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really confused with RH (?)

Discussion in 'Reactive Hypoglycemia' started by howdy, Aug 23, 2019.

  1. howdy

    howdy · Member

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    Hi everyone

    I've been reading this subforum for a couple of days and wasn't able to find answers to what bothers me, so I decided to start a thread myself.

    I'm an overall healthy male, in my 30ies, had have physical activity all my life (gym), lean (BMI 22,5), never had any major health problems.

    <tl;dr - cut it out>

    After longer workout i had prolonged extreme hunger (with anxiety that would disappear few minutes after i started eating), night sweats. Went to endo, done OGTT (and ton of other stuff - blood, USG, CAT - all good)
    here are my results of OGTT:
    75g 3h OGTT
    0 hour - 82 BS / 4,5 insuline
    1 hour - 77 BS / 71 IN
    2 hour - 59 BS / 24 IN
    3 hour - 49 BS
    I felt awful for the rest of the day and ever since this OGTT my BS would eventually drop under 70 after almost every meal, time depending on the meal and timeframe of the day (the biggest impact in the morning, the lowest in the evening).
    With these results i was diagnosed with insuline resistency and reactive hypoglycemia. I was given metformine (which i dont take, as im afraid of stomach side effects, since ive been prone towards gastrisis) and I was told to eat low IG meals with high frequency.



    questions:
    1. my BS peak maximally at 140 after meal - does it prove anyhow insulin resistance? Ive been told im insuline resistant due to RH, but i have doubts if its not the other way around (if im not insuline sensitive)
    2. my BS drops more after meals with lower carbs, contrary to what ive read on this forum and what ive been adviced by my endo - how is that possible, that with very little spike (if any, i recall checking every 15 minutes after more fatty meal and seeing 105 as my top) i still go into physical hypo? actually dairy products and low carb meal is the only food that gets me into 70ies and below
    3. i feel much better and more saturated after higher carb meals, also my BS is more stable, shouldnt it be other way around?
    4. my BS can go into RH state (65-70) and bounce back within much efforts from my side (the only downside is being slightly dizzy + pale), but it can also not bounce back and put me in a really bad mood (irritated, extreme hunger) that will disappear when i eat something - why isnt it one of the options all the time? what influences it?
    5. i often feel RH symptoms (irritation, hunger, dizziness) but when i check my BS its within normal range (but quickly dropping, for example its 100, 10 minutes later its 90, another 10 minutes later its low 80ies) - does it mean the meal was improper?
    6. im on decent surplus (at least 500 calories more than before), eating 6-8 times a day and im losing weight, visually body fat - how can it be? is that a sign of anything dangerous going on? Ive encountered this along with hypoglycemia back in the past when i had episodes of burnout (due to physical and mental stress), but this time there is nothing pointing in that direction (my stress levels are on their lowest, my mood is good, my libido is good, overall its all great but that damn RH :) )
    7. can metformine help anyhow?
     
    • Hug Hug x 1
    #1 howdy, Aug 23, 2019 at 5:47 PM
    Last edited: Aug 23, 2019
  2. Brunneria

    Brunneria Other · Moderator
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    Hi and welcome!

    I read your post, and I would really like to help if I can, but I’m afraid that your post was so long, wide ranging, and detailed, that I am afraid it is too big to respond to with any clarity.

    Could you break it down into a shorter format and/or specifically ask the questions you want answers to?
     
    • Agree Agree x 1
  3. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    I have just read your post three times and had a moment's thought to access my memory to see if I could filter the important bits.
    Firstly, wether you are hypoglycaemic are not, you do seem to be all over the place regarding your blood sugar levels. In fact it is typical of something akin to my condition if I didn't eat to my intolerances. Your advice from the doctors seem to be half hearted and not thought out because of the symptoms you are getting. Most types of Hypoglycaemia is your hormonal response to food or drink. You seem to be trying everything you believe is right but not getting the balance right to get control of your blood sugar levels. Hence the result of getting differing readings within a small time limit. You have had fluctuating levels for quite some time and unfortunately, you cannot and will not get good control until you find your balance of protein, fats and the little amount of carbs that you have.
    Secondly, glucose intolerance or insulin sensitivity is similar to insulin resistance, what ever words they use to describe what is happening, it's the hormonal response. Low insulin, high insulin, low glucose, high glucose, other hormones that responds to eating. If you have Hypoglycaemia, and from my experience, I would call my condition, carb intolerance. Because, wether it's high GI or low GI, it's a carb, and if you are carb intolerant then your reaction to carbs will be more or less the same.
    I have a weak insulin response, then an excess of insulin, called an overshoot that after the high glucose levels, I plunge down into hypoglycaemia.
    You are different, but the triggers for the hormonal response don't vary, too much carbs or sugars and you trigger the roller coaster ride of blood sugar levels.
    It's the same sensitivity from caffeine, your reaction is what triggers the symptoms.
    The same with exercise, too much and your liver will dump glucose because that is the natural response from exercise, your body and brain needs glucose, but too much and you get the symptoms. I can only usually only work or walk at a steady rate or I have a good chance of getting symptoms, it's the same with stress, anxiety, tiredness and alcohol.
    You have to know what triggers the insulin, glucose response to meals. The only way I know is to experiment with the foods of your choice and see which ones trigger the symptoms and by taking glucometer readings before, one hour, two hours and every now and then, three and four hours, regularly and use a food diary to note it all down, if you feel symptoms, take a reading and act if it is a hypoglycaemic episode.
    Eating every three hours is certainly not the way to go, it's too much food, for the long haul and won't help with weight loss. I found that, it was the only way the not so inexperienced doctors and dieticians with Hypoglycaemia, could only stop the hypos.
    They keep telling you, you need healthy carbs, complex carbs, good carbs, nutritious carbs, a healthy diet.
    Sorry! Not for someone with carb intolerant or Hypoglycaemia. Carbs and sugars that boost your glucagon and glucose stores in your blood quickly are the ones causing everything that is going on. I personally only have food that does not do that to me, including any grains, rice, pasta, wheat, oats, flour, bread of any type. I am lactose intolerant, my intolerance to potatoes and starchy vegetables really surprised me. I have an intolerance to any vegetable oils, a lot of additives, especially vegetables based, can't eat cooked vegetables but am happy with salad vegetables.
    I prefer to cook with animal fats, eat meat, protein, salad and eggs. I can manage some small amounts of fruit throughout the day, I don't eat regularly regimented meal times, just enough to keep me nutritional balanced healthy. I fast intermittently, I keep my blood sugar levels in normal levels this way and have not had a hypoglycaemic episode in over five years. My body has adapted to my balance of very low carb lifestyle.
    Other than the eOGTT tests, have you had other tests? Most of these types of tests are elimination tests to get a definitive diagnosis. Until you have had the succession of tests, can Hypoglycaemia (whichever type you have) can be diagnosed. Hypoglycaemia is also often found in pancreatic conditions such as insulinoma, pancreatitis, plus some serious conditions as pancreatic cancer. If you are not happy, ask for a specialist endocrinologist who is experienced in Hypoglycaemia.
    Hypoglycaemia can be also symptoms of type one or type two diabetes.
    Hypoglycaemia can be caused by medication as well.
    Are you on any other meds for other conditions?

    Yes, it's really complicated!
    Finding the cause is really important, especially if it food orientated, those so called healthy foods will not be healthy for you!

    To make it more complex, everyone who has posted on our forum is different in their Hypoglycaemia, we have so many different types of bacteria in our gut biotic, that giving individual advice is almost impossible, what will work for me, might not work for you.

    I can also write long posts, because the explanation and history is complex and long, it took me over a decade to get to go through the useless doctors and nurses, getting a referral to an endocrinologist who had enough training and experience to recognise the symptoms, I was extremely lucky. It took another year and lots of tests and appointments, hospital stay and blood tests galore, testing and experimentation with food and a food diary i still keep religiously.
    I had great support on this forum and a willingness to get fitter and healthier, a resolve to get my life back and a new dietary lifestyle to get control of my body.

    My best wishes, and welcome your forum.
     
    • Informative Informative x 1
  4. howdy

    howdy · Member

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    yes, sure, i tried to be brief, but yeah, put a lot of details eventually, edited
     
  5. howdy

    howdy · Member

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    @Lamont D

    Thank you for your detailed response. I'm happy to hear you found your way of dealing with this condition.

    What other tests have you had in mind? I've had a bunch of blood tests, USG, CAT scan, all clear, no tumors, not even an inflammation (with CRP on 0,2). Guess i will search for the second opinion of endo.

    I've read a lot of your answers on this forum, and you were one of the reasons why i decided to make this thread, as my experience is contrary to what you experience, or at least it seems so for me on first glance.
    I feel best on higher carbs, the fewer carbs i eat the worse i feel, both in terms of a general feeling and in terms of low BS.
    These are my results after a relatively high carb (50-60g)/regular protein (25g)/ low fat (10g)meal (breakfast)
    0min 90
    30min 111
    45min 134
    60min 117
    75min 99
    90min 98
    105min 93
    120min 91

    If i lower the carbs to 30 and increase fat to 25, i will be in low 80ies after 90minutes with a physical hunger craving after 45-60 minutes already, whats even worse - for the rest of the day i will have troubles keeping my BS steady.
    Maybe someone here experienced it the same way and could give me some insight of how to deal with it?
     
  6. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    Those readings are quite normal. You started in normal levels, your spike is not too high and you return to normal within two hours. The non diabetic fasting reading is typical hypoglycaemic, with the symptoms you describe.
    I believe that because you have been experiencing the roller coaster ride of blood sugar levels for a number of years, your inability to get some control is because your diet is not as in control as it needs to be, you are looking for a way to get some control, but changing it too often, hence the different symptoms, results, symptoms and blood sugar levels.
    It took me some time to get the control I needed to be at. It took a lot of will power and doing without carbs was foreign to me. My whole life was dominated by potatoes and wheat filled meals.
    When you are not in control, by which I mean continually in normal blood sugar levels (between 4-6mmols) you are in a viscous circle of abnormal hormonal response to food. Once you eat breakfast, probably wheat in one form or another, you are above the level your response will be a quick glucose boost, followed by an overshoot of insulin, this insulin continues until you eat again. You have too much insulin, then because you eat, too much glucose, then too much insulin. Over time, you get insulin resistance, excessive insulin, until you eat, then too much glucose because you don't get or have sufficient insulin. This counter hormonal battle, plus any other hormones, cortisol for example, will exacerbate the symptoms and the ability to get control.

    Have you had a Hba1c test?
    Is your fasting blood sugar levels in normal levels?

    This is why I fast!
    When I get up, my fasting levels are in normal levels, hence I am not diabetic!
    My Hba1c levels are in normal levels, again, not diabetic!
    I use fasting and eating very low carb to keep my levels in normal range, stopping the yo yo effect of fluctuating blood sugar levels.

    I think, you feel a little bit better on higher carbs, is because your body is happier with carbs, it is used to those levels. Your brain is telling you to eat carbs (craving, hunger, mooching around the fridge, cupboards) you will be getting symptoms of quick rises and quick drops in blood sugar levels. These symptoms are derived to feed the need for carbs.
    Until you get continuous control for a couple of weeks, you will always be in that viscous circle, and your symptoms will gradually become more extreme and unhealthy. I kept putting on weight, I was getting organ problems, such as fatty liver, liver function high, kidney function high, heart health deteriorated.

    Tests, that will diagnose Hypoglycaemia are full blood panel, c-peptide, GAD, insulin levels test, hba1c, extended oral glucose tolerance tests, mixed meal or breakfast test, allergy tests, 72 hours fasting test, then subsequent scans, and biopsies if necessary.
    If you can arrange a endoscopy, because you could have a bacterial infection, that your symptoms could also be ascribed to. This is why an endocrinologist is the best advice I can give you.
    I don't want to confuse you more, so, if you can get your head around that food is the culprit of all your woes, symptoms and the confusion you feel.
    It is so exasperating and difficult to understand.
    Your disbelief is normal, your anxiety is telling you to act upon your symptoms.
    But as I found out, it is a dietary lifestyle change. It is food.

    But until you get the tests, you won't get a true diagnosis.

    Best wishes
     
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  7. howdy

    howdy · Member

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    Im nondiabetes, my fasting glucose is between 80 and 90 and it seems to not drop if i dont eat for a while (considering that i dont do much of physical activity), but thanks for the hint with other tests, ill do the missing ones, won't hurt

    the results I've put were from the high carb breakfast, i will wait for the situation to normalize again (got myself into hypo yesterday with an evening lowcarb meal...) and will do a similar test for a low carb breakfast (probable eggs on butter, with bacon and veggies, so both low glycemic and low insulin)

    i will also buy this libra freestyle thing, combined with food & mood diary it should help me figure out whats going on, as im really confused with what my body tells me and what everybody else tell me ;-)


    "I believe that because you have been experiencing the roller coaster ride of blood sugar levels for a number of years, your inability to get some control is because your diet is not as in control as it needs to be, you are looking for a way to get some control, but changing it too often, hence the different symptoms, results, symptoms and blood sugar levels."​

    Do you mean by that, that i should stick to the certain food routine even if i feel awful after it in the beginning? I can handle the pain of hypos for a while if i know it will help, but im afraid i will just make it worse (since besides post-workout hypo from time to time, i would never have post-meal hypos until ive taken OGTT that seemed to be too much for my body to withstand, the OGTT started all that im going through now).
    Im not being ironic, it just sounds like a risky plan.


    Also, do you guys think metformine (or any other drug) would help in this case?
     
    #7 howdy, Aug 24, 2019 at 9:04 AM
    Last edited: Aug 24, 2019
  8. Brunneria

    Brunneria Other · Moderator
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    I think you need to learn more about Low Carbing.

    Many people experience an uncomfortable period for several weeks when they switch to LC. This can be due to ‘carb flu’, false hypos, dehydration and/or electrolyte imbalances. The symptoms you report on LC could easily be due to any or all of those.

    Fortunately, all those LC ‘flu’ symptoms are also easily dealt with, with time, steady eating, increased water and electrolytes, and once the ‘flu’ passes, the symptoms rarely return.

    Obviously, you need to do your own research on this, but I suggest you read the www.dietdoctor.com website on carb flu, it’s symptoms and solutions. Also do a google search on ‘the common keto mistakes’.

    Hope that helps.
     
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  9. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    What I suggested was to test your favourite foods and see if they caused the symptoms, because it may cause a hypo, you can always eat something that puts glucose levels up, I found that perhaps over a long period of time, you could take the experimentation phase gradually especially if you were getting good blood sugar levels before eating, you should always only test, when your fasting or pre meal levels are in normal range.
    This is to find those foods that causes the symptoms. Once you know these foods, I would avoid them and test some other foods.
    The portion size has to be taken into consideration, as is the amount of good fats.
    For instance, a small potatoe could be okay, but a large one would cause the symptoms.
    Once you have gone through the experimentation process, having the food that you can tolerate continuously for a while can only be beneficial.

    I was taken off metformin, but that's me. You may be different.
    If you was certain of a diagnosis and the process of digestion was understandable, knowing how your response to food causes your symptoms, there may be a drug that may help. However, if you have Hypoglycaemia, at this present time there is no magic pill or cure. It is food that causes the problem. Only dietary changes will help manage whatever condition you may have.
    And as I have found, it is manageable with good control, which in turn will certainly improve your health.

    I would never advise anyone with Hypoglycaemia to eat high carbs regularly!
    That is insane and would make you ill!

    Best wishes
     
    • Winner Winner x 1
  10. howdy

    howdy · Member

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    thank you, that clarifies a lot

    ive noticed that dairy and wheat are my triggers, now im testing rye (dry bread and pasta, as even rye bread has still some wheat) and it seems to be much better
     
  11. Brunneria

    Brunneria Other · Moderator
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    In my case it is gluten and whey, rather than wheat and dairy, but yes, they make my blood glucose much more unstable than the carb content of the food would suggest.

    Apologies, @howdy
    I only just noticed that you have completely rewritten your original post, with a clear list of questions.
    Will answer them now! :D (To the best of my ability)
     
  12. Brunneria

    Brunneria Other · Moderator
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    1. Afraid not. In order to calculate a snapshot of current insulin resistance (IR) you need glucose levels, insulin levels and then work out the HOMA-IR https://www.mdcalc.com/homa-ir-homeostatic-model-assessment-insulin-resistance
    2. You may be producing enough insulin to prevent a spike, but this still pushes glucose down afterwards.
    Your quoted low of 70 equates to 3.9mmol/l https://www.diabetes.co.uk/blood-sugar-converter.html
    This would be the top end of a hypo if you were on insulin injections. But it is a perfectly normal blood glucose level for non diabetics. Although I appreciate that it may be uncomfortable if you are used to higher blood glucose levels.
    3. I suspect this has a lot to do with personal food preferences and rate of digestion, whether someone is adapted to low carb eating and what the meal consisted of.
    4. Blood glucose levels are affected by many, many different factors, and these vary from day to day, and hour to hour; stress, activity, dehydration, fatigue, recent blood glucose levels, heat/weather, recent food choices, fasting, time of day (IR varies through the day), how well you slept last night... and many more. So the same food may result in different situations.
    5. Some of us experience hypo symptoms when our blood glucose drops sharply, even if our bg is not at hypo levels. These are often called ‘false hypos’ even though they may feel very real.
    6. Many people experience weight loss on keto (very low carb) eating. Various explanations exist. Take your pick :)
    Some say the weight loss is because carbs cause inflammation, water retention and couch potato-ness. Others say the body simply burns more calories, so you can eat more calories. Others say calories are irrelevant, and don’t count them, just eat what you need (I take the last view). If you don’t want to lose weight, then you can increase your portion sizes, particularly protein.
    7. Have a read up on how and why Metformin does what it does. In my opinion its only value for an RHer would be the slight reduction in insulin resistance it offers. But you will find others who believe that Metformin is of much wider benefit, even to those without glucose dysregulation. I encourage you to read up and make up your own mind.

    Hope that helps.
     
    • Winner Winner x 2
  13. howdy

    howdy · Member

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    fantastic, thanks a lot for your feedback

    i just want to clarify - im nowhere near low carb, im probably around 220g of carbs per day now (mostly rice and veggies), i know that low carb can increase metabolism, but in my case its something else - ive been eating X and kept weight, RH kicked in, now im eating X+500 and im losing weight, not in a super fast pace, but to how much i eat its still unimaginable for me
     
  14. Brunneria

    Brunneria Other · Moderator
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    The trouble is, RH is basically a symptom.
    It can have a number of different causes, and frankly I do not have enough endo knowledge to comment beyond that.
    I have a few suspicions about what my own RH cause may be - but I lack the resources (I don’t even know what the tests would be), to check if my suspicions are correct.

    So whatever it is that is causing your RH may also be affecting your metabolic rate.

    I would urge you to discuss any unexpected, unwanted weight loss with your doctor as soon as possible.

    Have your thyroid hormones been tested lately?
    Beyond that, I couldn’t speculate.
     
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