Hb1 is normal but I have lows

Messages
1
Type of diabetes
Other
Treatment type
Diet only
Hey guys. I've been struggling with reactive hypoglycemia for about a year. I'll have multiple lows a day sometimes when I have bad days and even the smallest meal will make me low.
I have a BGM and test so I know I'm having these frequent lows and have had a CGM and it didn't show any highs.
Even though I have this evidence my doctor wont do anything because my hb1 is normal.
How can it be normal? I've checked the tests it is normal but I know I'm having lows.
Is there anything I can do apart from finding a new doctor? I've been having complex carbs and smaller more frequent meals but sometimes that isn't enough to keep me stable.
 
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Melgar

Moderator
Staff Member
Moderator
Messages
1,556
Type of diabetes
Other
Treatment type
Tablets (oral)
Hi and welcome to the forum @Justneedhelpinfo . You are in the right place for help and advice. Although I do not have RH I may be able to shed some light on your queries. RH is not diabetes. It is perfectly feasible that your blood sugars are in the normal range for the following reasons: RH is an issue with your pancreas over-reacting to carbohydrates which causes the lows. The pancreas should stop producing insulin when your blood sugars fall into the normal range, but in RH the pancreas overshoots the insulin which cause your blood sugar to drop too low. When your blood sugar falls into the low range repeatedly, the lows will bring down your overall HbA1c readings. I had an issue with low blood sugars a while back, for completely different reasons. These low sugar events dragged my overall HbA1c readings down, giving the impression my blood sugars were not as high. HbA1c tests are the standard tests used, however, the test has issues, especially if you have blood sugars that are unstable, or if you have frequent low blood sugar events.
Many members with RH choose to go low carb to manage their RH. I am not an expert on diet so I will leave dietary advice to others here. I will tag @Lamont D who may shed some more light on the successes of low carb diets and RH management.
 
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JoKalsbeek

Expert
Messages
6,590
Type of diabetes
I reversed my Type 2
Treatment type
Diet only
Hey guys. I've been struggling with reactive hypoglycemia for about a year. I'll have multiple lows a day sometimes when I have bad days and even the smallest meal will make me low.
I have a BGM and test so I know I'm having these frequent lows and have had a CGM and it didn't show any highs.
Even though I have this evidence my doctor wont do anything because my hb1 is normal.
How can it be normal? I've checked the tests it is normal but I know I'm having lows.
Is there anything I can do apart from finding a new doctor? I've been having complex carbs and smaller more frequent meals but sometimes that isn't enough to keep me stable.
In an HbA1c they're mainly looking for it being too high, which you're not. And as you're not diabetic, and RH is a very unknown condition, that's all you're going to get from your GP, I'm afraid. You'll want a referral to an endo for this one. What do you call "no high's" though... Usually RH-ers have a spike before dropping down (too) low. Mind you, I'm just a T2, so... No matter.

What you could do, is follow a very low carb diet. If your lows are a response to the carbs you eat, then the solution would be cutting the carbs. No (relative) high, no low to follow it. That's the extremely simple version. @Lamont D is likely to be more of a help in this, but just wanted you to know, you're not entirely powerless here.

Good luck!
Jo
 
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Lamont D

Oracle
Messages
17,750
Type of diabetes
Reactive hypoglycemia
Treatment type
I do not have diabetes
Hey guys. I've been struggling with reactive hypoglycemia for about a year. I'll have multiple lows a day sometimes when I have bad days and even the smallest meal will make me low.
I have a BGM and test so I know I'm having these frequent lows and have had a CGM and it didn't show any highs.
Even though I have this evidence my doctor wont do anything because my hb1 is normal.
How can it be normal? I've checked the tests it is normal but I know I'm having lows.
Is there anything I can do apart from finding a new doctor? I've been having complex carbs and smaller more frequent meals but sometimes that isn't enough to keep me stable.
Hi, @Justneedhelpinfo and welcome to our forum.
Just a couple of questions if you don't mind.

What is your last hba1c?
Do you still use your CGM?
Could it be possible for you to post one of two of the daily readings?
What is normal? Sorry, had to throw that one in. Most people are not the norm. We are individually different.
I'm weird, been told so!
If I can understand your post, you are saying that even small amounts of food don't give you a high(spike)?
And on many occasions, for no apparent reason, you actually go either lower or into hypo levels?
And even though your doctors have not got a clue, I have heard and read similar symptoms.
You do get symptoms?
Do you know if you have an intolerance or an allergy?

This is, as has been already said, needs a referral to a specialist endocrinologist in these types of rare conditions.

They have been grouped as Hypoglycaemic. Varying types of when, like me, go actually hypoglycaemic, because of something not working as it should.
Mine is intolerance and I have a reaction to carbs and sugars.
It is because of overproduction of insulin, it is in reaction to high blood glucose, after eating.

If you manage to get a referral, to prepare for the appointment, any readings from a CGM, a food diary, with as much information as you can. And a list of symptoms.
You should have a few tests to get a diagnosis.

As for food, at this stage. You are at least trying and testing experimenting and finding what does work for you.
If you are finding, then test around those meals, pre meal, an hour and two hours after. And as you get used to doing the testing, you should see, the results making sense.
And if you do go low, just a small bite to nudge you back up, do not over treat a hypo, as it may cause another reaction.

Just to warn you, there are not many endocrinologist that are aware of some of the rarer Hypoglycaemic conditions. And it may come down to just controlling what you are susceptible to, once you find out what it is.

I have read a report and posts describing a thing called flatline hypoglycaemia. I don't believe that it is reactive hypoglycaemia(RH) but even within RH there are other descriptions of having hypoglycaemia due to food. Or it could be due to vitamins, pancreatic issues, or any organs. You can never get a true diagnosis unless you get the tests.

The longer version of my condition is....... Non diabetic Late Reactive Hypoglycaemia.
So I know the frustration from ignorant doctors. I fought and battled many and even a specialist, that didn't have a clue.

Keep asking.

Best wishes.