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Reactive hypo from hell

Discussion in 'Reactive Hypoglycemia' started by FeltCactus, Jan 3, 2021.

  1. FeltCactus

    FeltCactus · Member

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    I'm a woman of 46, normal weight.
    Since my teens, basically since working I get what seem to be sudden bouts of reactive hypoglycemia. Symptoms include everything you can expect, plus at times very low blood pressure, nausea and abdominal pain. Triggers seem to be being late for one of my endless meals, being active before breakfast and eating less carbs, more protein. A typical example for the first is sitting in a meeting that overruns and I'm missing my second breakfast. When I get up to walk back to my desk I get hit. Unfortunately, symptoms last into the evening and often return the next morning to subside again in the evening. A proper crash can last for up to 5 days.

    So yesterday I experimented and had a breakfast composed only of protein and some fat instead of my usual high carbs with some protein. Just over an hour later the crash came on. Blood sugar dropped by 10mg/dl instead of going up by about 30 but recovered quickly again. I would not have been able to work until 7 in the evening if this was a working day. Btw, traveling in countries where I had only little carbs I felt miserable for the whole 2 weeks and never improved during that time. So now I know this can be brought on by eating too much protein and/or fat indeed.

    Any other health issues? There's something I'm born with and will hopefully have investigated from next week. I can't fast for more than 2 hours as I just run out of energy when I'm active (that's not a crash as above). Thus if I stroll through a museum or work I just bonk after a max of two hours. I can run a max of 10km, but only very slow and my legs hurt the whole time. I can't walk up mountains without having a microbreak every 50-300 steps for the same. It feels like my body just doesn't know what to do with the oxygen, or how to oxidise fat for energy and I'm running purely on glycogen. Which of course is limited. If I exercise above the anaerobic threshold I might end up in hospital with a mild acid/base problem. Btw, I can only keep this up for a max of 12 minutes. Thus while I run for 6 years now I still can't do tempo runs. I feel that lactic acid might play a role, but I don't know whether it's too high or low. I never had a blood gas test, btw. Thus I have no idea what's going on.

    Thus, anyone in the same boat or with any ideas?
     
    #1 FeltCactus, Jan 3, 2021 at 9:50 AM
    Last edited: Jan 3, 2021
  2. EllieM

    EllieM Type 1 · Well-Known Member

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    You're posting in the right forum and hopefully will get some help soon from the experts but just some thoughts from an ignorant T1.
    Have you gone for a diagnosis from the medical professionals - eg insulinoma is treatable. There are a series of tests which the medical professionals can and should do (provided they are not distracted by covid?)
    Reactive hypoglycemia is triggered by carbs, so the RHers avoid them. If that's not your trigger then hopefully the doctors can diagnose and help.

    Good luck. As a T1 I get hypos and they are the worst. I cannot imagine the pain of getting endless hypos without being able to avoid them. Lots of virtual hugs.
     
  3. JoKalsbeek

    JoKalsbeek Type 2 (in remission!) · Well-Known Member

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    Nowhere near your boat, sorry. But.... Your hypo's don't sound especially reactive, to be honest.... RH is when you get an overshoot of insulin when you eat carbs. You get an overshoot no matter what you do, from the sound of it. Time to go back to the doc and request a referral to an endo, and get some research done into what your pancreas is up to. Bloodwork, ultrasound, the works. Something's off and this is affecting your quality of life to an extent where more tests are more than merited. Maybe a continuous glucose monitor for 2 weeks would help paint a clearer picture, especially if your doc's reluctant to help.

    Good luck!
    Jo
     
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  4. FeltCactus

    FeltCactus · Member

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    Hi Jo,
    after having written this down I do started to think whether this actually is a reactive hypo myself. Yes, my glucose took a nose dive about 1 hour after eating this high protein/low carb breakfast. But I get the same crashes when I'm active before breakfast or one of my many meals is delayed. Maybe my glycogen stores are depleted in the morning and I don't have access to another energy source. Which would come back to my exercise and fasting resistence. Hmm... Yes, I think I will add this to the list of problems I'll discuss with a specialist next week.
     
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  5. FeltCactus

    FeltCactus · Member

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    Hi Ellie,
    nobody has ever looked into this. I've been living with it for at least 30 years. It probably started when I started working and could only eat at lunch time instead of constantly eating. Oh yes, I had glucose tests, but they were always normal. If there's only one very short dive about an hour after a meal then that's not surprising. I'll discuss it next week when I finally, FINALLY! have an appointment.
     
  6. Brunneria

    Brunneria Other · Moderator
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    Hi and welcome,

    in your shoes I would be pushing for a proper investigation for this.

    reading your post, a couple of speculations spring to mind.
    Firstly, if your body has been running on fast acting carbs for the last few years (or decades), then the transition to keto, and running on fats/proteins would take weeks or months of consistent keto eating. Certainly far longer that 2 weeks, or 2 hours after a protein/fat breakfast. Digesting protein and fat takes time, several hours, and blood glucose can easily drop in the gap between eating a steak, or eggs and bacon, and the proteins being digested enough, and being converted into useable energy, which is when the blood glucose would start to rise again. If your body isn’t used to this slow rise and fall, and isn’t ‘fat adapted’ then your ‘bonk’ is not unusual, or unlikely. You may find it useful to read up on ‘carb flu’ (electrolytes) and ‘fat adaptation’ (where the body learns to switch smoothly from glucose burning to fat burning. A better solution might be to ease slowly into higher protein and fat, while easing slowly into reduced carb. For example, eggs and bacon with toast and butter. Then, over several weeks, reducing the toast portion while increasing the portion of eggs, bacon and butter. That would give your body time to learn to fat burn.

    from what I have seen/read/experienced, people seem to experience difficulty in switching to keto directly in proportion to their previous ‘carb dependency’ - and from your description it sounds like your body is extremely dependent on constant carb top ups.

    My other suggestion would be to see if you can get a referral to an endocrinologist who is willing to investigate properly. How much insulin you produce, what your current endless carb top ups are doing to your blood glucose over the entire day, what a 72 hour glucose tolerance test does to you... that sort of thing. You would be VERY lucky to find such an endo, but it would help to answer your questions. And it would eliminate (or reveal), other factors, such as an insulinoma.

    good luck with it all. I know how utterly stressfully exhaustingly miserable it is on the hyper/hypo rollercoaster, with no healthcare support and food as your only DIY medication. It is a v depressing and lonely place to be.
     
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  7. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    Hi @FeltCactus
    Welcome to our forum.

    I have reactive hypoglycaemia and had all the tests.
    I concur with the others, you definitely need those tests. Even if it isn't RH!

    What you're describing is not as I know RH, one of the diagnostic tests is fasting for 72 hours under supervision. If you go hypo it is not RH. If you don't go hypo, it more than likely is RH. I fast all the time, I use intermittent fasting, I don't have breakfast, or anything until mid afternoon, then if I feel like it, have another meal about 6pm, then nothing after seven, so I know I'm not going to hypo during the night.

    Did you get advised to eat so often?
    I did when I was first seen by a dietician after diagnosis. That is the usual medical advice, it didn't work for me. That was before my fasting test. Since talking to my specialist, he advised a low carb diet and after finding answers on here, have been very low carb for years. No hypos!

    Have you had any other conditions?
    Could the meds from that be causing the symptoms?
    Are you allergic or intolerant to certain foods, like I'm lactose intolerant.
    Have you had your thyroid checked?
    It could be a lot of conditions involving the metabolic system.

    Finally, if you have a blood glucose monitor, a glucometer, do you test your fasting levels? Do you keep a record of your food in a food diary?
    This was how I found out about what certain foods did to me. I was really surprised.
    A specialist would be really interested in how you react after food.

    I avoid carbs and sugars as much as possible.
    My fasting levels are always normal.
    My Hba1c levels are normal. 37. last blood test in October.
    I only react if I eat carbs. I don't!

    Stay safe and let us know how you get on.
     
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  8. Dr Snoddy

    Dr Snoddy Type 2 · Well-Known Member

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    A long shot. Could you be deficient in glucagon? This is the hormone that converts stored glycogen into glucose. An endocrinologist should investigate this.
     
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  9. FeltCactus

    FeltCactus · Member

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    Hi all, thanks for your answers. I was not advised to eat so often. Basically I crash when I don't eat so often. It happens when I'm active before breakfast (a short 3km stroll to a specialist bakery), when I miss one of my many meals, when I eat too much protein and fat at the expense of carbs. I also crash when I walk for about 2 hours, or slowly run for 80 minutes. Yes, I guess I hit the wall from doing very little.

    I did see a doctor yesterday, who for now did a lot of blood tests and then we discuss on. Turns out I had a mild lactic acidosis right at that moment. From cycling 2km to the hospital and sitting around for 2 hours. Hmpf. I sometimes do feel utterly miserable after mild exercise, exactly like I felt yesterday. So I guess that explains part of the problem. Or adds more confusion. Ketones were not measured in blood but in urine, and there weren't any. Thus that's fine. But yeah, high serum lactate with lowish capillary pH and bicarbonate. So something IS going on.

    Dr. Snoddy: I don't think so. If you ask me, for me it feels like my body is running mostly on glycogen and not really on fatty acids. Or at a much higher anaerobic level at very low intensity as it should. Every relaxed mountain hike feels like a cooper test for me. 50-300 steps during which my lower legs hurt immediately and I'm breathing like crazy but still don't feel relaxed, short break and problems are immediately gone, walk on and the hurting legs and oxygen-depleted air is back. Only uphill, mind! For Ben Nevis I needed 5.5 hours to get up, and 2.5hrs down. Crazy!
     
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  10. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    I would wait for the results of your blood panel results to see what the next steps are.
    I would definitely recommend googling lactic acidosis, it is a metabolic condition, which obviously is having an impact on your health. So if it is, you can be prepared.

    Stay safe
     
  11. FeltCactus

    FeltCactus · Member

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    I know what a lactic acidosis is, yes. Still not happy to see this. Ugh!
     
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