Please can we have a forum section on reactive hypoglycaemia?

AndBreathe said:

@Brunneria and @Giverny - These are my two posts from another thread, where I clearly had lost the ploy! @Brunneria , they're posts 217 and 221, for completeness.

Post 217:
Prefix? Who knew?

Is that field a search parameter @@Giverny ?

I'd agree in my time here, we have seen a number of people who show significant signs of reactive hypoglycaemia.

I'd speculate that when someone is new, they're unlikely to explore the prefix option. I've been here almost a year, and I had absolutely no idea it existed. Thinking back, I have seen it on threads, but very, very rarely.

Do others have a view on that?


Post 221:


How did that happen (user error, of course, sorry! )?

To be honest, unless it was clear how to set it, it's potentially just another hurdle to creating a new thread, but maybe I'm being far too picky.

I'll copy this back onto @Brunneria's thread, for completeness, and if necessary, continue that part of the discussion there.

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Brunneria said:

Hi,

@Giverny suggested I post this to remind her that I had asked the question
And it seems to be the ideal opportunity to explain why I'm making the request.

Reactive hypoglycaemia is not diabetes, but it lies on the same glucose intolerance spectrum.

Put simply, diabetics get raised blood glucose, while reactive hypoglycaemics (RHs) get lowered blood glucose - but they often go on to develop diabetes.

Because of this, we often (seems to be a couple of times a week) get people arriving at the forum saying things like 'my doc says I'm not diabetic, but I have all these hypo like symptoms, and I don't understand...?'

It just seems to make sense to have an RH section for these questions and answers.

I've recently read a book by Diane Cress called 'The Diabetic Miracle'. In it she filled in a piece of the RH jigsaw puzzle for me.
She's a dietician for diabetics, and a type 2 herself, and in her practice she has observed that many of her type 2 patients experienced the following pattern:
- normal appetite and weight
- food cravings (carbs) develop
- weight gain develops
- pre diabetes develops
- diabetes is diagnosed

And Cress talks about how she believes that RH is actually the earliest stage of the route for some type 2s. A kind of pre-pre-diabetes.

It occurs when a food is eaten that requires insulin to be produced.
A normal person produces exactly the correct amount of insulin for the meal and blood glucose quickly returns to a stable level.
RHs produce just a smidge too much insulin. As a result, the blood glucose drops a bit faster after the meal, and it also drops a bit lower.

The RH person ends up with lower blood glucose than before they ate (although, if left long enough e.g. overnight, the BG would return to normal).

So they get hungry, quicker.
So they start to crave foods that boost the blood glucose quicker.
So they eat more (carbs)
So they produce more insulin.
So their blood glucose drops again.
So they crave...

It becomes a never ending cycle with two results:
1. the patient often gains weight (we know that excess insulin causes weight gain)
2. The patient's insulin producing capacity is strained over time

This, Cress says, may lead to pre- and then full type 2 diabetes.

But it is important to note that not all RH sufferers develop pre diabetes, just as not all prediabetics develop diabetes...

Treatment may be drugs (@nosher8355 knows far more about that than me) and a diet that keeps BG levels from fluctuating too high or low.

So please can we have an RH section? Maybe in the 'Other health conditions' section?

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Brunneria said:

Hi again @Giverny

You asked how widespread RH is.
So I just spent half an hour on google, and I am STUNNED by the result (even so quickly)

Short answer: RH is astonishingly widespread.

This study (from 2010)
http://www.ncbi.nlm.nih.gov/pubmed/20509823
Took 362 people 'without a diagnosis of abnormal glucose metabolism through an oral glucose tolerance test (OGTT)' and tested them.
12.4% had idiopathic reactive hypoglycaemia !!!
And curiously, that only 54% of them had a normal glucose tolerance (but that is a discussion for another thread)
The study then went on to see if switching to a high fibre diet helped.
It did.
They concluded that: A reactive glucose pattern following intake of a high glycaemic load is relatively prevalent and this phenomenon could be modulated by dietary fibre supplementation.

This study (2005)
found that idiopathic RH is prevalent in 50% of lean young women with PCOS.
http://www.ncbi.nlm.nih.gov/pubmed/15808380
That actually blows my mind.
50%!!!
And bearing in mind that PCOS tends to lead to weight gain, presumably over weight PCOSers have an even higher incidence of RH (that is just my speculation)
Plus the fact that women with PCOS are statistically much more likely to develop Type 2

This study (2008)
http://clinicaltrials.gov/show/NCT00802971
Shows RH to be astonishingly widespread:
'The prevalence of IRH is not fully known. A British trial among 1136 random chosen women aged 17-50, reported that 37.9% experienced symptomatic hypoglycemia four times every month (mean value). However, not all reported symptoms attributed to a low blood glucose (BG) correlates with measured low levels of BG and a "true" hypoglycaemic episode, i.e., as defined by American Diabetes Association (ADA) when plasma BG value is < 3,9 mmol/l with or without accompanying symptoms. This was underscored in three studies from England, Canada and Denmark, in whom all reported hypoglycaemic symptoms, but in whom accompanying plasma glucose values < 3,3 mmol/l during hypoglycaemic symptoms only occurred in 23, 47 and 0% of the study subjects, respectively. The majority of those with symptoms related to IRH hence are having these symptoms without being classified as hypoglycemic according to conventional interpretations. However, a new (2005) ADA definition; relative hypoglycemia, also comprise these symptomatic cases of hypoglycemia following a plasma glucose > 3,9 mmol/l.'

So, my reading of these studies suggests that RH may affect
12.4% of the population
At least 50% of women with PCOS
And 37.9% of women of reproductive age may experience symptoms 4x a month

Now, obviously, not everyone gets it badly enough to turn up on this website with symptoms... But it still suggests that a fair few people would benefit from there being some easily accessed threads here on the subject.

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Brunneria said:

Thanks nosh!

Perhaps it would be best to have a section called 'hypoglycaemia'
And then stickies describing the different types. That would include the type 1 insulin variety (sorry, don't know if it has a proper name) and Nosher's late RH, and idiopathic RH... Plus others, if nec.

I'm thinking that would be really helpful to a lot of users on here.

What do the rest of you think?

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Brunneria said:

Hi, and welcome!

The following is based on my experience:
In my opinion, you've done the best thing you could have done, by switching to low carb.
That's the biggest and quickest step you can take.

Next, I suggest you get yourself a blood glucose meter (lots of advice across the forum on this about choosing one, but a lot of us get the SD Codefree because it is cheapest.)
Once you have a meter, then you can start fine tuning your low carb diet to suit your body, by testing foods.

You can also map out your personal RH reaction, find out when your blood glucose is likely to drop, and have something to eat before it happens.
You may need to have a low carb snack every 2 or 3 or 4 hours, depending on how your body reacts.
But please resist the urge to snack on sugary, carby things - that always sent me into a self destructive seesaw of highs and lows. Stick to snacks of meat, cheese, eggs and nuts, until you have tested other snacks to see what effect they have.

Hope that helps!

And please, ask any questions you like!

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