Tingling in hands and feet

[hyponilla]

Hi guys,

First off thanks for a great forum I've been lurking around for a while and found lots of good information here.

I was diagnosed with T1 four months ago after I ended up in the hospital with DKA and an HbA1c of 91. I read Bernsteins book and went on a low carb diet a few weeks in which has worked really well. My blood sugars readings for the past couple of months have mainly been within the 4,5-8 range, with some extremes as I haven't quite got the hang of this yet. I haven't got a new HbA1c yet (I'll get it next month when I go to see my doctor), but I've been putting all my readings into a diabetes app and the estimated HbA1c is 40 so I'm happy with that.

Now here comes the problem. My control has been really strict and a couple of weeks ago my insulin sensitivity changed (might be honeymooning or just the extreme heat) so I've been getting a lot of hypos in the low 3's and for the past few days I've had tingling in my hands and feet. Before this has been a sign of hypoglycemia, but when I test the sugars are at 5-6. I have a freestyle libre and test the blood as well so it's not a meter error.

Today it's been especially bad, the tingling has moved all the way up my arms and legs and lasted for a couple of hours. Also my vision has been blurry. I did some googling and found that rapid drops in HbA1c could cause problems like retinopathy and neuropathy, but as I understand it's quite rare and happens only after you've had elevated blood sugars for longer periods of time. Is it the many hypos I've been having lately that's doing it? Please help, I'd love to hear if someone else has had similar experiences. I feel like this disease is so complicated, as soon as you think you've worked something out there's always another factor.

 

[Caprock94]

Hi guys,

First off thanks for a great forum I've been lurking around for a while and found lots of good information here.

I was diagnosed with T1 four months ago after I ended up in the hospital with DKA and an HbA1c of 91. I read Bernsteins book and went on a low carb diet a few weeks in which has worked really well. My blood sugars readings for the past couple of months have mainly been within the 4,5-8 range, with some extremes as I haven't quite got the hang of this yet. I haven't got a new HbA1c yet (I'll get it next month when I go to see my doctor), but I've been putting all my readings into a diabetes app and the estimated HbA1c is 40 so I'm happy with that.

Now here comes the problem. My control has been really strict and a couple of weeks ago my insulin sensitivity changed (might be honeymooning or just the extreme heat) so I've been getting a lot of hypos in the low 3's and for the past few days I've had tingling in my hands and feet. Before this has been a sign of hypoglycemia, but when I test the sugars are at 5-6. I have a freestyle libre and test the blood as well so it's not a meter error.

Today it's been especially bad, the tingling has moved all the way up my arms and legs and lasted for a couple of hours. Also my vision has been blurry. I did some googling and found that rapid drops in HbA1c could cause problems like retinopathy and neuropathy, but as I understand it's quite rare and happens only after you've had elevated blood sugars for longer periods of time. Is it the many hypos I've been having lately that's doing it? Please help, I'd love to hear if someone else has had similar experiences. I feel like this disease is so complicated, as soon as you think you've worked something out there's always another factor.

Welcome! I'm also new here, and you will find a lot of support here. It's a great group. My story is similar to yours, except I am T2. I was diagnosed in early April. I dropped my levels quickly like you have done. It was only after dropping my levels that I got the tingling in feet and hands. Feet have a mild burning feeling at times. It happened after about 6 weeks of converting to the LCHF diet. I've heard from others here that said it happened to them as well. I'm hoping it resolves soon for both of us!

 

[NaijaChick]

So I am not the only one!!! When my BG was under control, I too would have hypos and this would be followed by the pins and needles with burning. I just would try to bring my BG to normal range and shake my body till it went away. Good luck

 

[kitedoc]

Hi @hyponilla,
Congratulations on choosing Dr B's way of managing your diabetes.
From my experience as a TID, not as health professional advice or opinion:
Four particular things to note.
1) Often when we start on insulin by injection, your own pancreas gland is less pressured and still has some capacity to release some insulin. This is what is called a honeymoon phase. Our injectable insulin requirement drops and sometimes some need minimal or no insulin for months. Obviously you need to discuss what you do with your insulin with your nurse and doctor.
Also with these hypos you may be taking some form of carbs to bring the blood sugar levels (BSLs) up so you may be taking more carbs than usual for your diet plus the adrenalin as part of the emergency perceived by the body (and brain particularly) leads to release of stored glucose from the liver. This can lead to a swing up in BSLs which may stimulate your pancreas gland to release more insulin. So you have your own controlled insulin injection input and your own pancreas doing its own thing.
This situation of one's own pancreas working is called a honeymoon because sooner or later this phase ends and your injectable insulin dose increases as your own pancreas gland with very, very, very rare exceptions runs permanently out of puff.

2) if we suffer from low blood sugar levels it can be not only the absolute reading, like the 3 mmol/l you mention but the rate of fall if fast enough can cause symptoms to appear at higher figures such as the 5 to 6 mmol/l you describe.

3) With frequent hypos our body becomes a bit tolerant of the symptoms and we can temporarily lose the ability to always sense the usual first warning signs like rapid pulse, tremour sweating etc. This is called loss of hypo awareness. Yes the tingling is a later sign usually but one where some impairment of one's brain, reflexes etc might be present as well and so not a state to be doing things like driving in. As suggested by @NaijaChick when your BSLs are more stable the usual hypo awareness should return. Care with driving or working in dangerous situations is important as stated above, e.g up ladders, driving, tightrope walking etc etc

4) dealing with the injected insulin vs one's own pancreas insulin is tricky and you need expert help with this.
One thought to run by your health team is whether on low carb you increase your protein intake. As you may recall from Dr B's book, he suggested maybe 50% of protein (grams in foods such as say, 50% of a the 6 g of protein in an average sized chicken egg) be counted as carbs, but carbs formed by the liver from spare protein not needed otherwise by the body. The slow rise of BSLs from such protein might peak a little say 3 hours after ingestion and might be less likely to cause the pancreas to pour out lots of insulin compared to the upswing in BSLs from a hypo or 'hypo food' etc. Long acting insulin at the right dose and timing is less likely to drop BSLs compared to short acting insulin also.
It is of course trial and error and thus needs that expert assistance with getting you through this phase without too much discomfort.
Best Wishes and please keep posting and let us know how you fare and what you find works best for you.

 

[hyponilla]

Thanks @Caprock94 for the welcome. I'm happy to hear it's not just me and I also hope things will be fine for us.

@NaijaChick I get the pins and needles when I have a hypo, but I also get them when the blood sugars have been normal for hours. Like today for example, I woke up at 7am to 4.5, after breakfast it was at 6.5 and then it went back down to a 5. By lunchtime the tingling started and lasted for about an hour the bg was still stable at 5. It's very annoying because it makes me unable to recognize hypos before I get complete brain fog, so now I'm leaving my levels a bit higher hoping that it might improve things. It's been two days since I had a hypo but the tingling keeps coming and going so far.

@kitedoc Thank you so much for your long and thoughtful reply. According to my c-peptide test I'm in the honeymoon period but I haven't really seen that my insulin to carb ratio varies too much. I'm very careful when taking carbs to correct hypos, because the times I've felt really ill have been when I've dived and then spiked up. I rather try and nudge it up from a 3 to a 4 and then give it some time before adding more carbs.

Dr Bernstein's book is amazing, however dosing for protein is a bit of a science. The amount of fat in the meal makes a massive difference, and sometimes the bg will rise 5-6 hours after eating. The rise is slow though so there's often time to correct before hitting a spike, but it's happened I've had dinner late and woken up in the night with very high levels. I guess time and experience will make things easier I find it very interesting to experiment with different meals, although at times a bit exhausting.