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Reactive Hypoglycaemia
- Thread starter Lamont D
- Start Date
Miss.T. Morning
Active Member
@Winnie53, Thank you!
Tara2401
Newbie
Hi there
I am currently undergoing investigation for reactive hypoglycaemia. I’ve been signed off from work due to a fainting episode. I am a swimming teacher in the water for babies and pre schoolers.
For years I have had low energy, irritability, shaking, excessive hunger, anxiety etc etc.
My fasting blood glucose is always 3.7. I’ve had the 6 hour glucose tolerance test and I went down to 2.9 after 3/4 hours and then it started to increase on its own. The hospital said that isn’t a true hypo, they want me to get to 2? Is this the same for others? They are sending me for a mixed meal tolerance test soon.
I’ve purchased a Dexcom to try and get a grip of any pattern occurring with foods I’ve eaten and doing a food diary. It’s been a huge eye opener and even more surprising the hypos I’ve been experiencing at night, as low as 2.4. Then the next day I am just so out of action. I can’t go back to work in September until I can show that I have it under control but at the moment it is very erratic and early days.
I feel quite overwhelmed by it all.
Thanks Tara
Dear Lara ,
Sorry to read about your problems ,but I think you will finish up getting ,some ,good advice ,and a lot of self help .Let me explain ,I’ve been an injecting Type 1 for over 55 yrs ,had many hypos but ,I think that there are several causes ,or types of hypos ,eg I’ve had hypos with BG of 5 ,(confirmed in ambulance ,)and other times ,still playing good golf at BG of 1 Diabetic specialist are very good at looking at hypos ,but seem to know very little about the range causes .
Hope you get over this
WJohn
kokhongw
Well-Known Member
Anything below 3 mmol would typically require some attention. The first time my dad had a 2.0 he was in unable to respond, in a seizure mode, rather frightening for my mum who was his main caregiver. We had to call for emergency service.
Sorry to hear of your symptoms Tara and they sound like RH. During my glucose tolerance test, the 6 hour one, the team wouldn’t let me go below 3.2 and effectively pulled the plug by feeding me and stopping the process. By that time I was cognitively impaired, very pale, cold and shaky and they didn’t want me to get worse.
The food diary is such a great idea and can be very helpful for when you see a dietician with RH experience - something I can’t recommend more highly. Low GI foods are so vital to feeling better. To help with your research I always suggest new people to this condition invest in a book about one persons journey through RH “Reactive Hypoglycemia - A personal journey into managing this condition” by KE Lytle. Whilst everyone’s RH is slightly different the main rule book is the same and you will find your carb levels and happy foods over time. I have lots of snack suggestions if you would like them? Every 3 hours and before bed. Until my condition settled down I was also snacking at 3am but no longer need to do that. Shout if you need help with anything. this forum is very supportive..
Tara2401
Newbie
Thanks ever so much for all the replies. I feel like I have been like it for a number of years but I always put it down to being exhausted with two young children who didn’t sleep, but now they sleep and I really just don’t feel any better.
I’m currently having to eat every 2/3 hours. Any snack suggestions are very welcomed please. Trying to follow a low carb diet, but every day is so different and I’m struggling to recognise any patterns. I’m worried I may be diabetic later on in life and this is just the beginning. I am 27 years old.
Thanks xx
I’m currently having to eat every 2/3 hours. Any snack suggestions are very welcomed please. Trying to follow a low carb diet, but every day is so different and I’m struggling to recognise any patterns. I’m worried I may be diabetic later on in life and this is just the beginning. I am 27 years old.
Thanks xx
Lamont D
Oracle
Hi @Tara2401 and welcome to the forum.
Knowing what your hypo level is, can be a personal thing as everyone has there own personal experience of a hypoglycaemic episode from around normal levels to go as low as 2mmols. Everyone has different symptoms, everyone has different responses to food and quantities of food wether carbs or protein and fats will be a factor. That is why a food diary is a must!
RH can be termed as a carb intolerance, so, your actual response to food which are carb laden will always trigger a response. A food diary will give you the results of the response to your meals.
If like me, I'm so intolerant to any carbs, that I have found that avoiding them totally gives me greater control of my blood sugar levels. Which is where you do need to be, if you do have RH.
Your eOGTT results are similar to mine, a true hypo according to my endocrinologist is below 3.5 and I find it irresponsible to allow you to go below 3mmols. Was an endocrinologist in charge of the test?
The reason you bounced back was because your brain needed glucose and your liver provided, but because of the high levels of insulin, it probably took some time to respond.
If you have RH, the insulin response after food is very weak, so you get a spike of glucose, as the glucose levels rise, your pancreas delivers insulin to counter the glucose, this is called an overshoot, this drives blood sugar levels down into hypo levels, and then your liver responds because of the low glucose, and your blood sugar levels bounce around, this gives you the symptoms.
You have hypers and hypos. Your fasting levels are in normal levels, like mine, but because I don't have carbs, I don't bounce around at all. I'm in control!
If you think about it, your fasting levels are in normal levels, if you don't eat, they will stay there if you have RH! Only food or drink will cause the reactive part of the condition. Having normal blood sugar levels will help you with control, lesser symptoms, better health and a better life, I work full time in a demanding job and I couldn't do it without control.
The mixed meal test is because of the amount of carbs and protein in that mixture and your response to it! It is not necessarily a definitive diagnosis but helps understand what is going on. Try and keep a record of what your blood sugar levels are during the test.
Ok, what you need to realise is the condition can be controlled and you don't have to suffer the symptoms, as you begin to find out what foods are causing this. There is no magic pill or cure that can correct the reactive hypoglycaemia. Just control, I myself have not had a hypoglycaemic episode in over four years now.
The reason for the meal every three hours is to prevent hypos, but if you don't trigger the hyper because of the carbs, then you won't go hypo.
No carbs, no hypers, no hypos!
I would advise a very low carb diet and discover which foods you are intolerant to!
I would say that most doctors, nurses and any medical advice is usually based on nhs advice for Hypoglycaemia, and doesn't take intolerance into account. You need a specialist endocrinologist who has experience with Hypoglycaemia. And even then, most will advise complex carbs or healthy carbs, but for us RH ers healthy carbs are almost certainly not good for our health.
Finally snacks, there is a list of low carb ideas in the low carb forum. But if you continually snack, you could be eating too much, it's a balancing act, small low carb meals are usually better, a small salad, some full fat Greek yoghurt with a few berries, a piece of meat, some vegetables, nuts, any bite that won't trigger the hyper will be better, than snacking all the time.
There is a lot of great information in our forum from many RH ers. Have a read, and again welcome to the forum.
Let us know how you get on.
Best wishes
kokhongw
Well-Known Member
It may also be helpful to note that glucose level is half the equation when it comes to hypoglycemic events, the other half is to have adequate ketones. The problem most of us have is that we have too much circulating insulin, which prevents substantial ketones production. So part of the investigation is to understand what is triggering the excessive insulin production.
A case in point is a recent twitter post of a fat-adapted athlete who ran a race with glucose < 2.5 mmol for more than 11 hrs...but has ketones level of > 4 mmol to compensate.
A case in point is a recent twitter post of a fat-adapted athlete who ran a race with glucose < 2.5 mmol for more than 11 hrs...but has ketones level of > 4 mmol to compensate.
Tara2401
Newbie
Thanks again for your replies. It was a specialist clinical nurse leading the eOGTT, I asked them to stop after over 5 hours as I felt so bad and fell asleep I was so exhausted, she thought I had passed out. They were happy to stop as my levels had got back up to baseline. I don’t understand why they want me t go so allow. She said that they want me at the point of passing out so they can send the blood off to the lab to check for c-peptide or something? I spoke to my GP about it as I said that I feel I may be fobbed off now as I haven’t got low enough and he suggested redder I f me to another trust if needs be.
I don’t know if this is relevant but in my blood testing urea level was really high at 11.9, they said I need to drink more but one of my symptoms is that I am constantly drinking as well as eating.
They’ve also found a small cyst on my pituarity gland but also said that this isn’t really relevant at all to the hypos.
I had two last night, one of 2.7 and one of 2.4. What would you eat in the night?
I don’t know if this is relevant but in my blood testing urea level was really high at 11.9, they said I need to drink more but one of my symptoms is that I am constantly drinking as well as eating.
They’ve also found a small cyst on my pituarity gland but also said that this isn’t really relevant at all to the hypos.
I had two last night, one of 2.7 and one of 2.4. What would you eat in the night?
Hi,
You are having a really miserable time of it!
If your RH is like mine, then I wouldn't be touching carbs at all. In order to keep from the hyper/hypo cycle I would try a day of just meat, fish, eggs and cheese. And keep a diary, and track your blood glucose.
I found that carbs, ANY 'carbs' used to treat a hypo just gave me knock on swings and a yoyo effect.
And @kokhongw is perfectly right - getting into ketosis and staying there is a fab preventative for RH.
As for your avoiding hypos at night... for me, the answer is simple. No carbs. and fill up on meat or cheese or nuts. If that means a snack of cold meat or a handful of nuts before bedtime, then so be it. Those would keep me rock steady all night, although I do tend to dip a little around 2.30 am. I think most people do. But if it happens slowly, the body just brings you slowly back up under its own steam. No need for drastic glucose treatments, because for me, that would set me off on the yoyo for the rest of the day.
And as for the pituitary gland link. Yeah, I have a tumour on it. But they have only linked that to excess prolactin, not to anything else. But I long ago lost faith in Western Medicine having ALL the answers. Now I just treat the symptoms of RH by avoiding them completely. No carbs. Problem solved.
Hope that helps.
Lamont D
Oracle
If your GP is willing to refer you, then by all means, ask him/her to do so, but as with all things, ask for a specialist who has experience with Hypoglycaemia.
The idea of you going so low that you collapse is truly irresponsible and unbelievable, if you hypo because of the glucose, then a 3mmols level is enough for a diagnosis that you do indeed go hypo as a reaction to the glucose, because nothing else will do that, however, there are other conditions that will have the same results such as insulinoma, but you need the diagnostic tests to get the results.
Could you give us an idea of a typical days food and drink intake?
This will help us understand, why you are getting the hypos.
As I'm in ketosis and use intermittent fasting, I don't have issues with hypos during the day or night, fasting seems to be my default position, as Brun said, no carbs, no hypos. As I said, I have a lot of food intolerance, I've just learned to avoid them, and it's helped me so much.
If you do have RH or some form of hypoglycaemia, then it's probably food orientated and its similar to allergies. If you have a nut allergy, the medical advice would be to avoid them. If you have an intolerance to carbs, why do they insist on you still eating them?
Best wishes
Tara2401
Newbie
This is so helpful, thank you. I’m definitely going to follow the Keto diet, just a bit nervous as I have two young children and I worry how it will fit our lifestyle but I also need to do something drastic and desperately.
My daily diet would be (I am hungry all the time!! And eat a lot but don’t really gain weight - I’m 5ft 7, 140 lbs). I am maybe on 2000-2500 cals a day, the doc wants me to eat 3000 to see if I can amend the urea levels results?
6am breakfast:
Multigrain toast and eggs (dietician advised the multigrain)
Maybe a protein bar too (grenade)
8/9am:
Apple and/or Greek yoghurt total 0%
11am:
Maybe some meat to snack or nuts
12/1pm:
Meat and veggie stir fry (no noodles) with eggs fried into it
Jelly pot (no added sugar 10cal)
3pm:
Maybe a fruit ice pop, fruit or same yoghurt as above
5pm:
Tea which is with family and usually meat and veg, no carbs.
7pm:
Maybe a yoghurt or another veggie stir fry
Where would I even begin with the Keto diet? I know I follow a low carb diet already but not very high in fat. I can be liberal with counting cals and macros if I need to be. What would you suggest I aim for?
Lamont D
Oracle
Ok that is helpful, the majority of your intake through the day is really low carb except your breakfast.
If like me, your blood sugar levels spike because of grains, despite being low GI, it is still so full of carbs, most dietary advice doesn't recognise this, it is not the how much but what kicks it off, the multigrain toast would certainly spike me, the eggs are fine, don't know about the protein bar, you would have to look at the carbs per bar!
So you start with carbs first thing, so you are not in control early in the day and of course until you gain control your symptoms are obvious. Feeling hungry, always wanting more and thinking constantly about what to eat is symptoms of the condition.
I have found, that eating something that won't trigger the roller coaster ride of blood sugar is always important, I have eggs, bacon or some yoghurt with berries or fast. But this me, of course depending on my working day.
I have never counted calories, because I realized early after diagnosis, that my body can cope with little or no food. We have enough to think about to worry about such things.
Yes, I would advise having a go with the Keto diet and probably trying fasting once you are in ketosis. It's not easy to do or maintain but the benefits are really good.
You'll get your energy levels back and the easing of symptoms and you should feel a lot better then your health should improve.
You have to be so careful, for all the reasons above, RH is the body's reaction to food.
So, what foods we eat are so important.
Best wishes
If like me, your blood sugar levels spike because of grains, despite being low GI, it is still so full of carbs, most dietary advice doesn't recognise this, it is not the how much but what kicks it off, the multigrain toast would certainly spike me, the eggs are fine, don't know about the protein bar, you would have to look at the carbs per bar!
So you start with carbs first thing, so you are not in control early in the day and of course until you gain control your symptoms are obvious. Feeling hungry, always wanting more and thinking constantly about what to eat is symptoms of the condition.
I have found, that eating something that won't trigger the roller coaster ride of blood sugar is always important, I have eggs, bacon or some yoghurt with berries or fast. But this me, of course depending on my working day.
I have never counted calories, because I realized early after diagnosis, that my body can cope with little or no food. We have enough to think about to worry about such things.
Yes, I would advise having a go with the Keto diet and probably trying fasting once you are in ketosis. It's not easy to do or maintain but the benefits are really good.
You'll get your energy levels back and the easing of symptoms and you should feel a lot better then your health should improve.
You have to be so careful, for all the reasons above, RH is the body's reaction to food.
So, what foods we eat are so important.
Best wishes
Lamont D
Oracle
Hi again, I will add, that it is a personal choice of the best way to try a ketogenic lifestyle. Your likes and dislikes are different to mine, I only eat salad vegetables, my protein is different, I cannot cope with dairy, grains, and so on.
And worst of all, potatoes are really bad for me, doesn't matter how I cook them!
Best wishes
And worst of all, potatoes are really bad for me, doesn't matter how I cook them!
Best wishes
Hi there
The list of food is really helpful. Your breakfast would cause me problems due to the bread (carbs) and protein bar (sugar & carbs). I am lucky that I can eat oats so I have porridge for breakfast with yoghurt and a few raspberries. The alternative is an omelette (plus cheese, mushrooms etc), or eggs and bacon. Or a yogurt and spinach/kale smoothie with added spirulina, linseeds and a few berries.
Snacks - red pepper and hummus, an apple with peanut butter, sardines on ryvita/oat cakes, celery and cheese, tinned tuna/mackerel with mayo and a few olives, cottage cheese and avocado. The list is endless!
I always carry an apple and some nuts in my handbag in case I need to snack while out and about.
Avoid potatoes esp mashed or baked, rice and pasta. Sweet potatoes or new work for me but start with small amounts. No desserts. Eat cheese instead. No alcohol without food and be wary of caffeine. No fruit juices or cordials or low calorie tonics.
The only bread I can eat is Ezekiel 4:9 ordered online but only one slice per day.
I think you have enough to handle without worrying about calorie counting. Yes you will be eating more fat and protein but if you feel better you can then keep an eye on portion sizes. I lost half a stone straight away but have now levelled out.
Keep the diary going. A reaction can be as quick as 20 minutes or 2-3 hours.
Just looked up Grenade protein bars. They are low sugar but stacked with polyols which is a replacement sweetener! They are also quite high in carbs. Most bars like these are not helpful to people with RH.
Mikeysclass
Newbie
Right guys I have been suffering from reactive hypoglycemia,I stick to the same diet low carb diet and usual decaff drinks , now things have changed having hypo every day now even though sticking to the same food.any suggestions.
Lamont D
Oracle
Hi, and welcome to our forum.
Can you give us an idea of what has changed in your diet lately?
If like me, you can't stick to a total regime of the same food that you started to have success with to stop the hypos, you will try different proteins and other vegetables, also dairy, nuts and so on. Is there something that upsets you, making you feel worse?
With RH it has to be food related unless you have started taking other meds for another condition.
Has your meds changed?
Any other medical conditions that could trigger the hypos?
In my experience, I have to be careful with so many different things, which includes taking meds that are usually have lactose in, anti biotic that have no sugar in them. Also vegetable based oils and cooking oils.
There are a lot of food additives that I also have to avoid in production foods.
I have found that fresh food is usually best for me.
Could you give us an idea how you got diagnosed?, it is always interesting how diagnosis is reached, what tests have you had?
Best wishes
Hello everyone,
I am new here. I have been having some postprandial symptoms that seem hypoglycemia-like. I am going through this with GP and specialists, but it has taken nearly a year to finally get to an endocrinologist.
So while the medical investigation proceeds at a glacial pace, I was thinking of trying a low-carbohydrate diet off my own bat.
Here's the problem: I am vegetarian, cannot eat eggs (except in small amounts), and cannot eat high-fibre foods (e.g. lentils, chickpeas, hardcore salad stuff).
(The egg and fibre thing relate to bowel surgery that I had many years ago.)
Is it possible to eat a low-carbohydrate diet with these restrictions? I have tried and failed several times as I am stumped at what to eat and I live in a small town so no suitable take-away or restaurant options. I just got overwhelmed trying to prepare meals from scratch.
Breakfast in particular is a problem - no fruit, no toast, no porridge, no eggs. What to eat? Plus I always feel a bit queasy so there's no way I could chomp down on a plate of stirfry first thing!
I guess I am prepared to go non-veg to see if the change in diet helps.
I would really appreciate your advice. Have tried one dietitian but she wasn't any help. A, gradually reading through thread and learning a lot.
Cheers,
Sarah
I am new here. I have been having some postprandial symptoms that seem hypoglycemia-like. I am going through this with GP and specialists, but it has taken nearly a year to finally get to an endocrinologist.
So while the medical investigation proceeds at a glacial pace, I was thinking of trying a low-carbohydrate diet off my own bat.
Here's the problem: I am vegetarian, cannot eat eggs (except in small amounts), and cannot eat high-fibre foods (e.g. lentils, chickpeas, hardcore salad stuff).
(The egg and fibre thing relate to bowel surgery that I had many years ago.)
Is it possible to eat a low-carbohydrate diet with these restrictions? I have tried and failed several times as I am stumped at what to eat and I live in a small town so no suitable take-away or restaurant options. I just got overwhelmed trying to prepare meals from scratch.
Breakfast in particular is a problem - no fruit, no toast, no porridge, no eggs. What to eat? Plus I always feel a bit queasy so there's no way I could chomp down on a plate of stirfry first thing!
I guess I am prepared to go non-veg to see if the change in diet helps.
I would really appreciate your advice. Have tried one dietitian but she wasn't any help. A, gradually reading through thread and learning a lot.
Cheers,
Sarah
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