Symptoms at not-that-high glucose levels

[Glink]

Has anyone else experienced this? I've been diagnosed pre-D for almost a year and been able to keep things within the pre-D range with a combination of LCHF diet and eventually metformin. (Was already thin and active, so that kind of advice was not helpful.) Seems like things have gradually been getting worse and know I may be LADA eventually, but hoping to delay progression as much as possible.

SO, my big issue right now is that I get all the classic diabetes symptoms at blood sugar levels that are not that high. Things like thirst, frequent urination, swollen feet and hands, etc. The worst of it, however, is the horrible mood I get. My partner and child can tell when my blood sugars are up by my mood, which makes me feel like a terrible person! However, as you all likely know, blood sugars are the biggest mystery and frustration in that (while I can certainly make things go high by eating something like apiece of bread or oatmeal), I can do the exact same thing 2 days in a row and have different outcomes.

None of this is so odd, except that I start to get these symptoms when I'm just in the high 5's (mmol/L). A 5.8 fasting, for example, or 6.5 2-hr postprandial, are not that bad #'s, but set me up for terrible grouchiness and sad outlook. When I am at 5.0 (or, when I used to be able to have fasting #s in the 4's!) I feel great, like a totally different person--the optimist I used to be before all this started.When I was first diagnosed and went LCHF I felt great for a while, but then my #s started creeping up again and bringing back symptoms (hence the metformin).

Apparently we're not "supposed" to have symptoms like this until much higher #'s, like 11 or whatnot. Because of this I'm not really sure how to manage things better. I'm on metformin (just increased the dose, oh my GI!), and hardly eating any carbs at all (~50-75 g gross carbs/day, mostly from veggies; maybe 20-25 net if you subtract fibre). I've been a bit less active lately because a frozen shoulder has restricted my ability to lift weights and bike long distances, but more exercise never seemed to help reduce my sugars anyway.

I guess my question has 2 parts:
1) Does anyone else here have experience with diabetes type symptoms at relatively low glucose levels?
2) Any advice for avoiding these low-highs, which are low enough that my clinician isn't worried, but really affect my/my family's quality of life?

Thanks for any insight you can lend. As far as my clinician's concerned, I'm fine unless/until my sugars get back to over 7 fasting on a regular basis or over 11 post-prandial. But I want to feel better now.

 

[andcol]

If you want to avoid low-highs then do not eat the carbs. That is it I am afraid. Exercise about 30 mins after eating will help keep the spike down but it will not remove it fully. You can look at replacing carbs with more fat and protein. There is growing evidence that fat is not bad for us and it is the carbs after all but the picture is probably a lot more complicated and is probably individual.

BTW controversially it may not be the BG levels making you feel like this but the insulin levels your body is producing to keep you in the normal levels.

 

[kesun]

Hi @Glink

I have a couple of suggestions. First, your symptoms sound quite familiar: if you're thin and have relatively low BG levels you should push to be tested for monogenic diabetes, also called MODY, including mitochondrial types. More and more doctors say that any thin T2 should be tested, as well as any T1 whose honeymoon period lasts unusually long.

Second, since you're testing, test for specific foods: test your pre-prandial (or preferably fasting) blood, eat one single food and nothing else and test again after one and two hours. By a single food I don't mean, say a salad, but just lettuce, followed later or the next day by tomato, then oil, then vinegar (or your favourite ready-made dressing). It's the only way to isolate ingredients. Especially with progressive monogenic and mitochondrial diabetes it's also important to test quantities: I can tolerate one cooked carrot with no BG rise but two send my level up. Others can manage one slice of bread or one slice of apple: I can't. I used to be able to tolerate pumpkin and parsnip; now I can't. You can only find out by testing.

Kate

 

[Glink]

Andrew, I am not sure what you mean by do not eat the carbs. My carbs are mostly coming from things like nuts, broccoli, zucchini, spinach, lettuce, and occasionally a small amount of raw carrot, raw beat or cooked sweet potato. I don't know how much more I can cut back and still be eating anything other than meat, fish, and eggs. However, I think you may have a different thing going on from me, as when I exercise 30 min after eating it also drives my glucose up higher.

Kesun, unfortunately I am unlikely to get tested for anything unless/until my sugars get much worse. I tried to get GAD testing (b/c LADA seemed likely) but with no luck. It was a big deal just to get a script for metformin because I'm thin and was able to bring the sugars into sort-of-control with a pretty hardcore LCHF diet (although the effectiveness of that waned somewhat over time). However, I will take your advice to test individual foods. I have done some of that and it's how I figured out I could tolerate 12 bites of sweet potato, although then I lost that after some months (although metformin may have brought that tolerance back?). I have a lot of food allergies, and maybe there are some weird sensitivities that I'm not aware of that are pushing things up? I dunno; I guess it's worth a try.

 

[andcol]

Andrew, I am not sure what you mean by do not eat the carbs. My carbs are mostly coming from things like nuts, broccoli, zucchini, spinach, lettuce, and occasionally a small amount of raw carrot, raw beat or cooked sweet potato. I don't know how much more I can cut back and still be eating anything other than meat, fish, and eggs. However, I think you may have a different thing going on from me, as when I exercise 30 min after eating it also drives my glucose up higher.

So I read from your last statement that you are low carbing and keeping your levels in pre-d state with some effort. I had to go back to a previous thread of your to get your history.. Out of interest have you tested your ketone levels to see if you are in ketosis. I find I feel great in or out of it but if I sit on the edge between the two I feel rubbish. Could this be what you are experiencing at the moment? You are on a sweetspot of carbs and protein that is just holding you there. Try adjusting you carb intake up or down a little and see if things change.

There are a couple of things that you may want to research into :

1. physiological insulin resistance
2. glycogenolysis
https://en.wikipedia.org/wiki/Glycogenolysis
Not really much help sorry, but I am trying to give you ideas.

 

[muzza3]

Hi @Glink
Welcome to the forum. Just out of interest are you also on low calorie as well as the LCHF?. I have been doing that for a couple of weeks and have been a bit short and cranky ( because I'm bloody hungry). I am also wondering about the Metformin do you still get high readings?

 

[Glink]

I'm not low calorie. I make sure to get plenty of fat. I'm not really supposed to be losing any more weight. The metformin does seem to be helping, especially with the fasting #s, which I just could not get down any other way. But, I hoped the medication would help more than it has been! I had fantasies of being able to eat small amounts of grains or pumpkin type things again. So far that seems not to be the case, although the combination of metformin plus the strict LCHF diet does seem to have gotten my fasting and A1c down, so that's good. I do get hungry a lot anyway, because the only trick I really have in my bag for when the #s are high is to just not eat until they go back down again (I mean, a glass of wine or a nap help too, but that's less practical most of the time!), so I just skip meals and go hungry whenever things are dicey.

I don't know about ketosis. I've never tested. I know I had weird breath for a while last summer when I first went on the LCHF diet, but I don't notice it now and the weight loss seems to have stopped or at least dramatically slowed. I don't really know what those other things are, so I guess I'll look them up in some medical databases and see what I can figure out.
Thanks.

 

[Indy51]

Sweet potato is very high carb, even higher than ordinary potato.

I'd also suggest looking into food intolerances. Maybe trying just a protein/fat fast for a week or so to see how it affects you and then reintroduce vegetables or other carbs you're eating one by one to test for reactions. Tedious I know, but might make a difference.

Shame you can't get the testing for MODY or LADA

 

[Kristin251]

Sweet potato beets and carrots are too high carb. Stick with salad greens. Even too much broccoli sends me and I am now on insulin. Perhaps explain to your Dr that you numbers are so low because you eat very few carbs and if you ate them you would have much higher numbers. I an mow LADA and thin and my Drs did nothing for a very long time because of that. Silly Drs. As T1 I still eat as I did as T2. VERY low carb. It got to the point inreducednmore and more food to keep numbers low. Explain how you eat to the Drs. I was eventually told I was starving in the land of plenty. It didn't matter how much fat I ate or food for that matter. I just kept losing weight
I know exactly how you feel when you feel funky and irritable even when numbers are good. I describe it as feeling like BS and insulin are bickering. I just went through that Sunday. I went to 130 which I never do, took a small correction dose and dropped to 90 and I was very cranky and irritable all day. I very rarely fluctuate that much and I do everything I can to prevent it because it feels terrible. I also agree that I have a 85 bingo number that I feel great. Under 80 or over 95 not so much. Wish I knew what the answer/ reason was

 

[Neohdiver]

I guess my question has 2 parts:
1) Does anyone else here have experience with diabetes type symptoms at relatively low glucose levels?
2) Any advice for avoiding these low-highs, which are low enough that my clinician isn't worried, but really affect my/my family's quality of life?

I have pretty dramatic energy level/mood shifts at around 7.2 (like you, they were noticed by someone else before I was aware of them.)

I can't tell from your comments whether you are actually logging your food or not. Your guestimate about total carbs/net carbs is certainly off from what I am logging - and I don't eat anything like sweet potato. Fiber makes up about 30% of the carbs I eat (and virtually everything I eat with carbs are above-ground veggies or nuts - so pretty high fiber content). If I was eating 50-75 gross, my net would be closer to 33-50 net (higher than I eat most days). If you're not actually logging, you may be eating more carbs than you think you are.

As for what to do - I have a few things that reliably drop my BG levels pretty quickly - an ounce of almonds or cheese usually do the trick. If I'm high, I eat one of those two things.

 

[Kristin251]

Inforgot to mention two things
1) as T2 if I was high I would have a very small fat snack ( not carbs or protein) like celery stick or a few olives or nuts. It was enough to elicit an insulin response but not enough to raise bs . As T1 now I miss that option

2) as far as exercise, as my diabetes progresses brisk walking or anything more intense raised my bs. For awhile I could eat one of those small snacks and it would come back down but eventually I had to slow it all down to slow/ moderate at most.

I also agree with Neohdiver in your over estimation of carbs. Do you have a food scale? Invaluable. I still use mine everyday. I weigh my protein because that does make a huge difference for me and very hard to judge. Sometimes I am amazed at how many carbs are in so little food. As I mentioned above even broccoli has to be eaten in small quantities for me. Sometimes not even worth making

 

[Glink]

Wow, thanks for all the responses. Mostly, I'm relieved that it's not just me being sensitive to the low-highs. My doctor makes me feel like I'm a crybaby because I have #s many diabetics would love to have. I just--I work had for those #s and I wish they would hold a little more consistent. They seem maybe sensitive to stress and hormones? I feel wonderful when I'm in the 4's and low 5's (mmol/L).

I have had serious food allergies (milk, soy, tomato, peanut, lamb...) for several years, so I've done a number of elimination diets over the years and am fairly accustomed to restricted diet eating.

I don't have a food scale. I logged all my food (carb estimates by volume, not weight) for several months after initial diagnosis (July - Nov). I stopped when it became apparent that it was just making me feel crazy and not improving my sugars (in fact my sugar were gradually getting worse, after initial dramatic improvement with the LCHF diet). It's entirely possible that my carb estimates are off; I've just looked up online things like how many grams carb in a cup of lettuce or chopped broccoli.

I typically eat mostly protein for breakfast (couple of eggs or sausages) or occasionally flax-egg "waffles" with almond butter, a green salad with avocado or leftover supper for lunch, and another salad or sauteed veggies (e.g. zucchini, broccoli & cabbage) with a cooked veg side (like cauliflower or kale) and some fish or meat for supper. If my sugar is high in the afternoon I sometimes just have a few celery sticks for supper, or skip it all together. I drink a lot of water and a fair bit of coffee, mostly black, occasionally with almond milk. I snack on nuts and celery. I saw a dietitian last fall, but she was unhelpful. She took my novel-length food log, and suggested I try eating barley, which was (perhaps obviously) a disaster. Then she told me to eat an avocado when I'm hungry, and that she had no other ideas.

Since starting the metformin and seeing some improvement in my #s I've let myself use a small amount of grated carrot or beet for garnish on my salads, and an occasional few bites of broiled sweet potato or squash with supper (sweet potato seems to go okay in very small amounts, whilst white potato is always a disaster for me!). Before starting the metformin I had to watch things more closely and had started to have to cut out things like onion, large portions of broccoli. Maybe I should go back to that again, although I'd rather not -- I'm so bored of salad! I used to be an avid cook of various cuisines and quite a baker -- "healthy" baked goods, but not healthy for me (us!) any more. Sigh.

 

[Kristin251]

I hear you on avid cooking. It was my hobby and I loved it. Another thing diabetes took away from me. I do however like my foods. I sometimes get sick of salads but eat lots of lettuce wraps with protein on Boston or romaine. I mix Chx turkey salmon tuna etc with mayo and maybe some mustard or hot sauce to mix up flavors if my salad gets too big bs dies to so wraps keep portions low. I eat a little chopped scallions or onions but just enough for a little flavor. Broccoli.... While weighing one small floret is about 1 carb. Hardly worth making as it raises my be if I have more than that. Lol crazy. I've been sticking mostly to wraps celery radish guac olives and keeping steady. I could take more insulin but this too suites my stomach and food intolerances. Looking at my plate ( appetizer plate) it looks like a snack but somehow it is satisfying. Luckily I never get bored of guac and it is satisfying.
When I ask my dr things he says try it and test....thanks for the help pal. Well I guess he never suggested grains dairy or starch so I guess I could look at it on the bright side. I do actually like him and his nurse but my previous one was the bottom of the barrel so up was the only way to go haha
So you don't really eat protein for lunch? If so just try to keep portions smaller. Like I said protein and meal size make as much of a difference as carbs for me but as always YMMV

 

[Indy51]

There seem to be a number of people who report significant mood enhancement by being on the ketogenic diet. I'm wondering if your mood changes aren't related to carbs bringing you out of ketosis? You might be really sensitive to it and it might be worthwhile experimenting with prolonged ketosis to test the possibility?

 

[Kristin251]

There seem to be a number of people who report significant mood enhancement by being on the ketogenic diet. I'm wondering if your mood changes aren't related to carbs bringing you out of ketosis? You might be really sensitive to it and it might be worthwhile experimenting with prolonged ketosis to test the possibility?

I am certainly one of those. I know you weren't directing it at me though

 

[Indy51]

terrible grouchiness and sad outlook. When I am at 5.0 (or, when I used to be able to have fasting #s in the 4's!) I feel great, like a totally different person--the optimist I used to be before all this started.

@Kristin251 - sorry, I should have been more specific - I had this quote from Glink's original post in mind.

According to Dominic D'Agostino (ketone researcher), lower BG levels usually mean higher ketones on a ketogenic diet, so it occurred to me that might explain Klink's mood changes.

 

[Alicki]

Hi. Exactly same here. Normal blood (5.5) but lots of symptoms. Diagnosed so far with hyperinsulin- thirst, tingling tongue, nausea