How low should I go?

[Quartermass]

I've promised myself for months that I'll go on a strict diet, so I'm now on a strict diet eating very low amounts of carbs, and as a result my appetite is shrinking.

However I'm a little concerned about my blood glucose levels going too low. I'm at 4.3 mmol/L just now, I've been as low as 3.6 today and as high as 5.5.

My understanding is 4 is about as low as I want it to go.

The difficulty is that I find I cannot diet unless I go 'all in'. If I start to allow myself to have some things then then diet just falls apart.

How much of a risk is going below 4mmol/L? I understand that in extreme circumstances there's a possibility of a serious episode but am I right in thinking I'd need to go a lot lower than 4 to run the risk of that?

 

[urbanracer]

Hi @Quartermass ,

Looking through your previous posts - have you actually been diagnosed as a diabetic? Have you been put on medication?

 

[Quartermass]

Yes, I have T2 diabetes. I was put on Metformin initially in 2013 and , and I'm on 4x500mg of that a day, and as of 2015 I'm on 10mg of Forxiga.

Edit : A bit more information, if it's relevant. When diagnosed initially I was at 27 mmol/L. Since then if I diet strictly I can get it within target limits. However usually if I eat fairly sensibly, avoiding the worst of things to eat then it's between 8 and 13.

This diet I've put myself on is very strict and I'm on less than 10g of carbs a day.

 

[urbanracer]

So technically if you're below 4mmol then you're having a hypo. Just to clarify, are you saying that it's when you eat 30g carbs per day, that you are getting down to 3.6. ?

Forxiga removes glucose from the body through the kidneys and your urine. Why can't you eat a little bit more if you are concerned about low levels?

Did you previously try the low carb diet with Metformin alone?

 

[AndBreathe]

So technically if you're below 4mmol then you're having a hypo. Just to clarify, are you saying that it's when you eat 30g carbs per day, that you are getting down to 3.6. ?

Forxiga removes glucose from the body through the kidneys and your urine. Why can't you eat a little bit more if you are concerned about low levels?

Did you previously try the low carb diet with Metformin alone?

Urbanracer, I'm absolutely not a fan of eating up to accommodate medication. That seems counter-intuitive to me.

@Quatermass - If you are intending to stick with this way of eating, I would urge you to have a discussion with your Doc or Nurse about the level of medication you are taking, with a view to considering trimming something back a bit.

It feels to me that if you are eating in such a way that you are experiencing blood elevels you feel uncomfortable with or at, then it would make more sense to trim the medication (pushing the bloods down a bit), rather then eat more to effectively counteract the drugs you have been prescribed.

Personally, I have been fortunate enough never to have required any medication to manage my diabetes. Since fairly early on I would see plenty of blood readings in the 3s, but because I felt absolutely fine, I have never taken any action on it. If I felt rough, or were on medication known to cause hypos, I would have taken evasive action.

It is my belief that many non-diabetics spend a fair bit of time in the 3s. They just run low (as I do), but they have no idea as they don't do that bonkers thing of stabbing their fingers then harvesting the blood onto a test strip. Why would they? So, I don't get strung up on it.

Much depends on how you feel, the specific medication you are taking and any other medical conditions you might have. As I say; possibly time for a chat with your Doc or nurse.

 

[SunnyExpat]

I feel uncomfortable below 5, so that's my limit normally.
I can get into the 4's but I really don't like being there.
I doubt many 'normal' non diabetics get that low, as liver dumps keep them higher normally.

 

[Sirmione]

Zero carbing or near zero carbing is perhaps best viewed as a short term approach with LCHF as the longer term measure.
You really don't want to run normally much below the mid 4's,
I think you already know you need to eat more and see your GP to discuss your medication.

 

[Pinkorchid]

Once you get to a low level that makes you feel unwell then it is to low It varies from person to person as to how low is to low and what level your body is happiest with

 

[Brunneria]

Sounds like you need to consider (with your docs knowledge and approval) reducing your meds.

Presumably they were prescribed to you when you were on higher blood glucose readings? So they may well be excessive now.

I agree with the 'being in the 3s is normal for non Ds' idea, but getting there by way of medication isn't advisable if your diet is already doing the work for you.

Re your diet - I am a total LC fan. And I also get the 'I do best with an All or Nothing Diet' idea. Some of us just do better like that. But that doesn't mesh with excessive medication, so I would be making a doc/nurse appt and showing them my blood glucose readings. I bet they agree to less meds.

WELL DONE on the bg control though - great achievement.

 

[SunnyExpat]

There is a graph on a website that is often referred to on here

http://www.phlaunt.com/diabetes/16422495.php

'Normal' seems to be around 80 which is about 4.4.
The graph doesn't appear to ever dip below 75, which is 4.2.
(Interestingly, it rises to over 7 after eating, which suggests a rise of three points is perfectly normal in a healthy subject after eating)

 

[Bluetit1802]

Yes, I agree it would be wise to discuss this with your doctor/nurse with a view to reducing your meds. In my opinion it is better to reduce the meds rather than increase the food if you are happy to sustain your very low carb diet, but don't attempt this without discussing it with your doctor/nurse.

 

[Quartermass]

Thanks for the responses.

I'm in a patch of working 7 days as week for the next month or so - I wanted the diet to match this so that I'm too busy to get tempted! So I don't have time to try to get a nurse appointment - the doctor doesn't see diabetics - and I've found they're not very good at all. I'm fairly sure they'd tell me to stick to the diet that they gave me when I was diagnosed, and eat pasta and rice and potatoes etc.

Since I created the thread I've been eating nuts to keep above 4. I live alone and while I think it's paranoia, I don't fancy going to sleep and not waking up I'm fairly sure that my blood sugar won't go below 3.5 and that I'm not going to go into a coma.. but I wouldn't have made this thread if I wasn't at least slightly wary. By the time I get up in the morning my blood sugar has increased again to about 5.5.

As for the amount of carbs I was eating less than 10g for a few days, the nuts will obviously have increased that to closer to the 30g mentioned.

I'm going to aim for a bit higher carbs next week. I'll be adding a small amount of greek yoghurt with some raspberries to what I eat, some coleslaw with my lunch and a few other small amounts of carbs. The reason for the extremely low carbs when I started is just to break the carb cravings as much as I can. I've done a similar diet in the past and once I'm through the first few days it gets easier - although it's now been 5 days and it's not easy yet!

 

[AndBreathe]

Thanks for the responses.

I'm in a patch of working 7 days as week for the next month or so - I wanted the diet to match this so that I'm too busy to get tempted! So I don't have time to try to get a nurse appointment - the doctor doesn't see diabetics - and I've found they're not very good at all. I'm fairly sure they'd tell me to stick to the diet that they gave me when I was diagnosed, and eat pasta and rice and potatoes etc.

Since I created the thread I've been eating nuts to keep above 4. I live alone and while I think it's paranoia, I don't fancy going to sleep and not waking up I'm fairly sure that my blood sugar won't go below 3.5 and that I'm not going to go into a coma.. but I wouldn't have made this thread if I wasn't at least slightly wary. By the time I get up in the morning my blood sugar has increased again to about 5.5.

As for the amount of carbs I was eating less than 10g for a few days, the nuts will obviously have increased that to closer to the 30g mentioned.

I'm going to aim for a bit higher carbs next week. I'll be adding a small amount of greek yoghurt with some raspberries to what I eat, some coleslaw with my lunch and a few other small amounts of carbs. The reason for the extremely low carbs when I started is just to break the carb cravings as much as I can. I've done a similar diet in the past and once I'm through the first few days it gets easier - although it's now been 5 days and it's not easy yet!

Does your Nurse do telephone calls at all? I have found for some things, not requiring any examination, that can be very efficient.

Otherwise, may I suggest you make an appointment to see your Nurse as soon as you are able to? If, by then, your concerns have been alleviated, by whatever actions you take in the meantime, you can always cancel it, but at least it would be in the diary?

 

[mfactor]

Hi, I had the same thing a while back and cut my meds in half (metformin) about a fortnight before I saw the doc, luckily she agreed...........

Your readings are much the same as mine were and i felt really rough with one 3.8 reading, I feel better now but doc also put me on another med ( very low dose antidepressant) so it could be some of that as well.......


If it was me I would drop down to just 1 or 2 metformin and ditch the rest and just monitor your readings for a while, mine have been fine since I dropped half the metformin and I have not dropped lower than high 4s, ...

 

[urbanracer]

Urbanracer, I'm absolutely not a fan of eating up to accommodate medication. That seems counter-intuitive to me.

@Quatermass - If you are intending to stick with this way of eating, I would urge you to have a discussion with your Doc or Nurse about the level of medication you are taking, with a view to considering trimming something back a bit.

It feels to me that if you are eating in such a way that you are experiencing blood elevels you feel uncomfortable with or at, then it would make more sense to trim the medication (pushing the bloods down a bit), rather then eat more to effectively counteract the drugs .

@AndBreathe , I agree in principal. Although not explicit in my message I wasn't really thinking of it as a long term solution, more to stop low blood sugars while meds are reviewed. Apologies for any confusion.

 

[nettyrim]

Hi. I would suggest you talk to your GP about stopping the forxiga. I have just stopped it as gp said there had been an alert about it.

Edit by Mod: Changed to not give direct medical advice

 

[Quartermass]

Well.... stopping the forxiga would have been a good idea. I went to see my doctor, and within an hour was in an ambulance.

I had DKA. The hospital believe that the forxiga caused it. A few days in hospital later and now I'm back home.

Following what was said in this thread I upped the carb intake to get well away from the low blood sugar levels, and was somewhere between 5.5 and 7.5 from that point onwards until I became ill with what I thought was a cold/flu. At that point I abandoned the diet, drinking milk and eating toast while I was off work for a couple of days before seeing the doctor.

So following that near death experience I'm going to take a different approach. I'm now on Victoza instead, and the hospital are going to look after me as an out patient rather than my doctors surgery.

 

[tpaz]

Well.... stopping the forxiga would have been a good idea. I went to see my doctor, and within an hour was in an ambulance.

I had DKA. The hospital believe that the forxiga caused it. A few days in hospital later and now I'm back home.

Following what was said in this thread I upped the carb intake to get well away from the low blood sugar levels, and was somewhere between 5.5 and 7.5 from that point onwards until I became ill with what I thought was a cold/flu. At that point I abandoned the diet, drinking milk and eating toast while I was off work for a couple of days before seeing the doctor.

So following that near death experience I'm going to take a different approach. I'm now on Victoza instead, and the hospital are going to look after me as an out patient rather than my doctors surgery.

The medication made your BG rise to the point of DKA? I'm so confused.

 

[zand]

The medication made your BG rise to the point of DKA? I'm so confused.

It's a rare side effect of both metformin and forxiga. The problems with forxiga weren't found until the product was marketed.

 

[catapillar]

http://www.fda.gov/Drugs/DrugSafety/ucm475463.htm

I think how it works is another underlying virus/infection (such as OPs flu) causes the DKA, but forxiga continues to stop the kidneys reabsorbing glucose, so blood sugar levels remain normal & so, DKA can go undetected. It doesn't look like it is the medication itself causing the DKA. But can certainly understand why OP doesn't want to chance it again - hope you are recovering well and will get support from the hospital team.