Diagnosed with Reactive Hypoglycemia - anyone managed to control with diet?

AmandaBJ

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In 2018 I was diagnosed with pre-type 2 and borderline liver function. Since then all my blood tests have been completely normal and I've been tested for everything. No idea why I have RH, no operations, no meds, no diseases. I don't drink a lot of alcohol - bottle of red wine on a weekend. I have gone off spirits completely in the past year or so. Captain Morgan was my favorite. We have the occasional Indian takeaway. I eat a lot of veg, fruit, pulses, dairy, grains and I don't binge on sweets or cakes or crips. If I over indulge in a lot of sugar I get something similar to a hangover which lasts all day - when I haven't had a drop to drink. I stopped drinking Vimto last July and only drink water during the day. Usually over 4 pints. When I have a hypo, usually after breakfast I can eat an apple - which has little effect, however a small bowl of Crunchy Nut Cornflakes and I'm right as rain. I've been told this isn't good for me but a hypo is much worse. I have had them my entire life, 60 years, and only found out this month what is actually going on. So any dietry advice would be appreciated.
 

everydayupsanddowns

Administrator
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Type 1
Welcome to the forum @AmandaBJ

My (non-medically qualified) understanding of RH in relation to diabetes is that it can stem from glucose disregulation, where the body begins to struggle with absorbing carbohydrate, perhaps particularly with impairment of ‘first phase’ insulin response, which can result in a sharp rise in glucose after eating carbohydrates, such that the second phase insulin then overreacts to the rapidly risen BG and pushes out too much insulin, resulting in a crash of BG sometime later.

I’m not sure of there are other forms of RH, but it seems that moderating / reducing carb intake to reduce the initial spike helps reduce the overreaction.

We had a new member join recently who was also diagnosed with RH, so you may be able to compare notes?

 

Inka

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Type 1
Hi @AmandaBJ :)

Do you test your blood sugar at home? How low is it going?

How were you diagnosed with RH and have you seen a dietician?
 

AmandaBJ

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I had a telephone consultation with a nurse from my surgery. She just said to eat fewer carbs and it wasn't necessary to test my blood sugar. Dietician wasn't mentioned. I understand 45-60 grams of carbs per meal is recommended for women. Breakfast of granola, and plain yogurt comes to about 40 and 2 plain scrambled eggs alone about 66 or a 2 egg smoked salmon omelette, not sure how many that is. Maybe for me I'm having too many carbs. Yet I can eat a high carb evening meal and not be affected until after breakfast the following morning. I did the Michael Moseley 800 carb diet and it made me feel quite ill. It wasn't until I increased my carb intake I began to feel better. Maybe I should l seek a dietician. I've asked my surgery twice if I could test my blood sugar at home and they have said its not necessary. I need to do something as I have now stopped driving due to hypos while driving causing confusion which is dangerous. Driving wasn't mentioned at all.
 

Inka

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@AmandaBJ I’d definitely get a glucose meter. That way you’d know if your hypo feelings were actually hypos, and you’d know how low you were going. You could then also see how you react to various meals. Sometimes a fast drop from higher blood sugar to normal can cause feelings like a hypo, and sometimes a hypo feeling can actually be from high blood sugar. I still mistake that occasionally even after having diabetes for years.

You’ve done absolutely the right thing by stopping driving - very, very sensible.

So what tests did you have done to diagnose the RH? What was the nurse referring to in her call?

I’m a bit confused by your egg counting - eggs don’t have carbs?

Before asking to see a dietician, if it was me I’d get a meter and do and record lots of tests to get a clear picture of precisely what’s going on. If that shows severe hypoglycaemia, I’d then want other causes ruled out.

If it is RH, I believe the advice is to eat lower GI carbs and to eat every few hours rather than leave gaps between meals.

Your high carb evening meal would cause RH within a few hours, I’d think, so a reaction after breakfast is more likely to be due to your breakfast. Again, a glucose meter would answer that.
 
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AmandaBJ

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Hi thanks, I'll look into a glucose meter. Eggs don't have that many carbs......Alexa was giving me the Calorie content....stupid Alexa!
 

Inka

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If I over indulge in a lot of sugar I get something similar to a hangover which lasts all day

I forgot to refer to this. That sounds more like high blood sugar. Having a meter would be so useful for you.

You say you were diagnosed as pre-diabetic in 2018. Have you had follow-up HbA1Cs? What were the results?
 

rebrascora

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Relationship to Diabetes
Type 1
Totally agree with @Inka
At the moment you have no idea of where your BG levels are or what is causing it. Testing will give you knowledge and knowledge is power. A basic home test kit is relatively inexpensive to purchase @approx £15 plus additional test strips at £8 per pot of 50 if you get a Gluco Navii BG Meter or a Spirit Healthcare Tee2, which are the most recommended on the forum by people who self fund as they are reliable and the most economical to use.
Your nurse clearly has no idea of the impact this is having on your every day life and unfortunately many Health Care Professionals discourage the use of home testing for Type 2 diabetics because they have no idea how a structured approach to testing can improve dietary control massively. At the moment you are stumbling along in the dark not knowing if what you are eating is helping or hindering. A home testing kit along with a structured approach of testing before and 2 hours after a meal and keeping a food diary will show you which meals/foods caused you a problem and which you can get away with.

Also agree on the comment about eggs which are pretty much zero carbs, so not sure what you are putting in your plain scrambled eggs to bump the carb content so high. Also I would be aiming for just 30g carbs for breakfast or less.... particularly as you are having this problem with RH after breakfast.
60g carbs might be OK for a non diabetic person but I would say that is pretty high for someone with RH or Type 2 diabetes. I might even go so far as to suggest skipping breakfast or having a low carb breakfast like scrambled eggs or an omelette or some creamy Natural Greek yoghurt with a few berries and seeds and see if you still hypo afterwards.

Most Granolas are quite high in carbs/sugar (around 65g carbs per 100g) so not a great choice unless you get a low carb version, like Eat Natural Protein Granola which is only 34gcarbs per 100g... so a 50g portion would be 17g carbs.

If you are looking to control this condition through diet then you absolutely need to know what causes you problems food wise and what doesn't so home testing with a BG meter is probably the only thing which will help you with that. People here on the forum who have success managing their BG levels will almost universally agree that home testing is invaluable in that process.
 

AmandaBJ

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Hi yes in response to an earlier comment re carbs in eggs, I made the mistake of asking Akexa and she gave me the calorie content. Thought it was high . Yes the confusing thing is I get hypos after smoked salmon omelette, plain scrambled eggs, no toast, or granola with plain Greek yogurt and fruit compote which I didn't think were high in carbs.
 

AmandaBJ

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Re granola, I have about 30 grams which according to the box is about 40 carbs. I eat a lit if fruit, veg, grains and likes and avoid white goods. Drink nothing but water all day and night. Good for joints.
 

rebrascora

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Yes, sorry, I saw you had used Alexa for the info on eggs after I posted.
How do you know that you are getting hypos if you don't test?
Have you tried skipping breakfast altogether to see if that makes a difference to how you feel?
 

AmandaBJ

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I don't get hypos if I don't eat. All my symptoms are the same as reactive hypoglycemia. The diabetic nursery at my surgery confirmed it. All my blood tests show I am no longer pre type 2. I have never had a blood test during a hypo. They can only go by my symptoms and say I don't need to test my blood sugar. I've ordered a testing kit online. I need to sort this out for myself.
 

Inka

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Type 1
I don't get hypos if I don't eat. All my symptoms are the same as reactive hypoglycemia. The diabetic nursery at my surgery confirmed it. All my blood tests show I am no longer pre type 2. I have never had a blood test during a hypo. They can only go by my symptoms and say I don't need to test my blood sugar. I've ordered a testing kit online. I need to sort this out for myself.

They are tests that can be done for RH and they can be used to give a diagnosis. Without those, people can only guess.

Do post your own blood test results here and you’ll get some useful feedback.
 

AndBreathe

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Type 2
AmandaBJ - How were you diagnosed with RH. Did you have something like an extended glucose challenge test, or did your nurse conclude RH, based on your description of events?
 

everydayupsanddowns

Administrator
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2 plain scrambled eggs alone about 66 or a 2 egg smoked salmon omelette, not sure how many that is.
Scrambled eggs don’t contain any carbs (which is why eggs are well loved by forum members!). Omelette may have a smidge if you‘ve fried any onions as part of it. No carbs in smoked salmon either. :)

Might be helpful to get hold of the Collins Gem calorie counter book, or Carbs and Cals (book or app) which might help you identify the carbs in various things?
 

AmandaBJ

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I got myself a glucose meter (which won't please my surgery) but I have to know. Not sure if what I eat at night has any effect on my blood sugar during the day, but I appear to be able to eat any amount of carbs in the evening; pizza, burger and chips, Indian, Chinese, without any effect. I used the meter when I got up this morning. Reading was 6.3mmol/l. Breakfast was homemade pancakes and maple syrup - yes I know, high carbs, but I need to test myself when I get the shakes coming on. An hour after breakfast I could feel the shakes coming on....I tested myself again 7.7 mmol/l. Interestingly the shakes have subsided. Maybe stabbing myself did the trick! Anyway I will continue testing myself at various times. I want to test myself when I get full blown shakes see if my reading goes much higher. I know I need to eat fewer carbs and testing what I can get away with helps. Clearly over 40g carbs per meal is a bit too much for me. I also get the shakes when I exercise. My blood sugar only drops after breakfast or lunch never after an evening meal, which I find odd. So I'm going along with the idea that I'm probably Reactive Hypoglycemic and cut the carbs. I love my scrambled eggs with no bread and the salmon omelette doesn't cause my blood sugar to drop. Oddly enough, the doctor I spoke to over the phone had never heard of my condition. Not sure how common this is. But I feel positive I can get it under control. And I will keep posting when I need help and happy to help anyone in the same situation.
 

Inka

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Type 1
I’m pleased you have a glucose meter @AmandaBJ 7.7mmol is a normal blood sugar so if you were shaking then, perhaps there’s another cause.
 
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rebrascora

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Relationship to Diabetes
Type 1
My blood sugar only drops after breakfast or lunch never after an evening meal, which I find odd
How do you know your BG drops at all if you have only just got a meter to test t?
Who diagnosed you as having Reactive Hypoglycaemia if your GP hasn't heard of it ( and yes it is quite rare so most GPs are unlikely to have come across it) and what tests were done and by whom, to come to that diagnosis?
 

Inka

Well-Known Member
Relationship to Diabetes
Type 1
I want to test myself when I get full blown shakes see if my reading goes much higher. I know I need to eat fewer carbs and testing what I can get away with helps. Clearly over 40g carbs per meal is a bit too much for me. I also get the shakes when I exercise. My blood sugar only drops after breakfast or lunch never after an evening meal, which I find odd. So I'm going along with the idea that I'm probably Reactive Hypoglycemic and cut the carbs.

RH is low blood sugar not rising blood sugar. Your blood sugar didn’t drop after breakfast according to your tests. If you did have RH, it being an evening meal wouldn’t stop the drop.

Self-diagnosis isn’t a good idea - not only because it can cause anxiety, but because it can lead people down the wrong path and mean that they miss out on the correct diagnosis. In people without diabetes, blood sugar naturally fluctuates throughout the day and night, and in response to food.
 
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