Hello Everyone. First time on here. Been diagnosed with ? reactive hypoglycemia - glucose levels low lots of time which has caused problems. Has anyone else been diagnosed with this and if so how were they diagnosed? Trying to work out diet to help glucose levels remain more stable. So far been told to eat about six times a day; carry glucose tablets with me if I go for a walk. Any information from others re eating or signposting re information would be greatly appreciated re avoiding hypos. Am still testing myself, levels seem lower in morning, slowly improving during the day. Do people who have hypos eat before they go out for walks/exercise? Gladys
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So much to learn..
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Leadinglights
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If you put reactive hypoglycemia in the search box (top right) there are some threads which may help you.
rebrascora
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Hi and welcome
From my limited understanding of RH the pancreas secretes too much insulin too late in response to food, particularly carbs, so if you eat carb rich foods the glucose from them will hit the blood stream and spike your Blood Glucose (BG) levels and then the insulin is released and suddenly drops them again, so you have a very rapid rise to quite high levels and then a plummet when the insulin does it's job. The fast drop is partly what makes you feel hypo but often with RH the pancreas over produces insulin so you do actually drop too low. My understanding of it is that it is usually triggered by food, so you might be best to exercise before food and probably low intensity exercise so that the liver doesn't release glucose causing the pancreas to be triggered.
A low carb diet and eating little and often is usually the recommended treatment to try to keep levels stable.
You mention that you often drop low on a morning.... Is that before or after breakfast?
Have you considered using a Freestyle Libre sensor to try to identify individual triggers so that you can adjust your diet to suit your body to better manage it's RH response?
From my limited understanding of RH the pancreas secretes too much insulin too late in response to food, particularly carbs, so if you eat carb rich foods the glucose from them will hit the blood stream and spike your Blood Glucose (BG) levels and then the insulin is released and suddenly drops them again, so you have a very rapid rise to quite high levels and then a plummet when the insulin does it's job. The fast drop is partly what makes you feel hypo but often with RH the pancreas over produces insulin so you do actually drop too low. My understanding of it is that it is usually triggered by food, so you might be best to exercise before food and probably low intensity exercise so that the liver doesn't release glucose causing the pancreas to be triggered.
A low carb diet and eating little and often is usually the recommended treatment to try to keep levels stable.
You mention that you often drop low on a morning.... Is that before or after breakfast?
Have you considered using a Freestyle Libre sensor to try to identify individual triggers so that you can adjust your diet to suit your body to better manage it's RH response?
Hello rebrascora
Thank you for responding to my post. Part of what I am still learning is what are carb rich foods. I have been given a list of Low GI foods a lady I saw once at Wellbeing clinic. Breakfast is two small slices of toast, with some peanut butter on them, then some greek yogurt, around 8.am. I feel o.k. in morning, less so a few hours later. By 11.00 11.30 I have dropped low to about 5.2, which can be tricky area for me when out walking. I will look up Freestyle Libre sensor - I had not heard of this. Thankyou Gladys
Thank you for responding to my post. Part of what I am still learning is what are carb rich foods. I have been given a list of Low GI foods a lady I saw once at Wellbeing clinic. Breakfast is two small slices of toast, with some peanut butter on them, then some greek yogurt, around 8.am. I feel o.k. in morning, less so a few hours later. By 11.00 11.30 I have dropped low to about 5.2, which can be tricky area for me when out walking. I will look up Freestyle Libre sensor - I had not heard of this. Thankyou Gladys
Leadinglights
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High carb food are things like potatoes, rice, pasta, bread, pastry, cakes, breakfast cereals, bananas, tropical fruits. Portion size can be all important.
The book or app Carbs and Cals may help you distinguish the higher carb foods as it gives carb values of various portion sizes of a whole range of foods.
rebrascora
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5.2 is actually a really good blood glucose reading so if you feel wobbly at that then I would suspect that your levels are spiking high after your breakfast and then coming back down fast. Have you tried testing before breakfast and then an hour later to see how high your levels are going before they come down?
Carbohydrate rich foods are kind of divided into two types, sweet or starchy foods.
Obvious things like sugar, honey, syrup, jam, cakes and biscuits, sweets, fruit juice, smoothies and fruit itself to a lesser extent. Most of us following a low carb way of eating limit our fruit intake to a small portion of berries as our daily intake most of the time, berries being the lowest carb fruits. Thankfully rasps are my favourite fruit and one of the best for this. Bananas at the other end of the scale and grapes are some of the highest carb fruits, so best restricted to an occasional treat and portion size kept low, so for me maybe just half a banana one day and the other half the next a few times a year or maybe just 4-6 grapes once in a while.
Starchy carbs are anything made from grains or grain products like flour, so bread, breakfast cereals, pasta, couscous, rice, porridge, pastry, batter dumplings etc as well as potatoes, including sweet potatoes and parsnips and carrots and beets to a lesser extent.
Not saying you should totally avoid these foods but be aware of portion size and frequency of consumption and substituting with lower carb alternatives will help..... For example, cauliflower can be boiled or steamed, drained well and mashed (with a good dollop of cream cheese and maybe a teaspoon of mustard) to replace mashed potato and works really well with sausages or gammon etc or used to top a cottage/shepherd's/fish pie with a liberal sprinkling of cheese. Cauli can also be grated and used to replace rice. Swede can be roasted instead of potatoes. You can make chips with celeriac instead of spuds. There are low carb bread options but they can be expensive and difficult to source and I found it easier to just not eat it at all
, which took a bit of getting my head around at first, but I am fine with it now. Maybe in your situation, try just one slice of bread but bulk your breakfast out with some scrambled eggs on it. I find berries and mixed seeds and several big dollops of creamy natural Greek yoghurt works well for me as a breakfast or an omelette with whatever filling I fancy, usually including cheese and mushrooms and onions and I have it with a large salad and a dollop of cheese coleslaw. That will usually last me all day and provide slow release energy without producing a spike in blood glucose.The Freestyle Libre sensor is a small plastic disk which is applied to the back of your arm and can be scanned with a phone to ontain your glucose levels. It samples every few minutes and saves the data so as long as you scan it every 8 hours or less, it will provide you with data for 24hours even whilst you sleep. Of course many of us scan much more frequently than that to see what our levels are doing at any particular moment as well as assessing what it has done over the day and through the night. It is expensive to buy, but Abbott Laboratories who manufacture it, do a free 14 day trial (one sensor) for people who qualify. I am not sure if you would with having RH rather than diabetes but in your situation, I would be inclined to tick to say I had diabetes, as RH can be a prerequisite to developing diabetes and I believe this device would give you a lot of useful information during that 14 day period and help keep you safe. It is certainly worth learning more about so definitely have a look at the information on their website.
Inka
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- Relationship to Diabetes
- Type 1
Welcome @Gladys 🙂 I think @TheClockworkDodo ‘s partner has reactive hypoglycaemia so may be able to offer advice. Here’s the general dietary advice - as you say, frequent small meals and plenty of protein too:
https://www.nnuh.nhs.uk/publication/download/healthy-eating-for-reactive-hypoglycaemia-v5/
Were you diagnosed in hospital with the special test (I’ve forgotten it’s name - sorry!) How low do you go?
https://www.nnuh.nhs.uk/publication/download/healthy-eating-for-reactive-hypoglycaemia-v5/
Were you diagnosed in hospital with the special test (I’ve forgotten it’s name - sorry!) How low do you go?
Hello Inka, Thank you for the link. Re diagnosis, I spoke with my g.p. as I was noticing I could not go longer than a few hours, particularly when out walking, and risk fainting if I had not eaten. G.p. suggested reactive hypoglycemia. I had asked for blood tests re diabetes but was told I had had six tests over last few years and they had all come back normal. Referred to an enocrynologist privately who did scan on me to rule out anything nasty e.g. pancreatic cancer. Scan fine so endocrynologists said symptoms suggest reactive hypoglycemia and to change how I ate. Was o.k. for about four weeks then had small piece of cake and about an hour and a half later passed out, injuring head badly, needing stitches. Still working on changing diet but have not had much guidance, hence using this site so thank you for information
5.2 is actually a really good blood glucose reading so if you feel wobbly at that then I would suspect that your levels are spiking high after your breakfast and then coming back down fast. Have you tried testing before breakfast and then an hour later to see how high your levels are going before they come down?
Carbohydrate rich foods are kind of divided into two types, sweet or starchy foods.
Obvious things like sugar, honey, syrup, jam, cakes and biscuits, sweets, fruit juice, smoothies and fruit itself to a lesser extent. Most of us following a low carb way of eating limit our fruit intake to a small portion of berries as our daily intake most of the time, berries being the lowest carb fruits. Thankfully rasps are my favourite fruit and one of the best for this. Bananas at the other end of the scale and grapes are some of the highest carb fruits, so best restricted to an occasional treat and portion size kept low, so for me maybe just half a banana one day and the other half the next a few times a year or maybe just 4-6 grapes once in a while.
Starchy carbs are anything made from grains or grain products like flour, so bread, breakfast cereals, pasta, couscous, rice, porridge, pastry, batter dumplings etc as well as potatoes, including sweet potatoes and parsnips and carrots and beets to a lesser extent.
Not saying you should totally avoid these foods but be aware of portion size and frequency of consumption and substituting with lower carb alternatives will help..... For example, cauliflower can be boiled or steamed, drained well and mashed (with a good dollop of cream cheese and maybe a teaspoon of mustard) to replace mashed potato and works really well with sausages or gammon etc or used to top a cottage/shepherd's/fish pie with a liberal sprinkling of cheese. Cauli can also be grated and used to replace rice. Swede can be roasted instead of potatoes. You can make chips with celeriac instead of spuds. There are low carb bread options but they can be expensive and difficult to source and I found it easier to just not eat it at all
The Freestyle Libre sensor is a small plastic disk which is applied to the back of your arm and can be scanned with a phone to ontain your glucose levels. It samples every few minutes and saves the data so as long as you scan it every 8 hours or less, it will provide you with data for 24hours even whilst you sleep. Of course many of us scan much more frequently than that to see what our levels are doing at any particular moment as well as assessing what it has done over the day and through the night. It is expensive to buy, but Abbott Laboratories who manufacture it, do a free 14 day trial (one sensor) for people who qualify. I am not sure if you would with having RH rather than diabetes but in your situation, I would be inclined to tick to say I had diabetes, as RH can be a prerequisite to developing diabetes and I believe this device would give you a lot of useful information during that 14 day period and help keep you safe. It is certainly worth learning more about so definitely have a look at the information on their website.
Inka
Well-Known Member
- Relationship to Diabetes
- Type 1
Awful about you passing out and injuring your head @Gladys I really think trying the Libre mentioned above might help you as it has alarms for low and high sugars. Also, if it were me, I’d keep a notebook to write down my meals and snacks (time and foods), my exercise (time and some detail about it) and my blood sugar. Hopefully you’ll find a diet and a lifestyle that works for you, and then you can have ‘safe’ meals and deal with exercise better.
Hello Rebrascora. Thank you for your helpful reply with so much useful information. I did not know that 5.2 was a good blood glucose reading. That is sort of information I am wanting to learn. Have tested myself sometimes and been 4, and would not have known; other times can be around 5.2 and am shakey. I will test before breakfast as you suggest, then an hour later to see how high levels are going. What is the ideal goal re glucose levels - is it for them to stay at a moderate level and stable level?
Notebook sounds a good idea Inka. I am still looking up whether I should eat before I exercise, which I think I should, I am talking of going for a walk, how long before I go walking somewhere should I eat; to take glucose tablets with me or something else just in case. It is all about learning right now and I am wanting to learn as safely as I can, not by having more falls like the last one. Lesson learned there. Never eat cake again, no matter how small - spiked too high. Hope to learn lessons on here and I have already so thank you Inka and everyone who has responded to me
Thank you Leadinglights for this information. I am interested in how others manage low glucose levels through eating so that it raises glucose but does not create a glucose spike/glucose drop cycle.
Leadinglights
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- Relationship to Diabetes
- Type 2
The measures that people who are Type 1 or Type 2 may well be something different from what you might need to be doing as their body will be react differently.
It may be worth your while seeing if you can get a free trial of the Libre as that could help you monitor more closely what is happening in various circumstances but also it will allow you to collect some data to show your consultant.
This link may help with menu suggestions. https://www.healthline.com/health/hypoglycemia-diet
rebrascora
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Gosh! That is awful that you fainted and cut your head. I imagine that has really knocked your confidence.
You would be well advised to ALWAYS carry jelly babies or glucose/dextrose tablets with you. and keep them by the bed and in the bathroom and in every handbag and coat and in the car etc. It will be even more important for you than most of us not to over treat a hypo otherwise your levels may spike and crash again, so maybe just one or two JBs or Gluco tablets and then test again 15 mins later to check that your levels have come back up. Once they are up above 4 then you should be fine but if after 15 mins they are still below 4 then have another couple of JBs or Gluco tabs and give it another 15 mins and test again. Always be prepared to deal with a hypo and when I am out walking, I regularly assess how I am feeling..... is my peripheral vision going blurry, do I feel a bit wobbly or like I am wrapped in cotton wool and isolated from what is happening around me, am I feeling a bit sweatier than I should for the exercise I am doing. Sometimes I get the feeling of mild indigestion or almost like going down in a lift when a hypo is coming on, like my stomach had dropped. That sounds weird but if you feel it you will know. Tingly lips and/or tongue is quite a common one. There are lots and lots of different hypo signs and everyone experiences them differently so you have to learn what yours are and be alert for them coming on, particularly when you are at risk of them like when walking and test as soon as you feel not quite right.
Normal levels are between 4 and 7 before meals and ideally you don't want to rise by more than a couple of mmols after a meal to keep levels reasonably stable. We class under 4 as a hypo that needs treating with fast acting glucose like Jelly babies of glucose tablets although in reality non diabetic people can drop a bit below 4 naturally, we need to preserve our hypo awareness so ideally we want to keep levels above 4. Below 3.5 the body starts to shut down non essential functions which is why vision starts to go blurry and lips tingle, to preserve the remaining glucose to keep brain, heart and lungs going. Sometimes the shock of levels dropping very fast might cause you to lose consciousness or when levels get extremely low (below 2 usually) and at this level there is a risk of some brain cells dying so very much something to avoid. The liver should be able to release glucose into the blood stream when levels get low to bring you back up itself but I am not sure if this function is inhibited in RH patients. I know with those of us who use insulin, the liver is sometimes unable to release enough glucose quickly enough to overcome the surplus insulin or if we have had a few hypos then the liver can become depleted and not have enough stores to release more.
As regards food, proteins and fats should help to provide you with plenty of calories whilst not spiking your BG levels. For me an evening meal low in carbs but high in protein and fat and nice and filling would be a thick slice or two of home cooked ham/gammon or high meat content sausages with a large portion of cauliflower cheese, made with just cauliflower and cheese rather than a cheese sauce made with milk, butter and flour (flour and milk both contain carbs) Basically, par boil or steam the cauli then drain well and place in oven proof dish. Coat with full fat cream cheese like Philadelphia, and then top with plenty of grated cheese of your choice. I usually use a mixture of mature Cheddar, Red Leicester and Parmesan and then place in a hot over to brown off. I would also have a good portion of green veg like cabbage or kale or leeks, cooked with a knob of butter or a dollop of cream cheese or some green beans. You can make a big plateful of food like that and not have many carbs at all, but plenty of calories to give you energy. Going for a walk after that sort of meal should not cause you problems, but always be prepared whilst you are out walking. I have a little back pack handbag that I carry all my gear in so that I always have my test kit and hypo treatments and phone etc with me but as a backpack it leaves my hands and arms free to walk or run more comfortably.
It would be a good idea to walk with someone the first few times after such a nasty incident rather than on your own and make sure they know to give you some carbs (a couple of Gluco tablets or jelly babies or whatever) if you need them. The other thing to know is that hypo treatments start working in your mouth as glucose can be absorbed by the cells on the inside of your mouth so chewing your hypo treatment well will enable it to work quicker than a couple of chews and swallowing it.
Hope I am not overloading you with too much info 🙄
You would be well advised to ALWAYS carry jelly babies or glucose/dextrose tablets with you. and keep them by the bed and in the bathroom and in every handbag and coat and in the car etc. It will be even more important for you than most of us not to over treat a hypo otherwise your levels may spike and crash again, so maybe just one or two JBs or Gluco tablets and then test again 15 mins later to check that your levels have come back up. Once they are up above 4 then you should be fine but if after 15 mins they are still below 4 then have another couple of JBs or Gluco tabs and give it another 15 mins and test again. Always be prepared to deal with a hypo and when I am out walking, I regularly assess how I am feeling..... is my peripheral vision going blurry, do I feel a bit wobbly or like I am wrapped in cotton wool and isolated from what is happening around me, am I feeling a bit sweatier than I should for the exercise I am doing. Sometimes I get the feeling of mild indigestion or almost like going down in a lift when a hypo is coming on, like my stomach had dropped. That sounds weird but if you feel it you will know. Tingly lips and/or tongue is quite a common one. There are lots and lots of different hypo signs and everyone experiences them differently so you have to learn what yours are and be alert for them coming on, particularly when you are at risk of them like when walking and test as soon as you feel not quite right.
Normal levels are between 4 and 7 before meals and ideally you don't want to rise by more than a couple of mmols after a meal to keep levels reasonably stable. We class under 4 as a hypo that needs treating with fast acting glucose like Jelly babies of glucose tablets although in reality non diabetic people can drop a bit below 4 naturally, we need to preserve our hypo awareness so ideally we want to keep levels above 4. Below 3.5 the body starts to shut down non essential functions which is why vision starts to go blurry and lips tingle, to preserve the remaining glucose to keep brain, heart and lungs going. Sometimes the shock of levels dropping very fast might cause you to lose consciousness or when levels get extremely low (below 2 usually) and at this level there is a risk of some brain cells dying so very much something to avoid. The liver should be able to release glucose into the blood stream when levels get low to bring you back up itself but I am not sure if this function is inhibited in RH patients. I know with those of us who use insulin, the liver is sometimes unable to release enough glucose quickly enough to overcome the surplus insulin or if we have had a few hypos then the liver can become depleted and not have enough stores to release more.
As regards food, proteins and fats should help to provide you with plenty of calories whilst not spiking your BG levels. For me an evening meal low in carbs but high in protein and fat and nice and filling would be a thick slice or two of home cooked ham/gammon or high meat content sausages with a large portion of cauliflower cheese, made with just cauliflower and cheese rather than a cheese sauce made with milk, butter and flour (flour and milk both contain carbs) Basically, par boil or steam the cauli then drain well and place in oven proof dish. Coat with full fat cream cheese like Philadelphia, and then top with plenty of grated cheese of your choice. I usually use a mixture of mature Cheddar, Red Leicester and Parmesan and then place in a hot over to brown off. I would also have a good portion of green veg like cabbage or kale or leeks, cooked with a knob of butter or a dollop of cream cheese or some green beans. You can make a big plateful of food like that and not have many carbs at all, but plenty of calories to give you energy. Going for a walk after that sort of meal should not cause you problems, but always be prepared whilst you are out walking. I have a little back pack handbag that I carry all my gear in so that I always have my test kit and hypo treatments and phone etc with me but as a backpack it leaves my hands and arms free to walk or run more comfortably.
It would be a good idea to walk with someone the first few times after such a nasty incident rather than on your own and make sure they know to give you some carbs (a couple of Gluco tablets or jelly babies or whatever) if you need them. The other thing to know is that hypo treatments start working in your mouth as glucose can be absorbed by the cells on the inside of your mouth so chewing your hypo treatment well will enable it to work quicker than a couple of chews and swallowing it.
Hope I am not overloading you with too much info 🙄
Not too much information Rebrascora, all very helpful. At moment wear a protective when go for short walk, but want to understand more about whether to eat small amount before I go out as well as take glucose tablets. And you are picking up why I am wanting to learn about diet - ideally I want to prevent hypos, but when they occur I want to be treating them in a way that I am not over treating and so creating a spike and then a crash - which I think the accident was - my blood glucose measured 5.2 in ambulance and I had eaten a small amount of birthday cake about an hour and a half ago, then feeling unwell and need to buy food. I think one of my early warning symptoms is my vision going a bit blurry; used to have more sweats, but these have reduced since changing diet, get them occasionally now. Thank you for sharing that proteins and fats likely to provide calories without spiking blood glucose levels. And seems eating lots of veg is good in general
That is a good idea do see if can get free trial of Libre before seeing consultant - which is in a couple of months time. Thank you for link.
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Sorry to hear about your reactive hypoglycaemia @Gladys
Hope you can find ways to reduce your glucose fluctuations and hopefully reduce the resulting BG drops where your pancreas overreacts.
Sounds line it would be good to keep hypo treatments on hand that can be divided into flexible subdivisions if you can tell your BG is dropping, so that you don’t get too much of a BG peak and then another dip and into the merry go round.
Skittles are about 1g to 1.5g of carbs per sweet, and gluco-tabs are often around 3g of carbs, which might give you some flexibility?
Hope you can find ways to reduce your glucose fluctuations and hopefully reduce the resulting BG drops where your pancreas overreacts.
Sounds line it would be good to keep hypo treatments on hand that can be divided into flexible subdivisions if you can tell your BG is dropping, so that you don’t get too much of a BG peak and then another dip and into the merry go round.
Skittles are about 1g to 1.5g of carbs per sweet, and gluco-tabs are often around 3g of carbs, which might give you some flexibility?
Thank you for reply everydayupsanddowns. At moment am carrying glucose tablets with me. Have not got back to walking to town yet, but when do wondering whether should have something to eat before I do i.e. does exercise cause glucose levels to drop - all things I am needing to learn as no-one medical telling me these things. Will take gluclose tablets out with me as a safety net. Thank you for sharing what you know about glucose tablets and skittles
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