Please help! Anyone been told this by a GP??

She is right. On a low carb diet, a person can develop "physiological insulin resistance". Essentially, temporary insulin resistance that goes away once you reintroduce carbs into your diet for a few days. So, if you do an OGTT while on a low carb diet, you might get a false positive for diabetes. However, if you do one after eating carbs again, it should be an extended one again.

Also, since you probably still have reactive hypoglycemia, it may not be very pleasant to start eating carbs again.

With regards to eating twice a day, that should be fine, as long as you're eating enough.

hi @KerryWilloughby !!!

welcome to the forum !!
RH is a tough one to deal with -- I am tagging @Lamont D and @Linagirl
to offer some support

hugs [[[hugs]]]

Hi and welcome!

I don't have RH but I do know that we are all intolerant to carbs already, whether we eat them or not, because too many make us feel ill and they all raise our blood sugar levels. Why would we eat something that we are intolerant to, or that makes us ill? With RH you will struggle if you eat too many carbs, even low GI ones, because your pancreas will over-produce insulin that will bring your levels down with a crash. (as you must know from experience).

Plenty of us don't eat fruit. I don't, other than half a dozen strawberries in a week. We get our nutrients from other foods.

Which nutrients in particular do you think you are missing out on? Have you any symptoms of vitamin or mineral deficiency?

Eating twice a day is fine. As you say, plenty of people do it. I do. All I have for breakfast is a coffee with double cream, then nothing till gone 1pm when I have lunch.

Is it only nutrients you are worried about? How are you feeling in general on low carb? If you are managing well with no RH hiccups, why change? You know your body better than your doctor does.

I'm tagging @Lamont D and @Brunneria who may have better advice for you.

Hi and welcome!

Well, my experience with RH is that the lower carb i went, the better i felt.
I flourished on one or two very low carb higher fat meals a day, especially when I was on less than 20g carbs across both this meals. Felt great.
But then the medical mantra of 'eat carbs, low GI carbs, every 3 hours' never worked for me. My body and my personality much prefer proper meals, much less often than that. But they have to be very low carb or i feel dreadful, no matter how often I eat.

And for me, an apple would have been too many fast acting carbs in one hit, since a large apple could easily have 30+ grams of carbs.

As for your doc saying that it is necessary to eat carbs... Nope. It isn't.
Going very low carb and then reintroducing carbs does cause issues to start with, because it takes a while for the body to readjust.
Whether you will feel better in the long run will depend on whether your new increased intake of carbs is enough to trigger your RH. If it does trigger it, you will feel dreadful, long term.
If it doesn't trigger it, then you will have to count carbs and monitor very carefully, to avoid accidently over-carbing, which will trigger it anyway.
But you may be able to find a middle comfort zone of more carbs and steady blood glucose, which would be great.

So, if you want to follow your doc's advice, then go for it. Your experience will (hopefully) be better than mine when I have done such things. It is worth trying.

Do you have a meter so that you can track your blood glucose and have evidence of any hypos and hypers that may occur?

Carbs release quickly, and the spike is often inside the first hour, so just testing at 2 hours wont show the peak, although comparing 1 and 2 hour reading may give you an idea of whether you are dropping, and how fast.

If your experience is like mine, spotting the peak may well give you an indication of whether you have a hypo incoming.
For me, the higher and faster the initial spike, the harder and lower the resulting hypo.
I found all of this out using a Freestyle Libre, rather than finger prick testing, but if you can spot the peak, i think you will find it very informative.

Hope that helps!

Hi and welcome to our RH forum.

Everything above is so relative about how to live a decent life with this condition.

I have 'Late Reactive Hypoglycaemia'. Which means that I have a very similar condition to yours though no two or exactly alike, the symptoms differ from each of us.
Eating every three hours is great advice if you can tolerate some carbs but in my experience it can't be right. I can't tolerate even a little amount but I can eat little pieces of fruit throughout the day. I eat very low carb. I eat only when I want, I fast, using intermittent fasting as much as I can.
The logic in not initiating excess insulin is what drives me, it also makes me healthy.
The relief that not having to think about food all the time is so enlightening!

My endocrinologist put me on a drug called Januvia, otherwise known as sitagliptin.
What it does is change the chemistry of the release of the first insulin response.
That prevents the spike going too high, thus preventing the hypo if I don't eat obviously. But I don't have to eat every three hours if I don't have carbs!
My endocrinologist is still adamant that I should have a certain amount of carbs but I don't!! I'm perfectly happy without them and healthier.

You are currently on a viscous circle because you eat too many carbs which produces the hyper and of course the excess insulin which rebounds to a hypo if you don't eat. The symptoms are caused by the fluctuating blood glucose levels, up and down all day. It's no wonder you are frustrated and feel that everything is s#!t.

You say you are having a fasting test, I take it, the test will be an extended fasting test. 72 hours in hospital?
I have had that, it's hard at first but well worth it because it eliminates other pancreatic conditions.
One of the good things to come out of it, is how clear your brain becomes. Very lucid.

Testing is so important, finding your spike and seeing what foods you can tolerate and seeing the trends in your food diary.
A simple thing like a food diary over your ten years of struggling would have helped so much, not only to you but your doctors.

The thing about doctors is the amount of research is pretty poor regarding RH.
They can only follow what is in the text books, even this site in its description on the home page says eat every three hours. It helps some but not others.

We do have to find what works for us individually, the balance of what we eat is important and always we have to be so careful about the portion size and exercise can be beneficial to how our bodies cope. Doing a fifteen minutes walk after eating is so good.

Do have a look around and get the knowledge necessary to really control your condition like I have.

Very low carb works.

Again welcome to our unique club!

No you are certainly not alone in this!

KerryWilloughby said:

Thank you all so much, it really makes me want to cry reading that I'm not alone and you all know what it's like!

Unfortunately it's literally a 12 hour fasting blood test so nothing particularly helpful other than to see if I'm actually diabetic.
Not sure if it will lead to a extended OGTT down the line like last time though.

Going low carb I felt the best I had in years. And felt like I didn't realise how bad I had been feeling until I wasn't anymore.
It obviously works for me and I can't wait to get back to it now. Just want all of this over and done with and would be nice if they could give me some sort of medication to help me be able to have a slightly more varied diet, but if not I just want to get back to my low carbing and intermittent fasting.

My gp actually scoffed when I told her I eat 2 meals a day

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The fasting blood test will probably not throw up any clues or prognosis uses they include c-peptide, GAD or for a test checking insulin levels.
It should have been done on your eOGTT, that's when I got mine done.
If you feel better doing it your way, most GPs should not argue or criticise you for trying to be healthy or feel better.
I still get a little criticism myself because it's Easier to say I stay away from carbs, but that's there problem not mine!
Having the knowledge and doing what works for you is more important.
Keep asking and let us know how you get on.

Best wishes

Learning stuff already! Result!

I don't think there is much mileage in asking whether 9 is high, because there are a lot of people who go higher, but the key thing is if you get to 9 and then drop sharply (and yes, a drop like that is a fairly sharp one) and it makes you feel rough, then it is something worth avoiding in future. Also, keep testing. Just because you were at 4.7 doesn't been that you had bottomed out. You may go lower, and it is worth recording.

With RH there are several factors which affect things - the speed of the rise, the speed of the drop, how you feel, what you ate, what you ate it with, and whether it causes a hypo, or a feeling of hypo because of the speed of the drop.

For me (and remember, I can only speak for myself because we RHers vary a great deal)
I could cope with a 9 and not hypo IF the meal had enough fat, fibre and protein in it to make a slow hump blood glucose curve, rather than a sharp rise and fall.
But eating low fat carbs, without protein or fibre will give me a classic sharp rise and drop followed by a hypo at lower than 9.

Also, for me, certain foods (the ones containing gluten) will give me a much greater chance of a hypo and feeling grotty.

Hope that helps!

So, what did you eat?
And have you recorded it, including the portion sizes and the timings?
Keeping a record is a lot of phaff, but it really is useful when you start to see the patterns emerge.

Hi, that is quite a drop!
But probably a normal spike, it depends on what you ate!
If it was carb laden then I've had higher spikes, if it wasn't that high carb, then it's about right (how do you tell?) If it was low or lower, then it is rather high.
The way you tell, is by keeping a food diary and recording everything.
And if that was only a few carbs in your meal, then that particular food needs to be avoided. I know it sounds complicated but you have to do this for quite a long time until you know what not to eat. It's all about experience and experimenting.
The usual suspects are the likes of starchy vegetables, anything with flour, other grains including rice and pasta. And finding other intolerant foods such as dairy for me because the lactose is too much to kick in my insulin response.
You have to avoid low fat foods, these are laden with sugars. Full fat foods are really healthy for us.
Best wishes.

Did you weigh the basmati rice? i.e. how small is "small"? I think 9.6 is quite high.

Did you keep measuring your BG to see how low it went after it got to 4.7?

KerryWilloughby said:

I'm keeping a strict food diary and blood sugar diary this week while I'm trialling the reintroduction of low GI carbs (at my drs request).

This is following my low carb diet I've been doing since November so to be fair my body isn't used to carbs so I guess it may settle down in time.
This was following a meal with a small portion of basmati rice which I've not had since before November.

I've felt the worst I've felt today for a long time having carbs again! Even when my sugars were within the normal range I've just wanted to sleep and had no energy to do anything all day!

Will keep testing. And am looking forward to seeing what my numbers are like when I'm back on low carb again too!
Will be so interesting to see which foods effect me more without having to get to the point where I feel unwell to realise certain foods are a no no!

Thank you all

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Am I correct in thinking; If you eliminated carbs more or less completely for so long, your body will have to switch 'back' from Ketosis (burning fats for fuel) back to burning carbs and glucose as its prime energy source? This could be contributing to feeling so rubbishy if you're in that transition adjustment stage (?)
- I do know I haven't found a doctor or dietitian yet who hasn't ''sung of their guessing NHS songsheet'' on giving advice of how best to manage RH. I've had some pretty ridiculous advice in the last few weeks alone and just found trial and error and keeping my own records, finding what works for me personally to be the best way forwards. The nausea could be due to stomach acid I wonder as our stomachs aren't really designed to be so carb/roughage free, especially for so long.. When I was on very low carb/carb free I know I got a lot of nausea and found it better when I have small aounts of brown rice and maybe an oatcake here and there throughout the day to dry that 'urrgh' feeling up. Fruits also turned my stomach especially acidy ones. (Just thinking out loud here!) Hope you can find your feet again!

basmati rice increased BG more then eating a log of sugar.