I wanted to ask as well- you have RH, when you say blood sugars rising then falling, is that rising above 7 and falling below 4? Or rising a ‘normal’ amount and then falling below 4?
And is RH considered the case if it’s within 5 hours after eating or is it less time?
RH varies between different people.
So some people with RH get high then low blood glucose. While others get not-high, then low blood glucose.
As I understand it, it isn't the height of the blood glucose rise that triggers the hypo, it is the amount of insulin produced.
Ideally, we should all produced exactly the correct amount of insulin to keep our bg steady while dealing with the amount of glucose released into the bloodstream from food or glucose stores in the liver or big muscles. In a perfect world, there would be a balancing act where glucose was released, or tucked away for storage (by the action of insulin), and our bg would stay fairly steady and in the 'normal' range.
But when we get bg dysregulation, all sorts of things can go wrong. If bg rises before the insulin kicks in, then that is when RHers get high bg after eating. But if the insulin is released at the correct time, then no 'spike' in bg occurs.
However, with a lot of RHers, including both of the two groups I mentioned in the last paragraph, the amount of insulin produced is excessive. So there is more than is needed, which tucks too much of the glucose away - removing it from the blood stream, and causing a hypo because the blood glucose is now too low.
Again, in an ideal world, the body produces exactly the correct amount of another hormone called glucagon. This acts as an insulin antagonist, and stops insulin from working. Which prevents too much glucose being tucked away, and prevents a hypo. But some RHers may have a problem with glucagon production too...
https://www.endocrineweb.com/conditions/diabetes/normal-regulation-blood-glucose
So for a Rher, it is the excess insulin production, followed by the body's inability to prevent the blood glucose dropping too low, that is the cause of the hypo. Even if their blood glucose never rises high, they have produced more insulin that necessary => hypo
Therefore, for those of use who can control it by diet, the answer is often to simply avoid eating in a way that triggers excess insulin production.
And since carbs, particularly quick release carbs such as potato, rice, pasta, bread, cakes, sugar, sweet fruit, etc. are what trigger insulin release, by avoiding eating those we can avoid the ensuing hypo.
You asked if a hypo is glucose levels falling below 4.
The answer is 'maybe'.
People with diabetes who are on glucose lowering medications, such as insulin or gliclazide, are told to treat a number below 4 as a potential hypo, since their medication may be working to lower their blood glucose further.
People not on glucose lowering medications (i.e. non diabetics) rarely get hypos at all, and may have blood glucose in the 3s with no problems. They feel fine, and (since they never test their blood glucose) may spend quite a lot of their lives with sub-3 blood glucose. Or be in the 4s, 5s, and 6s... Whenever their bg dips a little, their body takes care of it, by any one of the following; hunger, reducing activity levels, releasing stored glucose from the liver stores, releasing a bit of adrenalin to trigger those glucose stores to release, releasing glucagon, or even by continuing to digest the meal they ate an hour or two ago.
RHers's bodies will do all of those things, but since they have a bit of glucose dysregulation somewhere in the complex balancing act, they dip lower, into hypo territory before their own body, or their own hunger, brings the blood glucose back up.
As for 'what constitutes a hypo for an an RHer', I suspect you would get very different answers depending on who you spoke to.
For myself, after 40+ years of RH, my body has decided that it DOES NOT LIKE going below 5mmol/l and will release glucose from stores to bring my blood glucose back up to above 5.
But I don't call it a hypo, just a 'bit lower than usual, and maybe feeling like I want to eat'.
However, I have on occasion (v rare nowadays since I usually have things under control) measured blood glucose in the 1s and 2s, and those were
most definitely hypos, which a whole host of hypo symptoms.
If I find myself dipping a bit low (or heading for a hypo like an out of control train), then I eat something. Nuts, or a little very dark chocolate, or a coffee with cream. I do NOT fall head first into a pile of sweets, or a lucozade, since eating carbs would just cause another insulin over reaction, and a short time later I would be back in hypo-land.
Sorry this post has been so long!
Hope I have answered in a way that makes sense.
