same kind of breakfast, but somedays BGL stays fine at 3 hour, some other days its going too low. I wonder, why this BGL behave like this.
    Based on the information I provided above, did my case can be confirmed as RH ?
    Also, people with RH will have BGL 2.8 , 3 hours after normal carb+fat+protien food ?

    If its RH , I believe , KETO diet is mostly recommended diet to manage this. I am planning to start KETO. Before that, I would like to collect few information
    Is it possible to have KETO through out the life ? I am asking this because, KETO will reduce the body weight. If the body weight go beyond too much, will that be a problem?

    Next thing is, in KETO we are avoiding many foods. So, do we get all micro nutrients required ?

    RH is happening because of overshoot of insulin. We know that, carb is the primary cause of spike in Insulin. But, I heard that, insulin is produced in lesser volume
    when we consume protein. So, while in KETO, we are totally avoiding carb. So,we are not providing any glucose to the blood and BGL is maintained in blood by extracting
    glucose from the body fat. As I said above, the proteins will also result in lesser amount of insulin in blood. So, does that insulin(produced by proteins intake) will reduce the BGL to low(keep in mind that
    ,we are not providing any glucose from the food)

    Please check and provide your comments
     
  2. JoKalsbeek

    JoKalsbeek Type 2 (in remission!) · Well-Known Member

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    Keto would prevent spikes in blood sugars and resultant spikes in insulin. I'm a little surprised you were advised to eat complex carbs as a carb is a carb is a carb, but hey... Keto is, however, not 100% carb-free. (a carnivore diet would be, but no need to go that far. Unless you want to, of course.) It's 20 grams of carbs or less, and that should be good enough to prevent spikes in blood glucose and keep an overzealous pancreas from dumping too much insulin.

    Being in ketosis would usually result in weight loss, but if you think it is going too far, just start eating 3 meals a day and snack 3 times a day. (Don't go for intermittent fasting). All meals and snacks should be low carb though, but the protein and fats should keep your weight up to par. With cutting carbs, upping fats and keeping protein moderate, you'll still get all the macro- and micro nutrients you need. Keto is a sustainable diet (not a crash diet), so yeah... You could keep this up for decades. https://josekalsbeek.blogspot.com/2019/11/the-nutritional-thingy.html <-- this might help a little.

    Good luck!
    Jo
     
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  3. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    Hi @jebin
    Welcome to our forum.
    First, doctors unless they have experience with Hypoglycaemia, then it will be a condition which they have had no training, and because of this, they are following ancient dietary advice for treatment as this is what most doctors who deal with hypoglycaemia would advise to stop the hypos occurring every few hours, the eat every three hours is just to stop the hypos because the majority of hypos in patients happen after three hours ish! But that is dependent on how much carbs and the patients intolerance to carbs.
    We advise a very low carb diet, because it again depends on how intolerant you a r e to certain foods within the GI range of carbs and how much protein and saturated fat you have had with that particular meal.
    Complex carbs I have found are just carbs, so I just avoid them.
    I have been in ketosis for nearly seven years now, since 2013, I have no issues and my health is good! To maintain weight you can eat a little more if you wish but it has to be low carb.
    Since diagnosis, my yearly blood panel results have been very good, and as yet, no deficiency has been found to start taking supplements. But I do add salt and drink more water.
    Your test results are typical hypoglycaemic, the insulin overshoot is apparent and the excess insulin is certainly the cause of your symptoms and diagnosis.
    Your diet is a normal diet for a normal person without Hypoglycaemia, however, you have not got a normal dietary reaction to certain foods, your initial insulin response is not enough to counter the glucose derived, the trigger for the overshoot. It is not normal for a normal person to get an overshoot of insulin. It is rare and is the root of hypoglycaemia. This is why, we have to stop the rollercoaster ride of fluctuating blood glucose levels, no hyper from carbs, no trigger, no overshoot, no hypo!
    RH is food related, so our dietary restrictions are our treatment, there is no cure, no magic medicine, food causes it, not eating those foods is the treatment.
    Check your medication for your BP and reflux because it may contain too much sugar or lactose, are you lactose intolerant like me?
    If I may make a suggestion. A lot of people with RH, can track their symptoms from when like you have acid reflux, hiatus hernia and mainly a bacterial infection called heliocobacter pylori, which has similar symptoms as you have described. A test can be done by your GP and a course of antibiotics can make your health improve dramatically.
    I have had this discussion many times with doctors and my specialist endocrinologist, the reasoning behind this approach of having enough glucose derived from carbs is to guarantee brain function, most doctors are taught because modern dietary advice is we must have carbs as a vital part of dietary intake. Most doctors say we can't live without enough carbs.
    So after going through my 80 hours (ish) fasting test and then starting very low carb (going into ketosis) my brain function and other brain symptoms such as memory, brain fog, and so on including severe anxiety, it all cleared away, all the other symptoms diminished and my health improved so much over the next month, that no one could believe it was possible! From such a really poor health condition, I began to feel really fit and healthy, enough to hold down a busy full time job that is really not for someone I was seven to ten years ago.
    I have no doubt that ketosis is the only treatment possible with RH, if you want your health back!

    Keep asking, hope this helps

    Stay safe.
     
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  4. jebin

    jebin · Member

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    Thanks all for the clarification

    Based on the experiences shared by different people in this forum, do they have their BGL dropped to 2.8 , 3 hours after food? Usually my BGL was dropped to 3.9. First time it dropped to 2,8 , which is very low and strange to me

    I have read few threads and could see that many people benefited from KETO and some people has not benefited. So, on overall, do you think more people in this forum has managed RH with KETO ?

    While in KETO, what is the usual BGL maintained ?

    Regarding acid reflux, my GP did a endoscopy and ruled out heliocobacter pylori,
     
    #4 jebin, Jun 22, 2020 at 7:57 AM
    Last edited: Jun 22, 2020
  5. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    This might muddle the understanding of RH a little!
    Depending on how much carbs, protein and fats were in that particular meal the timing will be different but as a generality, if you have a hypoglycaemic episode because of what is called' Late Reactive Hypoglycaemia', then any where between three and fours hours is usual. How low you drop into Hypoglycaemia again is the individual, what you eat and so on.
    I would say that most RH ers have benefited from a ketogenic diet, or being just above Keto levels, but I believe that once introduced to a very low carb diet, (below 20-50g. per day) most would get healthier.
    From my own personal experience, my blood glucose levels remain in normal levels most of the time, only every now and then, does it go above normal levels. The idea of a very low carb diet is to maintain normal levels as much as possible. Control is the key to a healthy future.
    Because of something like a cold, infection, or illness, your blood glucose levels will rise a couple of mmols, that is natural. Exercise can give you higher levels than you want, again you have to find your exercise regimen through trial and error.
    Too much will cause a liver dump of glucose/glucagon, which will trigger a reaction.
    Not enough will hinder your health.

    Understanding RH and keeping control is the best treatment for your health.
    Having a food diary is essential to how you progress in getting a healthy balance of protein and fats you have with the vegetables you can tolerate.
    It is a journey of discovery and getting to know your body...

    Keep asking, keep safe.
     
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  6. jebin

    jebin · Member

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    Thanks @Lamont D

    So, the below are the options I have listed to manage this condition

    1. Undergo KETO diet
    2. Use a CGM and act when BGL is going low
    3. Wait for possible novel drug RZ358 to treat non-diabetic hypoglycemia

    Yesterday I tried KETO diet for breakfast. 2 egg and a butter coffee.
    The BGL was fine. It wasn't spiking or crashing , but maintaining a normal level. The problem is, feel too much tired . Feels like , I don't have ant strength and very much weak. I continued upto 3 hours and then took my normal carb+fat+protien food. After that, I got the energy back. I have read about the KETO transition process and difficulties. But, I didn't expect this much weakness issue. I experienced the weakness while in KETO yesterday is more than that I feel while in fasting.

    is this common when we try KETO first time ? how can we overcome this hurdle ?
     
  7. JoKalsbeek

    JoKalsbeek Type 2 (in remission!) · Well-Known Member

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    Bone broth, coconut milk, electrolyte supplements, extra salt. That should help you through.
     
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  8. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    I would definitely try all three!
    Yes, you have to get through Keto flu, intermittent fasting and going very low carb without going back to carbs, because if you keep going back to carbs, it will not work and the symptoms, tiredness, fatigue, lethargy will.not go away!
    You cannot keep eating carbs if you want to stay in normal levels until you know which foods don't spike you.
    As @JoKalsbeek has suggested, take these tried and tested supplements to your food to help you.
    You have to be persistent and patient, it will take a few days. It is worth it!

    Keep asking, keep safe
     
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  9. jebin

    jebin · Member

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    @swttbsy5
    @TalTal100

    both of you recently have started KETO for managing RH. Based on your experience, can you please check with my below clarification

    Lamont and JoKalsbeek clarified these , but I welcome a clarification from both of you who recently tried KETO


    I have reactive hypoglycemia and trying to find a way to handle it
    Yesterday I tried KETO diet for breakfast. 2 egg and a butter coffee.
    The blood glucose level was fine. It wasn't spiking or crashing , but maintaining a normal level. The problem is, feel too much tired . Feels like , I don't have ant strength and very much weak. I continued upto 3 hours and then compelled to took my normal carb+fat+protien food. After that, I got the energy back.
    I have read about the KETO transition process and difficulties. But, I didn't expect this much weakness issue. I experienced the weakness while in KETO yesterday is more than that I feel while in fasting.
    is this common when we try KETO first time ? how can we overcome this hurdle ?
     
  10. Brunneria

    Brunneria Other · Moderator
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    Hi @jebin

    have a google for recommendations for dealing with ‘keto flu’.
    The usual recommendations are to keep drinking plenty of fluid and to keep electrolytes up.

    there is no great mystery that makes eating keto more different, or special, for someone with RH compared with everyone else, so the standard keto advice will work as normal.

    have you found the www.dietdoctor.com website yet? It is full of advice for going keto, and gives great information debunking and demystifying the common internet myths around keto.
     
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  11. jebin

    jebin · Member

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    Thanks @Brunneria for the explanation

    In Dec-2018, I don't have any health issue. During that period, I came to know about Keto. So, just for a try, I started KETO . During that time , transition to KETO was not difficult al all, I maintained it for a month . But in Jan-2019, I faced an eye inflammation problem, when reoccurred twice in a month. This made me stressful and I thought KETO could be reason . So I quit KETO. Then after 2-3 month, the tiredness started. When I consulted doctor, they identified it as a RH.

    During Dec-2018 , I easily got into KETO. But now I am struggling to keep KETO in starting. That's the reason I asked about the experience of people who started KETO with RH.
     
  12. jebin

    jebin · Member

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    Along with this RH issues , somedays I feel hungry and kind of weakness after 2.5 hours of food. When I check BGL at that time, its normal around 5.4. That indicates, this hunger is not because of low BGL.
    Just would like to check whether anyone has similar experience and is there any kind of explanation for this
     
  13. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    Hi again, brain function issues such as you describe are unfortunately part of the symptoms, until I had really good control of my blood levels, especially in normal levels for some time, did this type of symptom ease.
    Hunger, craving, eating when full, trolling the fridge and cupboards for easy snacks especially carbs, is your brain demanding glucose because it is so use to living with higher glucose levels and more importantly trying to prevent the hypos that follows, the balance between glucose and insulin is really important in treatment.
    This is why being in ketosis for a long time is so important, so you give your brain time to get used to normal levels again.
    As I've said many times, that my brain and body works better without food for most of the day, we have to eat, eating something that doesn't trigger the hyper/hypo reaction and intermittent fasting works.

    Testing and experimentation is your personal battle to find those intolerant foods that trigger RH.

    Keep safe and keep asking.
     
  14. jebin

    jebin · Member

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    Thanks @Lamont D
    Your explanation helps.

    I have seen in one of your post about Sitagliptin. I believe, it helped you. When I talked with Doctor, he told its not suggested because it might increase insulin. But the theory of lack of first insulin response trigger RH is supportive to use Sitagliptin. Before you start Sitagliptin, did your Doctor did testing for initial insulin response ?
    One Doctor suggested a medicine Victoza (Liraglutide) , which has similar effect of Sitagliptin. Do you have any info about this ?
     
  15. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    Yes, I went through four glucose tolerance tests to verify how the drug was beneficial in increasing the initial insulin response. I was a guinea pig for a paper my specialist endocrinologist wrote. My last eOGTT, the spike from 75g of glucose was 8.3mmols, but I still went hypo!
    The drug is an insurance in case you have too many carbs but is not a cure!
    Doing Keto and intermittent fasting is the only treatment that works for me.

    There is a video on YouTube called ' How diabetes drug helped postprandial Hypoglycaemia' ! See if you can get it up. It is an American video about five years old (ish)

    Victoza does not help in any way the science is not proved and it is used to lower glucose during ingestion but does not directly help the initial insulin response. There would still be too much glucose, which would trigger the reaction.

    Stay safe
     
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