1. Get the Diabetes Forum App for your phone - available on iOS and Android.
    Dismiss Notice
  2. Guest, we'd love to know what you think about the forum! Take the Diabetes Forum Survey 2021 »
    Dismiss Notice
  3. Diabetes Forum should not be used in an emergency and does not replace your healthcare professional relationship. Posts can be seen by the public.
    Dismiss Notice
  4. Guest, stay home, stay safe, save the NHS. Stay up to date with information about keeping yourself and people around you safe here and GOV.UK: Coronavirus (COVID-19). Think you have symptoms? NHS 111 service is available here.
    Dismiss Notice
Dismiss Notice
Find support, ask questions and share your experiences. Join the community »

Low blood glucose but feeling ok?

Discussion in 'Reactive Hypoglycemia' started by swttbsy5, May 12, 2020.

  1. swttbsy5

    swttbsy5 Reactive hypoglycemia · Well-Known Member

    Messages:
    48
    Likes Received:
    9
    Trophy Points:
    28
    I've had 2 BGL test results today of 3.4 which for me usually means terrible symptoms of hypoglycaemia but strangely I feel just fine. Is this because of ketosis? I've been a on very, very low carb for over a week now and did a 16 hour fast yesterday.
     
  2. Brunneria

    Brunneria Other · Moderator
    Staff Member

    Messages:
    21,600
    Likes Received:
    34,957
    Trophy Points:
    298
    Now that you are adjusting to a low carb way of eating, your body is learning that lower bgs are not the end of the world. :)
    Plus, a bg of 3.4 (give or take a little for meter inaccuracy) isn't a major hypo, and many people with 'normal' blood glucose can experience the mid 3s without problems.

    However, it is worth knowing the following:
    Ketosis does seem to affect the experience of a hypo.
    My understanding is that it is both a benefit and a curse (typical, eh?)

    The benefit is that the hypo is less likely to be a horrible experience, because the brain and body are using ketones as fuel, rather than sugar. This means that a drop in bg is less serious, because the ketone fuel takes up the slack (as it were).
    Obviously, it is actually much more complex than that!

    The curse part comes in when you realise that someone can still function sort-of-OK with low bgs, and their body stops sending out 'hypo signals'. And in fact, some people become 'hypo unaware'. This has obvious implications for driving and operating machinery, and making judgement calls. Clear hypo signals are important for us to treat the hypo. Obviously, the ketone fuel goes some way to compensate, and the decision making process is likely to be less compromised, but it may still be significantly compromised. I would say hypo unawareness is less of a problem for people in ketosis than for those not in ketosis, and/or on insulin or other strong bg lowering medications, but it is still worth being aware of the potential problem.

    If you have a google, you will find quite a lot of discussion about this on forums, discussion boards, and in books.

    https://www.ncbi.nlm.nih.gov/pubmed/720768 (careful with this one, the study was done on mice, not humans)

    As a sort of aside, your profile doesn't say where in the world you are. If you are in the UK, you should have informed the DVLA about your RH status, because hypos can affect driving. There is a form on the DVLA website you can use, if you need to. If you are in another country, you might want to check what the rules are for driving when diagnosed with a condition that causes hypos.
     
  3. swttbsy5

    swttbsy5 Reactive hypoglycemia · Well-Known Member

    Messages:
    48
    Likes Received:
    9
    Trophy Points:
    28
    Thanks for all that info. It's gone back up to 3.9 now and I still feel fine. The strange thing is that usually, for me a level of 3.5 or lower would only come after a very rapid drop from 7.5 or so and the symptoms usually start around the 4.5 mark. But to be stable under 4.0 has never happened before so something has definitely changed and it would seem for the better. I'm hesitant to try and raise the BGL as it might then come crashing down.
    BTW I'm not in the UK and not sure on the laws here but I'll check it out. Thanks
     
    • Like Like x 1
  4. swttbsy5

    swttbsy5 Reactive hypoglycemia · Well-Known Member

    Messages:
    48
    Likes Received:
    9
    Trophy Points:
    28
    My BGL has been hovering in the low 3's now since yesterday. Overnight fasting level is 3.2. I'm worried this is too low. Sometimes after eating a low carb meal it goes up to 3.9 or I think the highest yesterday was 4.1. I don't feel like I'm getting hypo symptoms at this level but the glucose meter keeps telling me "low glucose" after every test. My BGL has never stayed this low for this long. Is it possible to have too few carbs on a keto diet? Is no carbs dangerous? My next available Endo appointment is not for 2 weeks and I feel like I'm flying blind here.
     
  5. Brunneria

    Brunneria Other · Moderator
    Staff Member

    Messages:
    21,600
    Likes Received:
    34,957
    Trophy Points:
    298
    How are you feeling? Any hypo feelings? Energy levels? Fatigue? Hunger levels? Concentration levels? Decision making?
    normal glucose levels can actually be much lower than the levels talked about for diabetics.

    I will tag in @DCUKMod
    She has far lower blood glucose levels Than my body likes, and she flourishes at those levels.
     
  6. swttbsy5

    swttbsy5 Reactive hypoglycemia · Well-Known Member

    Messages:
    48
    Likes Received:
    9
    Trophy Points:
    28
    It's hard to describe how I'm feeling. It's mixed and different to normal. I'm feeling anxious about what I'm doing with this diet. There are some mild hypo feelings. Definitely feels different to usual though. Not feeling hungry even though all I have eaten is 2 eggs fried in butter nearly 3 hours ago. Energy and concentration feels a bit low. I'm a thin person already so I'm not sure there's really much fuel there if I'm not eating more (I think). Today with hourly BGL's i've gone from fasting at 3.2, then 1 hour after the eggs was 3.6 and 1 hour after that it's 3.7.

    p.s I'm in Australia so different laws here regarding driving etc.
     
  7. DCUKMod

    DCUKMod I reversed my Type 2 · Master
    Staff Member Administrator

    Messages:
    14,302
    Likes Received:
    8,225
    Trophy Points:
    298
    Hi there Swttbsy5. As @Brunneria suggests my blood glucose meanders in the lower numbers. I'm absolutely in the 3s and 4s. In the 2s I would usually feel jolly hungry, but then I usually only go there if I have my fuelling a bit wrong and as a result I am hungry.

    These days I rarely count cards, as my way of eating is almost a way of life, after 6.5 years. Im not quite ketosis, but I am definitely low carb and gluten free.

    How are you measuring your bloods overnight? If you are using the Libre, I would caution you that it can be a bit unreliable at lower levels plus it is possible to experience compression lows.

    Compression lows happen when we lie on the sensor and that changes the tissue fluid make up. That said, my compression lows tend to read two point two.

    In your shoes, especially as you are already slight and fear you aren't eating enough, I'd think about eating a bit more, but concentrate on that extra food being fats and a bit more protein.

    When keto, your body gets its fuel differently. Uber simplistically when we eat starchy carbs, they start breaking down into rapid fuel in our mouths, whereas fats particularly take a good deal longer.

    In my mind, I see consuming cards as like standing in front of a fan heater to get warm. It's fast and effective, but as soon as we turn it off, we cool off fast. Eating low carb or keto, it's like having central heating on. It's a slower burn with a bit of residual heat when it goes off, but it takes longer to feel the warmth when it comes back on..

    As I say, that's what I would try, but I'm not you and haven't ever had a diagnosis of RH.

    Good luck with it all.
     
  8. swttbsy5

    swttbsy5 Reactive hypoglycemia · Well-Known Member

    Messages:
    48
    Likes Received:
    9
    Trophy Points:
    28
    I'm using a FreeStyle Libre but just finger pricking so there's no sensor. I did the sensor thing 2 years ago when I first saw the Endo and got the original diagnosis.
     
  9. swttbsy5

    swttbsy5 Reactive hypoglycemia · Well-Known Member

    Messages:
    48
    Likes Received:
    9
    Trophy Points:
    28
    Ok so after a very low carb lunch and then no food for about 4 hours I had a bad hypo, BGL of 2.7. I think I need more food. Maybe 2 or 3 meals a day is not right for me. Trying to treat the hypo with plain greek yoghurt and cashews. I'll keep testing. This is not fun.
     
  10. mansingh01

    mansingh01 Type 2 · Active Member

    Messages:
    35
    Likes Received:
    11
    Trophy Points:
    28
    What medication are you?
     
  11. Brunneria

    Brunneria Other · Moderator
    Staff Member

    Messages:
    21,600
    Likes Received:
    34,957
    Trophy Points:
    298
    Hi,

    how are you feeling now?

    sorry about the hypo. Did your bg come back up with the yog and nuts?

    Blood glucose often dips to its lowest point of the day in late afternoon. A lot of us find we get our lowest readings before our evening meal.

    If you are feeling rough like that then you definitely need to make some changes. As I see it, you can either reintroduce carbs, and return to where you were. or you can make some changes/do some more research into how to make the low carb thing work for you. Obviously, it needs to be your choice, and you need to be eating foods that work for you and your body and blood glucose.

    if you have a google into the things that go wrong when switching to keto, you will hear of something called keto flu, this is generally a transition period where the body adjusts to feeling with fat and needs more electrolytes and we just feel rough.

    It can take a while (weeks) for our bodies to learn to properly switch to fat as fuel, and of course it needs to be eating plenty of both fat and fuel in order to do so (unless it can draw on copious amounts of body fat, which not everybody has).

    In your situation, I would be probably attacking this from all sides. Eating more overall. Probably a lot more. Adding butter and oil and mayo to veg and salads. Eating nuts and full fat cheese and pate as snacks, if I felt the need. Adding cream to coffee. Making low carb hot chocolate with cream in it. Adding low carb desserts or finishing a meal with cheese. Have a google for keto mug cake recipes. Yes, you CAN eat cake while low Carbing.

    Plus I would be making sure that I was getting those electrolytes as added salt on food, and/or drinking bone broth.
     
  12. swttbsy5

    swttbsy5 Reactive hypoglycemia · Well-Known Member

    Messages:
    48
    Likes Received:
    9
    Trophy Points:
    28
    Thanks. Feeling fine now. BGL is back to 3.9. I ended up needing a very small glass of milk and more cashews. It's a new thing for me tring to manage a hypo without causing a spike and then another hypo. Seems ok so far! It seems if I can keep the level in the mid 3's or above I'm ok. It's a learning process and when there's a mistake, it's pretty punishing. Anyway. It's all valuable information for what to do and what not to do - for me. I'm keeping a detailed food diary anyway and will show all this to the Endo at my next appointment in a few weeks. Thanks for all the replies. Heaps of great info on this forum and helpful people. Much appreciated!
     
    • Winner Winner x 1
  13. Lamont D

    Lamont D Reactive hypoglycemia · Master

    Messages:
    12,482
    Likes Received:
    15,601
    Trophy Points:
    298
    Hi, I have just read most of your posts.
    Yes you have all the hallmark symptoms of hypoglycaemia, but because of you fasting for quite a period something else may be going on.
    I did a fasting test to confirm the diagnosis of reactive hypoglycaemia.
    This is usually done over a few days, up to 72 hours in a controlled environment supervised in a hospital. This test is designed to discover wether you have a hypoglycaemic episode during fasting.
    If you don't go hypo, you have reactive hypoglycaemia.
    If you do go hypo then more tests are done to find out what pancreatic condition is causing the Hypoglycaemia, such as insulinoma.

    So I would definitely stopped fasting, until you know what is going on.

    Best wishes. Keep safe
     
  14. Resurgam

    Resurgam Type 2 (in remission!) · Expert

    Messages:
    8,421
    Likes Received:
    5,069
    Trophy Points:
    198
    Might I suggest that you do have some small amount of carbs with your meals - just a small salad, like a half serving from a premixed bag, and introduce it gradually.
    As I understand it, it is rapid changes in BG levels which cause the problems, and you are avoiding those, but as you are slender it might help to see if you can fine tune your intake of carbs to lift your levels a bit and maybe gain a greater store of glucose in the liver as a buffer.
    I used to have what I now realize were hypos, way back in my early 20s, which I accidentally got rid of when I encountered the early form of the Cambridge diet, packing sachets for Dr Howard's hospital patients. These days to keep my numbers more stable I eat up to 10 gm of carbs, most usually around 5gm, with my first meal, as I could see that was a good thing from what my meter showed.
     
  15. swttbsy5

    swttbsy5 Reactive hypoglycemia · Well-Known Member

    Messages:
    48
    Likes Received:
    9
    Trophy Points:
    28
    When this was first investigated 2 years ago, the endo did a LOT of test. For pancreatic tumor etc. Even a ct scan. They all came back negative and she diagnosed me with "idiopathic reactive hypoglycaemia". Fasting has always been normal levels for me although I've never done the 72 hour in hospital test. The first time EVER that I have noticed low BGL after fasting was over the last week and since starting the low carb diet. I bumped up the carbs and fat ever so slightly yesterday and overnight fasting level this morning is 4.4 - which is fine. I will most definitely be taking all of this info to the endo and will not attempt any more fasting before then.
     
    • Agree Agree x 1
  16. swttbsy5

    swttbsy5 Reactive hypoglycemia · Well-Known Member

    Messages:
    48
    Likes Received:
    9
    Trophy Points:
    28
    Thanks and yes, that is the plan. I'll add small amounts of carbs and more fat and see what happens.
     
  17. Lamont D

    Lamont D Reactive hypoglycemia · Master

    Messages:
    12,482
    Likes Received:
    15,601
    Trophy Points:
    298
    As long as it doesn't trigger the hyper/hypo cycle.
    Eat low carb meals of around 25g of carbs, throughout the day, that should cover everything and prevent the trigger.
    And of course the carbs should be those that don't raise the blood levels up to quickly, using good fats to slow and satiate you is the best way.

    Keep safe
     
  18. swttbsy5

    swttbsy5 Reactive hypoglycemia · Well-Known Member

    Messages:
    48
    Likes Received:
    9
    Trophy Points:
    28
    Yep. Sounds good. This is the current plan!
     
  19. swttbsy5

    swttbsy5 Reactive hypoglycemia · Well-Known Member

    Messages:
    48
    Likes Received:
    9
    Trophy Points:
    28
    I've been stable for a week now. Blood glucose levels are not moving much from 4.0 to 4.8 mostly over the day. I got some ketone strips and tested. First test before dinner was 1.1 and then 2 hours after dinner ketone levels were 2.8. I guess I've been in ketosis for over a week now? Maybe longer, since I started the diet. I'm feeling good most of the time. I'm eating I think around 50g of carbs per day give or take. Definitely have had the breath/urine keto smell happening. I'm seeing the endo in a week. Interested to see what they say. The best part is
    This article describes why I may have had really low bgl when starting keto. I think it's a normal part of the process switching to keto. Seems to not be so much of a problem anymore after another week on keto but still eating regularly (every 3 hours) and very low carb.
    https://www.ketogenic-diet-resource.com/reactive-hypoglycemia.html
     
  20. Lamont D

    Lamont D Reactive hypoglycemia · Master

    Messages:
    12,482
    Likes Received:
    15,601
    Trophy Points:
    298
    That article ascribes that reactive hypoglycaemia is a symptom of going Keto or reducing your carbohydrates that your body reacts to the sudden drops in blood glucose levels, as he says, transient reactive hypoglycaemia happens when most people who have been eating a high carbohydrate diet.
    This is not the actual condition!
    Reactive Hypoglycaemia happens because of the patients intolerance to carbs and sugar in most forms. It triggers an overshoot in insulin, because of the amount of carbs eaten. It is food orientated.
    @@Brunneria has quite a few links about reactive hypoglycaemia, and if you read our forum's threads you will see the difference between having the condition and the symptoms many people get because of the sudden drops in blood glucose levels, some know it as a sugar crash.

    Keep asking
     
  • Meet the Community

    Find support, connect with others, ask questions and share your experiences with people with diabetes, their carers and family.

    Did you know: 7 out of 10 people improve their understanding of diabetes within 6 months of being a Diabetes Forum member. Get the Diabetes Forum App and stay connected on iOS and Android

    Grab the app!
  • Tweet with us

  • Like us on Facebook