Reactive to exercise?

Hi and welcome

Could you just clarify a couple of things?
- are you diabetic?
If so, what type?
What meds (if any) are you on?
And you say you get reactive hypos, but you don’t think you have RH. What makes you think that?
Thanks!

Ah.
Have just seen yr other thread here
https://www.diabetes.co.uk/forum/threads/low-carb-for-unexplained-hypos.159732/
Where you give more detail.
- you aren’t diabetic
So you won’t be on any meds for that.

I’m not a very active person
But I have definitely had hypos (I have had RH most of my life) from activity.

In my case, there seems to be a few circumstances that set the activity-hypo up.

- either not eaten recently, or when I did eat, there were carbs involved (low or high GI makes not a jot of difference)
- having been sedentary for several hours before the activity started
- going from sedentary to full on rushing about
- going from relaxed to full on rushing about
All of the above can make my blood glucose drop like a stone.

As an example, the worst I can remember was on a weekend away (actually it was a 2 day meditation retreat with vegetarian non low carb food), and I had just spent most of the day sitting VERY still contemplating my navel
Then we broke for supper and I went from deeply relaxed to running up several flights of stairs to fetch something, and the hypo hit like a train.

My assumption (based entirely on that and similar experiences) is that in the right circumstances then yes, you can hypo from exercise, but that eating the appropriate diet for my RH will prevent activity-hypos (and the other hypos too).

So I would suggest you look at the combo of circs that set you up for this situation, and try different things.

You could
- lower your carb intake overall, or
- just ditch the low GI stuff (I found it a total waste of time), or
- eat a bigger lunch of more protein and fat which give far better slow release energy, or
- eat a low carb slow release snack an hour before you leave work so that the energy is hitting your bloodstream as you hit the pavement. I find nuts are excellent for this. Or cheese, or 70% dark choc.

Of all of them, going low carb (well below 130g carbs a day) and ditching the ‘low GI’ stuff is probably going to have the most impact (in my opinion ). But a snack before you leave work will help you through the adjustment period.

Hello Kirstyr.
Welcome to this great forum, hope it helps you as much as it has me.
I have Post Prandial Reactive Hypoglycaemia which I have struggled with since 1997 but was finally diagnosed in 2010. Once diagnosed I just floundered until I joined this forum.
My main reason for joining was that I love to play golf but my energy levels were getting progressively worse however well I thought I was planning my food.
I only joined this site in August this year so I don't feel qualified to advise you but I have now found I can play 18 holes of golf instead of 3 holes without hypos.
First of all I have cut my carbs to 20g or less per day - this is every day, not just golfing days.
This is what my golfing day food now looks like:
Breakfast. Firstly. I cut cheese into strips about 1/4" thick and I lay them on my plate like a slice of bread, then I have 2 poached eggs on top. About 2 hours later when I start my round of golf I have a plastic box with a good assortment of nuts, sunflower seeds and cubes of cheese. Also in my box are a few raisins and dried apricots but I only nibble 1 apricot or 3 raisins about every 30 minutes. When I get home I have a meal high in protein and lots of 'above ground' vegetables with butter on them,
Sorry this is such a long reply.
Kind regards and good luck,
Atlantico

Sorry, I answered in your other thread about getting a referral.

I too struggle with too much strenuous exercise.
Because it is preferable to keep really good control of your blood glucose levels with a Hypoglycaemic condition.
If exercise is causing a similar situation as mine is to food, but I'm only speculating.
So, if your liver decided to boost your energy levels by increasing your glucose levels during exercise, the amount of insulin necessary to process the glucose, will not be there, the trigger for an overshoot of insulin in response to the high glucose will occur. This will send your blood glucose levels down into hypo levels.
I say this because this has happened to me.
I don't do strenuous exercise now, but I do work, on my feet all day and it is a manual job. I can't run, can't do gym work, and playing team games of say indoor football is too much.
I walk a lot, I do gentle exercise such as swimming or a light work out. Walking fifteen minutes after a meal, for fifteen minutes helps tremendously.

Best wishes, let us know how you get on.

Kirstyr said:

Thank you for all your kind comments.

I’ve managed to get a Libre sensor to test some changes and play around with diet and exercise for upto 2 weeks... , (I work in a paediatric diabetes team and used the local company rep... she was more than willing to give me one...)

Day 1: low carb lunch = no hypo on the walk home, in fact blood glucose increased slightly.
But then had a 45g low gi carb tea, spiked up at 10.2, (increased by over 5) crashed rapidly but wasn’t hypo, still went to gym to test my response to exercise had a mild hypo after treadmill and a further hypo about 20mins after the workout. (I just do cardio no strength)

Overnight had 2 hypos, woke up due to both... could be why I’m not sleeping great at the moment..

Today: high gi breakfast, 75g caused a spike around 9, which then crashed to Pop a mild hypo.. I’m thinking I manage carbs better in the mornings but need more data to prove that theory..

low carb lunch gave a flatter spike around 7, and slow return to my normal which is around 5.2..

going to try gym later without the large carb meal and see how I go...

I do think GP thinking could be correct after all... I’m thinking I’m slightly insulin resistant, but will need more data for that one...

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It is understandable that you are insulin resistance, if you are of course!
If you are getting hypos, then it is more than probable that you have had an imbalance of insulin for quite a while. Hyperinsulinaemia (too much insulin) is a known cause for diabetes or similar conditions such as RH. If you continue to eat low carb, the insulin resistance will become better. As you won't over produce too much insulin.
Having read your posts a few times, the necessity of more tests to me is important, more than anything, to rule out other pancreatic conditions. I went through a series of tests, eOGTT, blood panels, breakfast test, allergy tests, mixed meal test and finally a 72 hrs fasting test. Then more blood panel results and eOGTT tests.
I'm glad you will be testing when you feel that you are going low, but a more regimented testing regime is needed to give you an overall picture of what is happening when you exercise and of course before and after eating.
You will discover many things about how your body and your blood glucose levels react to what you are eating.
Your readings are telling me that the roller coaster ride of your blood glucose levels is not right, the quick spikes and sudden drops are not good.
You are having too many carbs, you need to keep your blood levels in normal levels as much as possible. You are probably trying to stop the hypos before exercise or going the gym by loading up on carbs. With Hypoglycaemia, this is not the correct approach. Because carb loading will trigger the overshoot of insulin, which is what you need to avoid. A low carb approach will in the long term, help with control and give you the different energy of ketones, instead of energy from carbs.
Take it easy, let us know how you get on.
Best wishes

Wot Lamont said.

I read your description of how many carbs you were eating, I kind of flinched.
I would be a wreck with that many, low GI or not.

More tests would be great. More info is always good.

But my best short term suggestion would be to give yourself a carb free day, with a protein breakfast (bacon and egg), a protein lunch (chicken salad, mayo, and so on), then a protein evening meal (meat and veg).
Just one day, as an experiment.
Eat well. Don’t go hungry. Add butter, oil, mayo as needed to feel comfortably full. No carbs, even those low GI ones.
Keep up your usual activity/gym levels, and see how you feel.

Wot @Brunneria says, as well!

We can advise this course of having carb free days because, it was inevitable once I found that I could not eat food that I was intolerant to.
Once through testing and recording and experimenting my favourite foods and not so favourite, I learned that I became healthier and more aware of my body's natural needs, without the carbs.
Our experience with Hypoglycaemia, has altered our lives totally.
Since diagnosis, I have only had two hypos in over four years and one of them was my last eOGTT!

Best wishes

Kirstyr said:

Anyone with experience in meal spikes? After wearing the libre sensor for a week, I can see a trend of sharp spikes post meal (between 45mins and 1hr 15), usually upto 12 on anything 30g carbs or above. (from 5 or 6 depending) followed by sharp drop in glucose, which can lead to symptomatic hypos... the hypos seem to be more frequent if I then do exercise whilst blood sugar is rapidly falling... the maximum rise I’ve had so far was 6 from the pre prandial number. (Plus I feel really really rubbish on days where my blood glucose is acting like a yo yo)

The meals I’ve been having are the traditional low GI low fat thing that the medical community like to advise... I think my issue is carbohydrate related so can see where a low carb approach will work.

Is there an amount for the meal spike I should be aiming for? I’ve heard of the no increase of more than 2 at 2 hours, but mine seem to be good at 2 hours, and my dip occurs after, presumably reducing the spike will then reduce the over correction. I thought I had nailed it earlier, my glucose had been relatively stable all day, then had cream crackers, cheese, olives and went from 6 to 8.8 which seemed a lot for just a couple of cream crackers, so I’m guessing they are off the menu!

I’m seeing GP next week, but going to trial some low carb days to see the difference and I’ll be able to show the doctor the differences.

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It is called glucose dumping.
It is because you have a weak initial insulin response, probably.
Like me, if I have over 5% (ish) carb content, my blood glucose levels rocket and spike in double figures, within an hour or so, depending on what else I had with the carbs.

It is so individual what and how quickly you spike.
I have been told I'm carb intolerant, and I suspect it is similar to what you are experiencing.
The quick spike and quick drop in blood glucose levels is why you feel awful, the rollercoaster ride upsets the balance of hormones and your brain is trying to correct by telling you to eat something, and trying to correct the imbalance of hormones by overcompensating by a second insulin response, which causes the quick drop.
The hypo like symptoms just add to the misery.
Low GI carbs are if you have carb intolerance, does not make any difference, the glucose derived from the food is what spikes regardless of how high or how low GI it is.
A carb is a carb.
Very few dieticians or doctors or dsns understand Hypoglycaemia and the impact that certain foods have on your health.
I often say, that if you had an allergy, would you eat something that triggers the allergic reaction.
The reaction to carbs that I suffer from, is as similar to an allergy even though it is my intolerance and causes the symptoms and the rollercoaster ride of blood glucose levels!
The two hour mark for testing is used for certain reasons, if you are looking for diabetics. When I wrote the sticky on the forum about testing to find the food I was intolerant to, I have always said, that testing at one hour is as relevant as the two hours readings, you should find especially with the libre, that if you have carbs, you spike within a certain time frame, as you have said, within an hour or so.
If your pre meal or fasting reading is in the normal range (4-6mmols), and you fall down back to normal levels, within two hours, that proves you are non diabetic.
So like me I use three readings, pre meal, one hour and two hours. You could also at some point take the readings at three hours, four hours just to see what happens.
Is your fasting levels when you get up always in normal range?
Keep testing, it will help your medical team understand what is happening.
Ask for a referral, you need tests to get a definitive diagnosis.
Let us know how you get on.
Best wishes

Kirstyr said:

Is there anyone here who gets hypos with simple exercise e.g 20minute walk?

GP suggested a higher protein, lower carb diet to see if it helps... just wondered if anyone had a similar experience and what helped them? I’ve tried having carbs pre exercise and still get the massive drops, I’ve tried not having snacks thinking it’s an active insulin thing, but still dropping... it doesn’t happen as much when I’m less active but don’t want to give activity up! (It happens usually after work when I’ve been sat at a desk all day!) my diet is low gi, no simple sugars, I’ve swapped out fruit for vegetables to see if that helped... I was having around 200-220g carbs (reduced from 300) and I’m going to reduce further to the 130g mark.

I think next step is endocrine referral if we can’t work it out... I don’t mind the hypos I only went to doctor to see if there was an underlying reason... but she couldn’t see any reason why there would be, unless it’s a ‘weird endocrine thing’. (Or insulinoma which she doubts)

I’ve not been diagnosed with reactive hypos and I’m not convinced I’ve got RH as my hypos really do only seem to happen with exercise... (and not intense exercise)

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I exercise a lot and even a fast walk really knocks blood sugars down. Try having less insulin before exercising and maybe a longer acting meal? I have a Burcher type muesli that works quite well but I take carbs with me. Good luck

Kirstyr said:

I don’t have diabetes so don’t have the luxury of changing insulin.

My morning walk is fine, (I have unsweetened porridge, I get a small spike but nothing major) it was the afternoon and evening exercise that was the most problematic for me, I seem to have stopped hypos by reducing carbs in the day, and now only go hypo during exercise if I’ve eaten a large proportion of carbohydrates, (opposite to how it works in some people) it still needs doctors to work out why etc though! As I seem to hypo by eating carbs as a reactive type reaction, having carbs doesn’t always help, as it usually ends in a further hypo later in the day... it’s really interesting seeing the trends on the libre scanner, and great to test reactions to different foods and exercise.

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No, you are correct, you don't have diabetes, in fact you could say the opposite, because if you do have a type of Hypoglycaemia, then you have too much insulin, rather than too much glucose and insufficient insulin, as a diabetic does.
However, the symptoms are similar and if you don't have control, then becoming diabetic is more than likely.
You have learned so much already from your libre, knowledge is key and the readings are telling you, and will tell you how intolerant you are to carbs and sugars.
Best wishes

@Kirstyr

All I can do is urge you to progressively cut your carb intake until your symptoms disappear.

(I am willing to stick my neck out and make the following statements:
- if cutting carbs enough/more doesn’t improve/eliminate your symptoms, then you probably have the wrong diagnosis
- if you do have RH, then continuing to eat all the carbs you talk about is going to make you feel worse and worse over time.)

If your bg is fluctuating the way you describe on your current way of eating, then it isn’t working for you.

Hi Kirstyr, I would follow Brunneria and Lamont's advice, I did and it stopped my hypos.
If you don't try it you won't know if it works!

Why should we keep beating our heads against a wall?
regards
Derek

This strand has been a fascinating read. I feel moved to share my history re RH and subsequent diabetes - but if it is too much to read then the bottom line is if you have started having RH then go low carb and stick to it

First significant RH event in late 1970's. GP a bit sceptical but did suggest slightly low carb diet (cheese and oily fish recommended!) but nothing as clear as these days (if only...).

This carried on for some years, but at simple approach, kept having toast but with Marmite rather than marmalade - slight beneficial effect. Kept drinking fruit juice and smoothies (idiot) and other carb drinks such as beer.

Come 1994, diagnosed with diabetes, but not specifically which type. Insulin treatment from 1996. Mad spiking until about two years ago (when I bought the Libre system). Currently it is thought I have LADA, but no proper tests to define this.

Now in my 60's I have a variety of diabetic complications and am very motivated to try and prevent progression. However, I can't help but think that if I had followed a full low carb diet back in the 70's it would not have come to this.

IMHO if you have started having RH, go to low carb!