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Type 2 diet managed - hypo??

A

Amyfaith

Well-Known Member
Relationship to Diabetes
In remission from Type 2
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Hi all, silly question but: are hypos possible for type 2s managed purely by diet? If so, at what point should we be treating them?

I know normally they aren’t meant to happen (only really if on meds), but like, if you’re feeling shakey/dizzy and your CGM/finger stick is giving you 3s, should you treat it like a hypo? (Basically like you would if you were metabolically normal - eat something if you feel funky!)

I’m using some Dexcom One +s at the moment and though I know it runs a little low on me anyway, I was getting symptoms of a hypo while teaching this afternoon. Read a 3.2 once I got back to my office after teaching (and stayed around there for a bit - I know exercise can make things look lower than they are briefly) and it’s only off by about 0.5 usually, so I sort of decided to treat it as a hypo. This particularly one seems to be running *higher* than I am in reality so I was rather concerned by that. I frequently have upper 3s before dinner especially if I’m running around a lot/had a small lunch, but usually it’ll pop back up to 4-something in 15 mins on its own. This… didn’t.

Thoughts? I’m heading home shortly but didn’t fancy commuting by foot when feeling funky so know I did the right thing overall, but I’m really curious - are type 2 hypos possible without medication?
 
(also like a silly person I don’t keep a meter in my office… so I was having to guess based on the CGM…)
 
Hi @Amyfaith, I wouldn’t have thought someone not on oral medication or insulin would have a hypo? I thought that someone who isn’t diabetic would see BG in the range 4 to 7 and not get into hypos.

Low blood sugar can be caused by having too much insulin (either injected or endogenous, I.e. produced by the pancreas which may have been stimulated by some oral meds).
 
@Amyfaith - I'm a non-medicated T2 who has been in remission (or whatever you want to call it) for over 10 years now.

I frequently see numbers in the 3s, and sometimes the low 3s and rarely into the 2s. The low 3s and 2s tend to be when I'm very hungry and would like to eat. I don't snack, so that statement means before mealtimes. If food is imminent, I just wait, but if it is a while away, I usually just have a cup of tea with some milk in it, and that just nudges me up a bit until my meal.

I can honestly say I have never felt bad in any of those circumstances, although in the 2s I would say I am/was uncomfortable.

In reality, you have to do what feels right for you. I'm content that as someone not taking glucose lowering meds, I am extremely unlikely to experience a medically concerning hypo. Obviously, if I felt unwell, or very lightheaded, I'd rethink my cup of tea and add something to that.
 
AndBreathe said:
@Amyfaith - I'm a non-medicated T2 who has been in remission (or whatever you want to call it) for over 10 years now.

I frequently see numbers in the 3s, and sometimes the low 3s and rarely into the 2s. The low 3s and 2s tend to be when I'm very hungry and would like to eat. I don't snack, so that statement means before mealtimes. If food is imminent, I just wait, but if it is a while away, I usually just have a cup of tea with some milk in it, and that just nudges me up a bit until my meal.

I can honestly say I have never felt bad in any of those circumstances, although in the 2s I would say I am/was uncomfortable.

In reality, you have to do what feels right for you. I'm content that as someone not taking glucose lowering meds, I am extremely unlikely to experience a medically concerning hypo. Obviously, if I felt unwell, or very lightheaded, I'd rethink my cup of tea and add something to that.
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Good to hear it’s not outside the realm of possibility! I didn’t think it was likely to be a medical emergency at all, but didn’t fancy feeling extra woozy walking home after dark.

Interestingly, 1 hr after eating a small snack (when I got home), meter read 4.6, so I must have been rather low for me indeed for that to be the case at that point, even with the walk! (That’s my normal reading on getting home when not feeling funny!)
 
As you are now into the normal range and well below even the prediabetes threshold I wonder if you are perhaps not eating enough and over reacting to your CGM. Your liver should release some glucose if your level gets a bit low and just having a drink will set you right.
Do you feel it really necessary to be using a CGM given you could be classed as being in remission.
 
Sorry to hear you’ve had a few wobbles @Amyfaith

As you suggest, it’s unlikely that your glucose levels would get worryingly low unless you are on glucose-lowering medications, but it is possible for people without diabetes to experience hypoglycaemia (eg in endurance sports), or warning signs of being a bit ‘close to the edge’.

Do you think it might help to give your BG a little bump, just maybe 5-6g of fast carbs, rather than a standard ‘hypo treatment’ of 15g?
 
Leadinglights said:
As you are now into the normal range and well below even the prediabetes threshold I wonder if you are perhaps not eating enough and over reacting to your CGM. Your liver should release some glucose if your level gets a bit low and just having a drink will set you right.
Do you feel it really necessary to be using a CGM given you could be classed as being in remission.
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I bought ‘em before my test results came in, so figured I’d use them to do some experimenting with new food combos and such without having to stab my fingers. Normally I just look at the rough pattern and relative rise, but it was an unusually low number for being upright (nighttime frequently ends up in low 3s and 2s). Not sure if GP will consider me in remission or not (presumably so!) - appointment with them isn’t for two more weeks!

Today in particular I know my lunch was a little light calorie-wise (accidental, I swear! Carb count was normal for me but lower in terms of calories somehow), so won’t make that mistake again on a day when I won’t be home till 7:30ish. Most of the time I’m absolutely fine, eating what seems like plenty, so the aberration is what threw me. Probably down to the very long afternoon on top of a lighter lunch!
 
everydayupsanddowns said:
Sorry to hear you’ve had a few wobbles @Amyfaith

As you suggest, it’s unlikely that your glucose levels would get worryingly low unless you are on glucose-lowering medications, but it is possible for people without diabetes to experience hypoglycaemia (eg in endurance sports), or warning signs of being a bit ‘close to the edge’.

Do you think it might help to give your BG a little bump, just maybe 5-6g of fast carbs, rather than a standard ‘hypo treatment’ of 15g?
Click to expand...
Exactly what I did - I didn’t have anything in my office of the sort of fast acting 15g carbs, but I did have a bunch of small granola bars which were 7g (obvs with protein/fibre/etc too) - I normally have one with my lunch but didn’t today because I had something unusual that took me up to my usual 30ish g limit.
 
Amyfaith said:
I bought ‘em before my test results came in, so figured I’d use them to do some experimenting with new food combos and such without having to stab my fingers. Normally I just look at the rough pattern and relative rise, but it was an unusually low number for being upright (nighttime frequently ends up in low 3s and 2s). Not sure if GP will consider me in remission or not (presumably so!) - appointment with them isn’t for two more weeks!

Today in particular I know my lunch was a little light calorie-wise (accidental, I swear! Carb count was normal for me but lower in terms of calories somehow), so won’t make that mistake again on a day when I won’t be home till 7:30ish. Most of the time I’m absolutely fine, eating what seems like plenty, so the aberration is what threw me. Probably down to the very long afternoon on top of a lighter lunch!
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To be fair, depending how your graph looks, that your night time very lows are compression lows, caused by sleeping on your sensor. Th graph usually has a giveaway look to it.

If I'm using a sensor, if I don't position it well back on my arm, almost going to the inside of my arm, or wear it on my chest, I persistently read at 2.2, or just Low. Of course those numbers skew my averages, so I do what I do.

You've done really well, and of course now the challenge is to embed these newer ways of doing things into your daily living, but you seem to have a level-headed approach to things. Just be aware we do still got those "Eh?!??" moments from time to time.

That's life.
 
Eternal422 said:
Hi @Amyfaith, I wouldn’t have thought someone not on oral medication or insulin would have a hypo? I thought that someone who isn’t diabetic would see BG in the range 4 to 7 and not get into hypos.
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Reactive hypoglycaemia can cause hypos, as can other things like a lot of exercise or alcohol
 
Lucyr said:
Reactive hypoglycaemia can cause hypos, as can other things like a lot of exercise or alcohol
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Thanks @Lucyr , I did wonder if there were other causes of hypos.
 
AndBreathe said:
To be fair, depending how your graph looks, that your night time very lows are compression lows, caused by sleeping on your sensor. Th graph usually has a giveaway look to it.

If I'm using a sensor, if I don't position it well back on my arm, almost going to the inside of my arm, or wear it on my chest, I persistently read at 2.2, or just Low. Of course those numbers skew my averages, so I do what I do.

You've done really well, and of course now the challenge is to embed these newer ways of doing things into your daily living, but you seem to have a level-headed approach to things. Just be aware we do still got those "Eh?!??" moments from time to time.

That's life.
Click to expand...
Ha yeah - some are definitely compression lows (doodling around at 4.5, then sudden drop to LOW for an hour, then back up after what looks like a brief reset where it thinks I’ve died…), but a fair few just dally in the 2s/3s for a while and slowly come back up. I only use my right arm as I sleep on my left 90% of the time, and definitely see the low 3s when I wake up needing the loo middle of the night and am not on the sensor. (I am mostly glad to see constancy overnight - same patterns, no random highs.) Again, mostly using these to test a few theories and new foods/meals at the moment. It’s also useful to see what happens at work (high stress - hello the impending destruction of UK HE - and often lots of running around). I’ve got some theories about wheat I need to play with at some point here, too.

I also know that my existing auto immune stuff means that the longer the sensor is on, the lower it tends to run compared to a meter, which is useful to know. (Basically, my immune system is a bit easily distracted then once it kicks in, it overdoes it - means that the glucose levels local to the sensor are lower over time as my immune system starts going INVADER! OUT OUT OUT!) Though this particular one is mostly bang on or higher for some reason and it continues on that way a week in. ‍*shrug*

And yeah… luckily I’ve managed to get things pretty well incorporated into my daily routine. It’s when I can’t control the routine when I get a little extra anxious, and when I get the odd unexpected thing like last night, but mostly let me cook for myself and/or have a good walk shortly after eating and I’m good. Which, honestly? Good for the mental health as well, so I’m loathe to stop any of it.
 
Amyfaith said:
Ha yeah - some are definitely compression lows (doodling around at 4.5, then sudden drop to LOW for an hour, then back up after what looks like a brief reset where it thinks I’ve died…), but a fair few just dally in the 2s/3s for a while and slowly come back up. I only use my right arm as I sleep on my left 90% of the time, and definitely see the low 3s when I wake up needing the loo middle of the night and am not on the sensor. (I am mostly glad to see constancy overnight - same patterns, no random highs.) Again, mostly using these to test a few theories and new foods/meals at the moment. It’s also useful to see what happens at work (high stress - hello the impending destruction of UK HE - and often lots of running around). I’ve got some theories about wheat I need to play with at some point here, too.

I also know that my existing auto immune stuff means that the longer the sensor is on, the lower it tends to run compared to a meter, which is useful to know. (Basically, my immune system is a bit easily distracted then once it kicks in, it overdoes it - means that the glucose levels local to the sensor are lower over time as my immune system starts going INVADER! OUT OUT OUT!) Though this particular one is mostly bang on or higher for some reason and it continues on that way a week in. ‍*shrug*

And yeah… luckily I’ve managed to get things pretty well incorporated into my daily routine. It’s when I can’t control the routine when I get a little extra anxious, and when I get the odd unexpected thing like last night, but mostly let me cook for myself and/or have a good walk shortly after eating and I’m good. Which, honestly? Good for the mental health as well, so I’m loathe to stop any of it.
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I see an Endo consultant for my very wonky thyroid. My family medical history is absolutely littered with auto-immune conditions, which, much to my Endo's astonishment. My coeliac panel was inconclusive, but I hadn't carbed up for it - with the Endo's knowledge.

His strong recommendation was to go gluten free, which is obviously a wide exclusion than just wheat. His recommendation was he found that folks with AI conditions do very well on it, and he just thinks nobody has found mine yet.

I was astonished to find, having gone GF for a couple of months that I just felt better. I'd not knowingly had any signs or symptoms of gluten challenges, but my body works better without it.

These days if I am glutened it is quite unpleasant.

Should you decide to ditch wheat, maybe consider the gluten option, but if you do, you have to commit to a minimum 3 month trial as it takes a long time for all the impacts to settle.
 
I went mostly wheat and gluten free about 9 months ago, as I noticed my post prandial measurements were waaay out of kilter after my weekend lunches (usually eggs and avocado on toast) compared to meals with similar carb/fat/protein content. Switched the bread out for GF of same carb count (there was a lot of weighing and math!) and - tada - more normal results at 2 hours. So there could be something to that. A corner (not a corner piece - literally a 1cm square piece) of brownie sent me waaay higher than usual for four hours. Again, no issue with GF sweets of reasonable size and carb count. But I want to do some experimenting as I’m not sure if it’s just longer amounts of time at raises glucose levels (which, if they’re in the 6s, aren’t necessarily an issue for an occasional treat), or if it does something really wild. I’d like to know as eating lowish carb AND GF is really, really irritating - I miss pizza!
 
Amyfaith said:
I went mostly wheat and gluten free about 9 months ago, as I noticed my post prandial measurements were waaay out of kilter after my weekend lunches (usually eggs and avocado on toast) compared to meals with similar carb/fat/protein content. Switched the bread out for GF of same carb count (there was a lot of weighing and math!) and - tada - more normal results at 2 hours. So there could be something to that. A corner (not a corner piece - literally a 1cm square piece) of brownie sent me waaay higher than usual for four hours. Again, no issue with GF sweets of reasonable size and carb count. But I want to do some experimenting as I’m not sure if it’s just longer amounts of time at raises glucose levels (which, if they’re in the 6s, aren’t necessarily an issue for an occasional treat), or if it does something really wild. I’d like to know as eating lowish carb AND GF is really, really irritating - I miss pizza!
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There are recipes for flour free pizza bases using ground almonds, cauliflower rice and eggs or fathead pizza dough which is ground almonds. eggs, cream cheese, mozzarella as the base.
 
I’ve tried fathead before and found it just not quite right… bit stodgy for me. I’d be interested in the ones using almonds/cauliflower, though! (I eat so many almonds I think I’m gonna turn into an almond, let’s be honest….)
 
Amyfaith said:
I’ve tried fathead before and found it just not quite right… bit stodgy for me. I’d be interested in the ones using almonds/cauliflower, though! (I eat so many almonds I think I’m gonna turn into an almond, let’s be honest….)
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2 eggs, 150g cauli rice, 150g ground almonds bake 200 degrees for 20mins then add toppings.
 
Well I know what I’m making this weekend…
 
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