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Low BG. Time for more regular carbs?

W

WeeBobbyBee

Member
Messages
18
Type of diabetes
Type 2
Treatment type
Diet only
Hi folks,

I'm a few months into this now but still figuring things out. I'm wondering if my current situation has been experienced by others on the forum.

After 4 months of being mixed low carb / keto, this past week has been day after day of battling to avoid low BG and mild hypo type symptoms. Sleep quality has been deteriorating.

Yesterday saw a definite dizzy wobble on the way home from work. Once home, dinner was a sizeable plate of curried veg, fish and rice, followed by oats, rasps and sunflower seeds with Greek yoghurt. 3 hours later, I was fuzzy again so it was, more oats, berry porridge, then an orange. BG peaked at 6.9 before starting to slowly tail off. By breakfast time, once up and about, I was just above 4 and reaching for the porridge again.

Today has been better but I've done a power of eating compared to the last few months. I knew those homemade cheese scones in the freezer would come in handy.

I'm sitting at just over 70kg now and am active, cycling, walking and gym, where I do both cardio and strength.

Is this a case of the body telling me that fat as energy isn't enough any more and sensible, regular carbs are required, or something else?

I am not on any medication.

Thanks for taking the time to read.
 
Did you test your blood glucose when you felt wonky? If you did test, what was the result? (I see you tested later on) On a more usual basis, where do your blood glucose numbers run, before and after food?

With T2 and not taking any medication, it is unlikely you would have a medically concerning hypo. That doesn't mean you couldn't feel uncomfortable. Do you takes meds for anything else?

I am further on in my journey than you, but have never taken any notice if MY blood glucose dips under 4 - provided I feel OK. I sometimes feel hungry, but if scheduled food isn't imminent, I just have a cup of tea, with some milk in it. That just nudges me a little.


Edited to add: If this sort of thing continues, it makes sense to ask your GP to check it out.
 
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As AB says, hard to tell if you didn't test to see what your BG actually was when you felt woozy. I wouldn't for myself be concerned by a "just above 4" reading, which crop up fairly regularly. And I've never tried to "correct" a BG reading by eating something. My liver will usually set my BG where it's needed.

I've been doing 20g/day for five years now, playing football three times a week, no medication, and the only time I've felt anything similar was after having some carb - you go on a bit of a roller coaster. Having maybe got your liver used to a lower BG, then you raise your BG through carb, then when BG drops - although it's never really low - it feels odd to the liver, which will probably starting trying to adjust BG levels which becomes more difficult for it, if you then complicate matters by feeding yourself more carb.

The risk with this is that the cycle repeats and your system starts to accept that an increasing BG is the new normal. And the more carb you eat the more your system will expect that level of glucose.


It is of course possible that something else entirely is going on, and for that you would need to see your doctor. .
 
Hi @WeeBobbyBee. My blood glucose system is pretty wrecked, so I just don't see adding to my blood sugar count as ever a good thing! And definitely not necessary.

And I re-read the phrase "sensible, regular carbs" several times and got very stuck on the word "required".

I used to love scones back in the pre-diagnosis days too, and still have the image of your lovely homemade cheese scones right up there in the front of my brain (where what I would call my addiction to yummy carby food is). Since diagnosis I have made hundreds of batches of Swedish breakfast buns, care of the dietdoctor website, as a really good almond flour, sour cream and seed substitute. But yeah - the picture of your scones is still a good one!

But back to the carbs. My own understanding of folks generally, and definitely folks with broken blood glucose systems, which diabetes is (although sometimes fixable), is that carbs are never required. (How about preferreed but not essential? That's a fun phrase.) Can be very useful for quick easy tapped energy, which is what I believe we evolved that part of our food as fuel system for. Quick energy, and easy storage for future foodless times. (Body fat in other words.) And easy access for fuel for the brain. (We would otherwise make that from fats and protein, as the brain requires glucose.) So that is the 'required' part covered. (As in, it isn't.)

Vegetables, and fruit, are arguably very good for the gut biome. So goes a compelling argument. But not necessary, and not required, even though the fruit and vegetable boards of all our countries would have it known otherwise.

As for sensible and regular. I know I too was brought up on the idea that carbs were a necessary part of every meal. But alas, in excess wrecked my poor ol blood glucose system. Along with chemicals and polutants and anti biotics and, and now the argument that it is Ultra Processed Food ingredients and the processing generally wrecking our health.

So regular - as in conventionally accepted - yes. But sensible? With type two diabetes?

Ah yes, only you can decide for yourself on that one.

I agree with above that wooziness is a symptom of many things, including cardio vascular disease, so get thee to a doctor on that one. They run the tests, rule things out. At the very least - to reassure you.
 
Hi, thanks for commenting.

Last 2 months-ish, I've generally been mid 5s pre meals, low 6s 2 hours after

Wonky tends to kick in about 4.2. I'm not sure exactly where I was on first wobble yesterday. I was in Tesco so just grabbed some of what was in the trolley and explained myself at the checkout

As I say, today has been much better so I'll probably continue and keep an eye on it
 
Those numbers are what you are looking for really so well done even the 4.2 isn’t yet in hypo territory, that starts at 3.9. As a T2 on diet only myself personally I wouldn’t treat a 4.2, I can be very near that often before my evening meal. Feeling wobbly especially when out isn’t nice though. If that happens to me on the odd occasion I will have a low carb snack - a bit of cooked meat or a hard boiled egg, or if I have some in my back a couple of squares of 85% chocolate. If I’m near a coffee shop I will have a cortardo coffee, But my liver usually kicks in and does it job before I need to do anything.

Just be careful not to over-treat if you do have something and send your BG too far the other way. A small snack of 4-5 carbs should very easily take you back where you want your BG to be - and you may be back up to a none hypo number but the feeling in your body will take time to pass and catch up ( which is where the temptation to keep having carbs to make you feel better can keep you reaching for carbs and send you back too high as described by @KennyA above)
 
A level of 4.2 isn't officially a hypo, although it could easily be that your body has been used to running higher, and is "objecting" to being pushed out of it's comfort zone. If you search the forum for "false hypo" there will likely be plenty of results returned.

The thing about treating even a clinically low blood sugar is that not all food makes us feel better straight away. The usual fast acting stuff tends to be glucose tablets, fruit juice, Coke/Pepsi, but full sugar versions or sometimes Jelly Babies or Haribo style of sweets. Even with that, the usual guidance is to take a "dose" of around 15gr of carb (what that means will vary between what is being consumed - someone will likely know approximate amounts of each), the wait 15 minutes and test again. Repeat if necessary.

Over treating a hypo can lead to erratic blood sugars for a while afterwards as the body sorts it all out. As non-medicated T2s, we are lucky not to have injected insulin in the mix.

If you are finding you feel a bit wobbly at 4.2, maybe try something like some tea with milk. If you are going very low, then you may need something, as mentioned above.

Many normies (i.e. folks without diabetes) can spend quite a bit of their time in the 3s, and be totally unaffected, but as a relatively newly diagnosed T2, your body is still likely adjusting.

As I say, if this continues, then seek a medicla opinion. There are other things that can bring on similar symtopms to low blood sugars.

If you feel unsafe, call NHS 111, or if really bad, 999. Better safe than sorry.
 
Those numbers are what you are looking for really so well done even the 4.2 isn’t yet in hypo territory, that starts at 3.9. As a T2 on diet only myself personally I wouldn’t treat a 4.2, I can be very near that often before my evening meal. Feeling wobbly especially when out isn’t nice though. If that happens to me on the odd occasion I will have a low carb snack - a bit of cooked meat or a hard boiled egg, or if I have some in my back a couple of squares of 85% chocolate. If I’m near a coffee shop I will have a cortardo coffee, But my liver usually kicks in and does it job before I need to do anything.

Just be careful not to over-treat if you do have something and send your BG too far the other way. A small snack of 4-5 carbs should very easily take you back where you want your BG to be - and you may be back up to a none hypo number but the feeling in your body will take time to pass and catch up ( which is where the temptation to keep having carbs to make you feel better can keep you reaching for carbs and send you back too high as described by @KennyA above)

Hi LL,

All makes good sense, thanks for the response. Looks like a good thing to learn is to relax a bit and let the liver do its thing.
 
Thanks for all the responses folks. Apologies for not responding to all. Either my tablet, or more likely user-error, occasionally goes rogue when posting replies. I'm not talking about going full out carbs, just needing to make sure I can fully function. I've certainly seen a wee kick down in the daily norm over the last couple of weeks so, as mentioned in one of the responses, the wobblies might just be another recalibration going on for the brain.

Thanks again to all
 
I’m into fitness @WeeBobbyBee . I could not get my blood sugars into the ‘normal range’ despite 9 months of <35 g of carbs. I suffered lows (low 2’s blood tested) with an entire raft of symptoms. At the time I was not on BG meds. A point others have raised is anything above 4mmol/Ls is not in the hypo range. It is in fact okay to drop into the mid 3’s and it would be of little concern as long as you were not on blood sugar lowering medication, or insulin) . Furthering this point, I fasted 14 hours for a glucose test. The lab range was set at 3.3 - 5.5 mmol/Ls . Note the lower number. Having said that I would not want to start any sporting activity under 5 mmol/ls. As you know, being into sports, listening to your body is key to remaining competitive and injury free.
If you are feeling lack lustre with low energy, diet and hydration are the first things one looks at and reviews. If you are cycling long distance at a pace, then your body can use up its glycogen stores which basically means that your liver may not be as effective at correcting falling blood sugars, however your blood sugars remained normal. You may want to look at your electrolyte intake. Are you giving your muscles enough time to rest ie rest days. Over training? These last points pertain to feeling sluggish, hydration levels would impact your performance as well as making you feel a bit light headed. Sleep of course comes into it, are you getting enough? Do you check your blood pressure ? There are athletes that perform on a keto diet, but everyone is different and what can work for one person doesn’t work for another. I know my Performance would be affected without carbs.

As someone who has been a competitive runner for much of my life there are a number of considerations to look at not just diet, but in the end it may well be it’s striking a balance with what works for you.

Edited to add sentence about meds
 
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Thanks for the response Melgar.

Whatever the cause of the wobbles, things have calmed down in the last couple of days. BG now seems to be fairly steady at around 5.0 during the day, with slight bell-curves after meals but nothing 'high and spikey'. The dizzy spells have, at present anyway, gone.

Electrolyte intake is certainly something I've been taking a look at. In the past, this would have been mixed electrolytes and carbs but there do seem to be several, reputable, no/lo sugar electrolyte supps on the market.

Were you a distance runner? If you were, can I ask what your long run fuelling strategy typically looked like?

Thanks again
WBB
 
@WeeBobbyBee that’s great to hear it’s all settled down. My competitive days are over, as with many long time runners my knees and ankles have suffered. Yes i was a long distance runner 10 k upwards. My body is built for distance, although apparently I have a protein in my muscles that equips me for fast short distances. Termed elite muscles, as all elite short distance runners have this protein. I can tell you that I was never a fast runner over 50/100/200/400 meter distances, so all track runners under 10k have this type of muscle, but not all who have them are built for explosive speed, me included.
Whilst a runner I was not diabetic. My blood sugars, when I did test them using my mother in laws meter, were consistently in the 4’s. My blood sugars went weird following sepsis / pneumonia.
As for fuelling, as I was not diabetic I fuelled up with complex carbs. I carb loaded the night before and drank electrolytes during my runs. So it was carbs, carbs, carbs. So no help to you really.
 

Thanks for the reply Melgar.
 

If you are a runner, have a look at Type 1 Keto: https://type1keto.com/ . This is Dr Ian Lake who is a UK GP who lives a keto lifestyle, but also undertakes extreme exercise.

Ian is on the usual social media platforms and very approachable, were you to pick his brains.

Other resources include Type 1 grit, on Facebook.

Whilst both these resources cite T1, the subject of fuelling will be very similar, except you won't be juggling taking on board exogenous insulin.
 
@WeeBobbyBee - you've made a great change in a short time, and that's fantastic - you may just need to give your body a chance to catch up.

We discuss blood glucose levels and what's going on in our livers, but actually the brain overrules everything if it thinks it's low in glucose (without anything else to use) and - with a totally separate "normal" - can engage the sympathetic nervous system to kick in - this is pretty much the reason for the difference between "hungry" and "hangry".

When we are carb-heavy - the only fuel for the brain is glucose - as @AloeSvea says above. However, after some time in the low-carb world, we become a little more fat-adapted (meaning more easily switching to releasing and burning fat for fuel), and the liver starts to regularly produce ketones - which the brain can use just fine. It just takes a little time for everything to settle down.
 

Thanks AB,

Not a runner, but a cyclist. I'll certainly take a look for sure. I've struggled with long bike rides on strict Keto, especially where there has been a lot of hard climbing involved. Steady tempo rides aren't too bad but anything that needs prolonged hard effort has tended to empty the tank. I'll get a good read tonight though. The lates bloods results suggest what I'm doing is pretty much on the nail, but I'm always keen to see what has worked for others and if it might work for me.

WBB
 
Ah, @Chris24Main , I thought the brain always needs some glucose, but of course we can make it ourselves from fats and protein. I have the figure of 5 % asserting itself, but I can't remember exactly what that 5% signifies - maybe that the brain needs 5% of its fuel to be glucose? And of course, if you aren't eating it, then the body makes it. this is from memory (big national holiday tomorrow, my galpals are on their way, and I don't have time to fact check...sorry y'all!) I might be wrong!
 
The overwhelming narrative for some time is that the brain needs glucose, or parts of the brain need glucose. It seems a certainty that "glucose is the preferred fuel for the brain" - as many nutritionists will tell you; but I haven't seen any research that actually proves this. Glucose will be used up first, but that can be explained by saying that glucose is toxic, and all tissues will use it first. The brain seems perfectly happy with other fuels and one thing that is totally beyond argument - free fatty acids (which primarily power the heart) and triglycerides cannot pass through the blood-brain barrier.

So - it's more that "the brain cannot burn fat, in fact fat is a structural building block for the brain" - rather than, "the brain needs glucose".

Thus - in people adapted to run on glucose (ie, anyone with chronically elevated insulin, ie, most of us) Must provide glucose for fuel for the brain. The liver will produce it, sure; but the brain has a different idea to the liver as to what the normal level should be - so your brain can be running low on energy even while the liver thinks everything is fine -

Insulin resistance of course plays a huge part in this - you can be flooding your brain with glucose and not be able to do anything with it because the glucose cannot get into the cells because the insulin receptors aren't working.

However - all of that only really applies to people adapted to glucose - the rules change somewhat if you allow yourself to become fat-adapted.

The brain can use many alternative fuels - it's simply that fat cannot cross the blood-brain barrier because it's too big - thus ketone bodies - the liver makes these from fat (when insulin is low) and they are small enough to cross into the brain (and do a whole bunch of good things alongside being available for fuel). Also Creatine, and some other minor players.

You may consider that in many contact sports (where concussion is relatively likely) - a diet that prioritises ketone production is becoming quite common - in the event of concussion, the long term damage to the brain is far less if ketones are present, because the brain can continue to use them. Not so for glucose. This makes it difficult to hold on to the "glucose is the preferred fuel for the brain" narrative.
 
Interesting reading @Chris24Main

We may have an answer to the fuzzy headedness after a short stay in the local hospital. Seems that my BP drops a tad when I go from sitting to standing and takes a wee bit longer to rebalance than it ought. I now have some medication to deal with that.

Interestingly, and more in line with the topic of discussion, while being fed typical short-stay NHS fare of breakfast carbs (thankfully I knew I didn't really react to a small bowl of porridge), lunchtime veg soup and a tuna sandwich, and something a bit more 'normal' at dinner time, my BG had a low of 4.1, a high of 6.0 and a bunch of my usual mid-5s. This while pretty much sat on my bahooky for three days, feeling less than optimal. I'd have expected more of a rise. Maybe it would have happened if I'd been there longer. Maybe the volume wasn't enough to cause too much response - I was certainly normally looking for the next meal a lot of the time. Anyway, back home now and back to the diet that's been working well for me since October.
 
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