Hypoglycemia not improving on Low-carb

[Bethklok]

So I'm looking for advice from people who have had this problem. I've been following Atkins for about two months now and have started having hypoglycemic episodes. I was under the impression that Atkins was supposed to even out blood sugar. I've never been diagnosed with hypoglycemia, but I know the symptoms. I've been getting lightheaded, blurry or blacked-out vision, weak & fatigued, sweaty & clammy at the same time.

I've been eating about 20g of veggie carbs a day. Sometimes I'll have almonds or blueberries as well. Should I increase my carbs even more or will that make my symptoms worse?

Two more questions. How serious is hypoglycemia? Should I be worried about diabetes? Any info would be greatly appreciated. Thanks for your time and knowledge.

[pennink]

20 carbs of veggies? you know there's no 'rule' that you must do that.
How's your fat and protein? That's what will keep your blood sugar stable.

It took me a week to conquer my hypo issues.
Now, i did start feeling dizzy, lightheaded, tired and blurry. It was B12 deficiency. Not my blood sugar. Get a blood test or just simply start taking some B12 to see if that, along with fat, helps.

[Bethklok]

20 carbs of veggies? you know there's no 'rule' that you must do that.
How's your fat and protein? That's what will keep your blood sugar stable.

It took me a week to conquer my hypo issues.
Now, i did start feeling dizzy, lightheaded, tired and blurry. It was B12 deficiency. Not my blood sugar. Get a blood test or just simply start taking some B12 to see if that, along with fat, helps.

Thanks for responding so quickly Pennink!
I know I don't need to eat 20g of carbs. I don't always make it that high. My fat intake is usually about 65% of calories, protein 30%, carbs 5%. I eat anywhere from 1,200 to 2,200 cals a day. I also take a B12 supplement daily.

[eddiemcm]

You should probably get a glucose meter and test to verify
hypoglycemia.Good advice from pennink.
Good luck on this
Eddie

[Lottadata]

You might be having low blood pressure, NOT hypoglycemia. The symptoms are similar, but low blood pressure is more likely on a very low carb diet.

Get a cheap meter (Walmart has the cheapest) and double check. Anything over 70 mg/dl is NOT hypoglycemia.

If it is blood pressure, up your potassium and sodium.

[Bethklok]

Thanks for the advice everybody!

[Squid]

I have had bad hypoglycemia at times on low carb. It usually happens after some kind of exertion - exercise, or a walk up a steep hill, etc. I can handle it pretty well with keeping food with me - and it doesn't have to be very high in carbs. Cheese seems to work really well for me. Nuts are another good one. I just always have a snack in my purse for those times. The weird thing is that I can fast for a day and my blood sugar dips but doesn't go that low (low 70s).

I agree that a BG meter would be a good idea so you can learn what triggers your lows. It might be not eating or it might be after exertion or 2-3 hours after a meal (reactive hypoglycemia).

My endocrinologist told me not to worry about it. If it gets so low that you're passing out, that's a different story.

You also may not be having low blood sugar so much as a quick drop in blood sugar which can bring on the same symptoms.

Bottom line - with a BG meter you'll probably do a better job at figuring out what's going on than your doc. They mostly dismiss hypoglycemia unless you're a diabetic.

[Nancy LC]

You also may not be having low blood sugar so much as a quick drop in blood sugar which can bring on the same symptoms.
Yeah, need to rule out false hypoglycemia. Not really low, just lower than your body is used to.

[Legeon]

This might sound a bit odd but one of the reasons I avoid food high in salicylates, amines, and additives is because they will trigger my reactive hypoglycemia if eaten often enough. It could be it's not just sugar at work here. Things like blueberries and almonds would definitely set me off.

I personally consider hypoglycemia to be pretty damned serious. It's the first step on the road of no return towards Type 2.

[ambimorph]

I concur with Lottadata - lightheadedness from low blood pressure is a known common problem on low carb if you are not getting enough sodium, potassium and magnesium.

Lyle McDonald suggests the following supplementation:
sodium 3-5g above food
potassium 1g above food
magnesium 300mg

I don't generally bother, since I'm not having symptoms, but for a while, last time I was eating low carb, I took potassium to counter muscle cramping. Also, I do use salt and those salt-replacements with potassium (Mrs. Dash, etc) liberally, though.

[Korban]

Lyle McDonald suggests the following supplementation:
sodium 3-5g above food
potassium 1g above food
magnesium 300mg

I hope they don't supplement, as above, and have high blood pressure or heart problems, particularly, CHF.

/smile

[dancinbr]

Well I am the last in a long line of thoughts.

My issue when strictly sticking to a low carb and/or any diet that lowers my calories is that my blood pressure drops to low levels.

So you move around more slowly. Don't jump up out of bed suddenly.

Have a snack if necessary.

All of this is stated above.

However, I also agree that you should be measuring your blood sugars to eliminate the possibility that it is hypoglycemia.

I take it you are NOT diabetic. Or are you?

If you are, it is even more important that you have a meter and start tracking your BG throughout the day.

Even if you haven't been diagnosed as a diabetic be aware of what your A1C is and your daily BG averages are.

Too many doctors wait way too long to finally diagnose you as a diabetic.

I was diabetic for over a year before being diagnosed properly.

Ralph

[Lisa N]

I hope they don't supplement, as above, and have high blood pressure or heart problems, particularly, CHF.

/smile

The medical problem itself would not be problematic with those supplements, but if a person is taking medication for high blood pressure or diuretics for fluid retention, it would be a good idea to check with a doctor or pharmacist first to be sure that your medication doesn't cause you to retain potassium specifically.
Sodium (salt) isn't the problem for high blood pressure as it was previously touted to be unless you are sensitive to it. I'm not sure I would supplement with that much sodium, though, since it's present even in meats today through injected solutions, it's doubtful many people are deficient in that particular mineral.
Magnesium and potassium are both necessary for proper muscle function, but too much isn't good, either. Fortunately, both are water soluble and very difficult to overdose on unless you are taking medications that cause you to retain them or have kidney problems.


Beth, I'll add my encouragement to those above that you get yourself an inexpensive glucose monitor and start checking your blood sugars so that you can see for yourself what your readings are when you feel like your blood sugar is low. If you test and it shows you are 70 or above, it's not likely to be hypoglycemia and you know you need to keep searching for the cause.

[Korban]

[QUOTE=Lisa N]...Sodium (salt) isn't the problem for high blood pressure as it was previously touted to be unless you are sensitive to it. I'm not sure I would supplement with that much sodium, though, since it's present even in meats today through injected solutions, it's doubtful many people are deficient in that particular mineral.
QUOTE]

You are correct that sodium is not now the "issue" it once was considered to be for most people. However, as I understand it, most people with high blood pressure are sensitive to sodium. Regarding CHF, a diet of no more than 2 g Na per day is highly recommended (and preferably less) and I know first hand that poor control of sodium intake will cause edema or even death due to fluid retention. My sister and I won the rare filial dilatant cardiomyopathy raffle.

/smile

P.S. I should say that idiopathic cardiomyopathy is much more common than the genetic variety.

[dancinbr]

The medical problem itself would not be problematic with those supplements, but if a person is taking medication for high blood pressure or diuretics for fluid retention, it would be a good idea to check with a doctor or pharmacist first to be sure that your medication doesn't cause you to retain potassium specifically.
Sodium (salt) isn't the problem for high blood pressure as it was previously touted to be unless you are sensitive to it. I'm not sure I would supplement with that much sodium, though, since it's present even in meats today through injected solutions, it's doubtful many people are deficient in that particular mineral.
Magnesium and potassium are both necessary for proper muscle function, but too much isn't good, either. Fortunately, both are water soluble and very difficult to overdose on unless you are taking medications that cause you to retain them or have kidney problems.


Beth, I'll add my encouragement to those above that you get yourself an inexpensive glucose monitor and start checking your blood sugars so that you can see for yourself what your readings are when you feel like your blood sugar is low. If you test and it shows you are 70 or above, it's not likely to be hypoglycemia and you know you need to keep searching for the cause.

The real problem is potassium too high or too low you can be in serious trouble. Magnesium washes out of your system. Too much and you spend more time in the lavatory if you get my drift.

Ralph

[Korban]

The real problem is potassium too high or too low you can be in serious trouble. Magnesium washes out of your system. Too much and you spend more time in the lavatory if you get my drift.

Ralph
When I have to take a diuretic (which I haven't had to take once since my bg's have come in line ~ 9 weeks), since the diuretic quantity used to sometimes be pretty high, I would take a K supplement as lite salt on food but I also take spironolactone (in small doses) to help selectively retain K. Spironolactone in higher doses is prescribed for PCOS and Bernstein has written about it.

I am not sure if bg's or diet, or neither, is responsible for me not having to take furosemide, but it has been a blessing as it makes me very tired. YMMV.

/smile

[ambimorph]

You are correct that sodium is not now the "issue" it once was considered to be for most people. However, as I understand it, most people with high blood pressure are sensitive to sodium. Regarding CHF, a diet of no more than 2 g Na per day is highly recommended (and preferably less) and I know first hand that poor control of sodium intake will cause edema or even death due to fluid retention. My sister and I won the rare filial dilatant cardiomyopathy raffle.

/smile

P.S. I should say that idiopathic cardiomyopathy is much more common than the genetic variety.

That's interesting. IIRC, Taubes says that if people with high blood pressure reduce their salt intake by half, they might see a drop in systolic BP by maybe 4 or 5 mm HG (whereas to qualify as having high bp, you are already 20 mm HG above normal), and that what determines how much of the salt you eat is going to be excreted by the kidneys is actually carbohydrate intake.

I'm definitely not an expert on this, let alone on genetic cardiomyopathy, but I'm convinced that a lot of the current recommendations don't apply to low carb dieters.

[Korban]

I'm definitely not an expert on this, let alone on genetic cardiomyopathy, but I'm convinced that a lot of the current recommendations don't apply to low carb dieters.

Based on my recent experience I really can't disagree... I think the LC WOE has had a remarkably beneficial effect for me especially wrt water retention, but I still believe my cardiologist would go into a fit if he knew I were adding 5 g Na over normal baseline per day.

/smile

[dancinbr]

When I have to take a diuretic (which I haven't had to take once since my bg's have come in line ~ 9 weeks), since the diuretic quantity used to sometimes be pretty high, I would take a K supplement as lite salt on food but I also take spironolactone (in small doses) to help selectively retain K. Spironolactone in higher doses is prescribed for PCOS and Bernstein has written about it.

I am not sure if bg's or diet, or neither, is responsible for me not having to take furosemide, but it has been a blessing as it makes me very tired. YMMV.

/smile

I am still taking furosemide along with a K supplement 20meq. This is to control blood pressure along with Norvasc 10mg and Avapro 300mg.

This keeps my BP at or around 120/80.

I know. I need to knock off the weight. It is happening slowly but steady.

I have refocused my efforts for this spring paying much more attention to LCing as peer Dr. B and it is already producing wonderful results.

My BG readings are in the 80s a lot now. My 7 day average is under 100 as is my 14 day average and my 31 day average is approaching 100 as well.

Ralph

[eddiemcm]

About hypoglycemia and LC:
I can't see why locarb diet would be expected to help hypoglycemia.If anything,I would think it might be detrimental.
Locarb generally means less glucose in blood-not exactly the
right path for fixing hypoglycemia.Maybe a medium carb diet
would be better.
Bye for now
Eddie

[ambimorph]

Because hypoglycemia is a disorder of not responding to insulin properly, and insulin metabolism is regularized with a low carb diet.

[eddiemcm]

"Because hypoglycemia is a disorder of not responding to insulin properly, and insulin metabolism is regularized with a low carb diet."
It still appears that LC causes BG drop.
Improves hyperglycemia-yes.
Improve hypoglycemia-I don't think so.
Eddie

[ambimorph]

Your question was why would anyone expect it to help.

Here are a few reasons:

Hypoglycemia is a symptom of insulin resistance, which is believed to be cured by a low-carb diet. In this scenario, hypoglycemia occurs when the pancreas secretes too much insulin in response to food and then lowers the sugar in the blood too much. This happens because of chronic overeating of foods that cause a lot of insulin to be released. If you stop eating those foods, your body, over time, stops automatically secreting insulin every time you start to chew. This would also imply that hypoglycemia would temporarily be worse when beginning a low-carb diet, until the insulin resistance begins to subside.

Relatedly, hypoglycemia is a symptom of the beginning of diabetes. If you believe that a low-carb diet cures diabetes, which many do, then it makes sense that it also cures hypoglycemia.

Finally there is a lot of anecdotal evidence that it does help.

That said, Dr. Keith Berkowitz, M.D., Medical Director for The Center For Balanced Health says that a low-carb diet by itself might not be enough to resolve it.

The following comes from Jimmy Moore's Livin' La Vida Low Carb:
http://livinlavidalocarb.blogspot.com/2007/04/is-hypoglycemia-hidden-low-carb-side.html

The Forgotten Blood Sugar Disorder: Hypoglycemia
by Dr. Keith Berkowitz, M.D.
Medical Director for The Center For Balanced Health

According to the American Diabetes Association, 21 million Americans have diabetes and another 54 million American are at risk with pre-diabetes or elevated blood glucose.

Because of this, our attention has been concentrated on treating high blood glucose while largely ignoring other blood sugar disorders. Poor eating habits, the addition of unhealthy ingredients, increased stress and poor sleeping habits has led to the increased incidence of this underappreciated blood sugar disorder: hypoglycemia.

Hypoglycemia has been traditionally defined as a low blood glucose level (serum levels less than 70 mg/dl either taken fasting, randomly or after a glucose challenge). Unfortunately, most individuals I see in my practice do not present with these results but instead present with normal blood glucose levels, the ability to lose some weight but not the last 10 to 20 pounds or unexplained low energy levels.

One reason for this is that most individuals only have fasting blood glucose or an HgbA1c taken by their health professional. An HgbA1c level represents the average amount of glucose in the blood over a three month period. A level of 4.0% is equal to an average blood glucose level of 60 mg/dl while a level of 5.0% is equal to a blood glucose level of 90 mg/dl. HgbA1c levels between 4.8% and 5.9% are considered normal. Levels below 4.8% are usually consistent with hypoglycemia.

Individuals with hypoglycemia can often have symptoms that include: headaches, increased irritability, difficulty concentrating, palpitations, light-headedness, fatigue, anxiety, excessive sweating or urination, leg cramps, dizziness and clamminess. Other symptoms can be related to eating. Patients I see with this diagnosis often feel more tired after meals, feel “sick” when they either miss a meal or if a meal is delayed.

So, if you have significantly reduced calories or carbohydrates, are you still unable to lose weight? Are you unable to lose that last 20 pounds no matter what you try? Eating a low carbohydrate diet but still hungry and/or tired after meals? I just may have a solution for you.

Traditionally treatment for hypoglycemia has been to give sugar. Unfortunately, this treatment only provides temporary relief and in very sensitive individuals causes an even greater reaction thirty minutes to two hours later. Although, a strict low carbohydrate diet is helpful, it does not always solve the problem by itself.

In my practice, Center for Balanced Health, I see individuals with such pronounced hypoglycemia that their blood sugar drops almost immediately after a glucose challenge. It’s the equivalent of filling an automobile with gas only to find that the gas tank has a very large leak.

At the Center for Balanced Health, we help patients manage their hypoglycemia by telling them to:

- Eat five to six small meals a day about every three hours. Think of yourself as a fuel-efficient automobile. You want constant flow of energy (glucose) throughout the day.

- Avoid meals that are too small or too large especially at night. Meals that are too small will not provide enough energy to get you through the day. Meals that are too large place a larger burden on your metabolic system to process these nutrients and thus can trigger a hypoglycemic reaction.

- DON'T skip meals especially breakfast. Breakfast is the most important meal of the day because it sets the tone.

- Balanced eating. Always have some protein and fat at each meal or snack. Avoid and limit foods high in sugar or other refined carbohydrates especially on a empty stomach. Still utilize a controlled carbohydrate approach and get your carbohydrates from foods high in fiber (dark green leafy vegetables, non starchy vegetables, avocado, high fiber low carbohydrate crackers as examples)

- Get a good night’s sleep. Good sleep helps replenish your system so that your body works more efficiently.

- Use of a fiber supplement (make sure you take with enough water) or eating a high fiber food (without refined carbohydrates or sugar) before meals or snacks can help slow the absorption of carbohydrates and thus prevent rapid declines in blood sugar.

- Exercise regularly. Strength training can improve glucose metabolism

- Avoid alcohol, caffeine, tobacco use

- Avoid the use of stimulants

If you suspect hypoglycemia, the best diagnostic test is a glucose tolerance test with insulin levels and an HgbA1c. I usually do this test in my office because a glucose challenge can sometimes precipitate symptoms of low blood sugar.

[eddiemcm]

I still find it difficult to believe that a person with hypoglycemia
can expect improvement from a VLC diet-I would think that
would worsen the condition in the short term.Maybe,in the
long term,it could be helpful though I doubt it.
I also doubt that the first symptom of diabetes is hypoglycemia.
With me,it was hyperglycemia.I never experienced hypoglycemia
until I used glyburide.
Sometimes a doubter/sometimes wrong
Eddie

[Nancy LC]

Reactive hypoglycemia seems to be over production of insulin when eating a lot of carbs. I saw the results of someone's OGTT and they hit a high of 100 BG (which is great), but it went down to below 40 at 3 hour.

Probably on a low carb diet they could avoid the issue entirely because they're not needing the insulin to deal with the carbs.

[JAnn]

The reason hypoglycemia is the first step to hyperglycemia is because the constant over release of insulin over time wears out the pancreas and then it won't put out enough insulin, hence, hyperglycemia (diabetes)--or that is what my doctors told me. I was told that if I didn't control my hypoglycemia I would be diabetic by the age of 40. I passed that 20 years ago and I'm still not diabetic, but I have been on low carbing pretty much since 1972.

[eddiemcm]

Every T2 diabetic I've known had hyperglycemia as first symptom, usually because of way too many carbs hence too much glucose in blood.It is sometimes genetic regardless of
carbs.Maybe diabetics caused by genes might have hypo as first
symptom.
Eddie

[Korban]

Every T2 diabetic I've known had hyperglycemia as first symptom, usually because of way too many carbs hence too much glucose in blood.It is sometimes genetic regardless of
carbs.Maybe diabetics caused by genes might have hypo as first
symptom.
Eddie

I am T2 but don't really know if I had an issue with "sugar" going hyper, then hypo as I understand can be characteristic. In those days I never tested. I do know as I got older and continued to eat the MacDonald's diet or similar heavy carb diet I eventually got fatter... was told to check my BG and I did... It used to often run 130 to 150 which I thought was pretty close to normal so I didn't test much... /sigh... I continued with "normal diet" and gained another 20 lbs --- my cardiologist asked about my bg and mentioned (the first time I had heard of it) insulin resistance. I thought what the heck and checked bg again a few times - 250 and stayed around 250 - just from 20 lousy pounds I thought...

Did I demonstrate characteristics of hypoglycemia prior to all this? It is very possible as I never checked. I do believe though that I probably had a period where my bg was very labile - and would go way up with carb/sugar and then crash... I don't have data to verify it though. My bad -)

/smile

[Lisa N]

Every T2 diabetic I've known had hyperglycemia as first symptom, Eddie

Well, now you know one who had hypoglycemia as a first symptom. I had documented hypoglycemic episodes when I was in college (as in they checked my blood sugar and it was 60 one time and 53 another) because I had a habit of sleeping in and then skipping breakfast to get to my 7AM clinical shift on time but then became diabetic about 10 years later.

That said, I don't believe a very low carb diet is necessarily recommended for hypoglycemia, although a controlled carb plan (40-90 grams per day) is usually quite effective at stabilizing blood sugars in most. The goal is to avoid spikes and crashes in blood glucose and to keep blood glucose as steady as possible which would mean no high GI carbs and not a lot of carbs at one time in general; carb intake should be spread out through the day and not eaten all at one time. Most sites I've seen on the subject recommend avoidance of alcohol and caffeine as well.

[eddiemcm]

Thanks for the info,Lisa.
Sounds reasonable.
I wonder how many carbs per day the average American consumes.These days,I go about 60.
Eddie

[Lisa N]

Thanks for the info,Lisa.
Sounds reasonable.
I wonder how many carbs per day the average American consumes.These days,I go about 60.
Eddie

From what I've read, it's a lot more than 60.

[dancinbr]

Thanks for the info,Lisa.
Sounds reasonable.
I wonder how many carbs per day the average American consumes.These days,I go about 60.
Eddie

I promise you the average American these days is probably taking in more than 300g or more of carbs.

Now, I will go look it up and see what we find.

Just think of the food pyramid where it is recommended that 60% of your intake is carbs. Many people consume at least 2000 calories. 60% of 2000 is 1200 calories. 1g of carbs converts to 4 calories. 1200/4 = 300g of calories.

Yikes!

Now I am always below 100g and when I am behaving 30-60g of carbs and when I get my ~ss in gear and start to drop more weight less than 40g of carbs.

Ralph

[jem51]

the word hypoglycemia is thrown around pretty freely and in fact, most peop have never checked. that is the only way you can really know. low BP is more like it w those symptoms. the body knows very well how to increase BG...the adrenals are signaled to bump the metabolism (same as 'fight or flight, hence the shaking), the liver releases and the BG is increased. that is simplifying but is the basics. that is the reason that most peop don't show significant hypo when tested. of course, if you're taking insulin or other meds for diabetes, hypoglycemia is very real.

[Korban]

the word hypoglycemia is thrown around pretty freely and in fact, most peop have never checked. that is the only way you can really know. low BP is more like it w those symptoms. the body knows very well how to increase BG...the adrenals are signaled to bump the metabolism (same as 'fight or flight, hence the shaking), the liver releases and the BG is increased. that is simplifying but is the basics. that is the reason that most peop don't show significant hypo when tested. of course, if you're taking insulin or other meds for diabetes, hypoglycemia is very real.

My BG has been in the high 40's with absolutely no apparent symptoms. It occurred several times when I was on sulfonylureas. I also take a beta blocker which is known to cause hypoglycemic unawareness... i.e., it helps reduce BP by mitigating the "fight or flight" response among other things... therefore, I don't get the typical epinephrine rush usually found with low BG. I haven't been below 60 since I went on basal insulin (Lantus). I could just never seem to get the timing down with the glipizide... I don't think I used the extended release glipizide though.

/smile

[eddiemcm]

I take extended release Glipizide and Metformin.
In 4 months,I have been in the 60's a couple of times.
No symptoms for me either.
Eddie