Could anyone explain to me what the sawtooth curve for hypoglycemics mean?

I've been monitoring my BG these past few days and it seems common for it to dip down maybe 20 units in half an hour (although biggest drop was 25 units [1.4mmol] in 20 minutes) before rising (a little bit, maybe 10 units at most, 0.5mmol) and then going down and then slightly up again.

Add: I have also seen it rise about almost 20 units in 15 minutes about 2.5 hours AFTER eating.

When i tested both times, i did not have any hypo symptoms, however, and it never dipped below 80. I was eating a hypo diet however, so i am not sure.
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replied May 7th, 2008
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Various hormones in the body work to regulate blood sugar. Even in a non hypoglycemic person you'll find these slight fluctuations.

The rise about 2 and half hours after eating is perfectly normal, this is your body preventing any further drop in blood sugar.

Also bare in mind that the typical blood glucose monitor has a 1mmol margin for error - a blood sugar reading of 4mmol could be anything between 3mmol and 5mmol.

Personally, a GTT will see my blood sugar drop from 13mmol (234mg/dl) to 2.4mmol (43mg/dl) in just over an hour. If I haven't passed out, you'll then see a small rise of 1-2mmol (18-36mg/dl) which is blood sugar regulators (glycogen, for example) kicking in. It'll then fluctuate by around 1mmol. Aside from the initial drop, the rise and fluctuation is perfectly normal.
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replied May 7th, 2008
I remember reading on this forum somewhere that dropping too quickly is bad as well? How fast of a drop is bad?

i was eating hypo diet too though, which makes me worry a bit about how much it can potentially drop if i don't. But maybe i am worrying too much.
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replied May 7th, 2008
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The steep drop is the main problem in a lot of cases. For me, my blood sugar drops so fast and so far that glycogen can't always stop the hypo in time. Yes, it is a problem. I've seen reactive hypoglycemia defined by the rate of drop of glucose levels.

As far as I know, the drop for reactive hypoglycemia should be over 2.6mmol/l in an hour, or 1.6mmol/l in half hour. These values vary a little depending on the source.

Try not to worry too much. If you're following the right diet and not suffering symptoms, then it sounds like you're doing fine to me. If you've had the condition for some time you should be familiar with the feeling of low blood sugar and be able to take action if need be.

Are you diagnosed hypoglycemic? Has the cause been found?
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replied May 7th, 2008
Ive had like 1.5mmol drop in 30 minutes actually, but sometimes when it drops like that i do not get symptoms. It is usually a quick drop within 30 minutes then it stabilizes a bit around the same number for the next 30 minutes before anything else happens.

Ive not had hypoglycemia diagnosed yet, my GP is referring me to an endo today. Sigh, have to wait probably another 3 weeks.

At the very beginning when i was getting symptoms, i was eating a lot of white rice, and i basically became disorientated and just had to lie down a bit after the meal. I went to the doctor and he suggested that i may have low blood sugar based on that, but the tests (poorly done though) and my own GTT has never shown my blood glucose lower than 3.8mmol/l. My fasting was from 4.3-4.7 and 3 hrs after eating i usually go back down to 4.7.

After the beginning, i had adjusted my diet so that i do not eat so much at once. i no longer became disorientated, but a new problem popped up, apparently about 2 hours after a meal i would get nervous. Some days i feel nervousness/anxiety throughout the day as well as not being able to think.

I went on brown rice / vegetable / meat diet recently, and the symptoms subside quickly, but i am not truly sure if that is why i feel a bit better. I still havent had a completely normal day in the last 2 months though.
However, i seem to relapse when i loosen my diet. It gives me bad days after a few days of eating "slightly" bad stuff. But for a time in vancouver, i mixed white rice 3/4 with brown rice 1/4 and ate it with dishes and had no problem for a week.
I seem to be a bit more sensitive to wheat though, is something that i noticed, but i had my disorientations eating rice. weird.

It's all a mixed jumble of issues in total. I read alot about hypo. I get the concentration and the nervousness issues. Somedays i would get bad anxiety and nervousness throughout. Abdominal pains/aches happen alot too. I feel my best (on the non nervousness-throughout days) in between meals.

However, i never feel cold chills, tremors, or get hungry after i eat, or alot of the stuff listed. Ct scan came back nothing, except hemangioma which i knew i had for a while. I also get diarrhea and gas alot, especially after bad days. Soft stools, purple nails for some reason as well, which is very confusing. I never really saw diarrhea and stool problems as symptoms of hypo, or purple nails.

Every week is a bit like a rollercoaster, some days are so-so but others are horrible. i have no real idea what is wrong with me, but it seems to be a hormonal thing, which is depressing since they seem to be hard to treat.
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replied May 7th, 2008
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I'd ask for a celiac test to check for wheat intolerance. It's just a blood test done at your surgery. Stress to your doctor that diarrhea is a problem after eating. I have a friend with this condition and it shouldn't be left undiagnosed, he's almost a skeleton.

In the mean time, have you thought about cutting out rice???

I assume you're in the UK as you're using mmol units. 3.8 is a little low, but not low enough to diagnose hypoglycemia. I'd be concerned about the diarrhea, especially if your symptoms are occurring within an hour following a meal (rather than 2-3 hours later).

If I was you I'd get onto your doctor about the diarrhea and other symptoms. And as of now, cut out wheat and sugar completely and see if your symptoms improve.

PS check the symptoms of celiacs, a lot of the symptoms cross over. For example, someone with celiacs can suffer malnutrition, fatigue, and even low blood sugar.
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replied May 7th, 2008
Yeah i was thinking about celiac too. But im not sure what it has to do with blood sugar. I am from Canada also Smile

I usually only get diarrhea at the days i feel the worse, then it subsides progessively. funny thing is, it seems the more rice i eat the more solid it becomes too. back in vancouver, when i ate a lot of white rice and felt fine, i had perfectly normal stools.

I don't get issues with brown rice, and since i am actually a bit skinny (have always been) i am not sure about eating too much fat or protein. So i am eating a bit of brown rice with every meal for energy.

I usually tend to get nervousness 2-3 hours after putting stuff into my mouth if i eat certain things before it going away and i will feel ok in between meals.

As for 3.8, i only seen it twice, one was immediately during waking, and the other was after moving a lot of stuff into my new dorm. Both times they up to 4.3ish after about 5 minutes though. Normally, my BG never gets below 4.3 during or after eating or fasting and 4.3 is a bit lower as compared to my typicals despite my usual 4.7 fasting/3hrs after eating.
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replied May 7th, 2008
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From your blood sugar readings it doesn't sound like hypoglycemia - rather a digestive problem like celiac. You may have a sensitivity/intolerance to any one of a range of things, wheat, lactose, fructose, etc.

Make sure your doctor is aware of the diarrhea and other symptoms. If an endocrinologist can't confirm a diagnosis then maybe a gastro would be the next step.

And cut out the things you know bother you. If the problem is diet related then you can start eating right before a diagnosis.

Don't be afraid of protein and fats, both are essential parts of your diet. It sounds to me like it would be worth cutting down on the rice a little and adding more lean meats/fish/veggies, especially if your condition IS blood sugar related.

Have you tried cutting out rice altogether? That's where I'd start to see if it helps.
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replied May 7th, 2008
Yeah, the diarrhea is definitely one of the stranger phenomenon i have that makes me think it is not hypo. The purple nails too.

I will try to gradually cut out rice to see what happens within the next few days, im gonna have to find a good filling recipe with lots of olive oil to get my energy then too. Would you have any suggestions? Smile


I checked with my university's clinic earlier and it turns out my doctor referred me to an internologist? im not sure what it is, maybe an enterologist? apparently its someone who deals with internal organs. Maybe that will shed some light on this issue.
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replied May 7th, 2008
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I chose not to comment on the purple nails, I have absolutely no idea on that one. Have you tried nail varnish remover? Very Happy Very Happy

You should be able to get plenty of energy without the rice. Eat more often, every 3 hours or so, make yourself some nice meat and veggies (steak, chicken, there's a lot you can do with those alone). Get some fruit in you too. Cheese is filling as well as milk (assuming you're not lactose intolerant), eggs, peanut butter. A nice omelet with cheese and ham. At the moment my favourites are spicy mince with veggies, or chicken fillet stuffed with cheese and garlic Very Happy Broccoli is great for getting fibre in.
Check the labels on things, especially sauces, it might be worth sticking to gluten free foods for a few days. Eliminate things until you find a diet that doesn't come with diarrhea, so you can get back on track until a diagnosis is made. It'll also help the doctor if you know what foods upset you.

The key is to eat frequently, this will keep your energy stores topped up. There's no need to pile a load of carbs onto your plate in one go, or you will feel rubbish. If I did that, I'd be sleeping before I'd cleared the plate!

An internologist I haven't come across over here, Google Very Happy Hopefully whatever it is, he'll be able to help. Don't focus on your blood sugar, the diarrhea (and purple nails?!) seems to be more of an issue here.
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replied May 10th, 2008
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Have you tried eating wild rice instead of white or brown? It's a bit more expensive, but if you like rice you may have luck with it. Avoiding things that cause celiac problems is quite easy as well, you don't necessarily need to be diagnosed because you'll just be told to avoid certain foods anyway. Try avoiding them totally for about four weeks and then add some back in to see what happens. You'll know there's a connection if there is one. If there is, then you may have it, or it could be something else, but at least you know how to avoid it. Looking into sprouted grain products may be a good idea as well, I was recently able to add in bread after THREE YEARS because I chose sprouted grain bread. Very good too.
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replied May 20th, 2008
The diarrhea went away completely as i ate a more hypo diet in 3-4 days and i have not had it since. But yeah. Sometimes i don't have diarrhea and BG still drops pretty fast. I looked over everything again, and the sharpest are sometimes 2.4mmol/hr now but it sort of drops 1mmol and then stabilize 20 minutes and then drop another 1mmol. Very much like steps on a ladder.



Anyways, i have some questions.


Would this observation say anything?

After not eating for a while, my BG would be 5mmol-ish ( 90 ). But when i exercise afterwards (usually for 15-20 minutes cardio) i would drop below 4. 3.5 ( 63 ) and 3.2 ( 58 ) the two times i checked. But the strange thing is, i do not get nervousness or shakiness at all, or any issues i usually get. I would only get light headed and need to rest a while, which i think would be normal? Would this indicate anything? Perhaps that my nervousness is a digestive issue? Can 15-20 minutes worth of cardio really lower BG that much too? Maybe it suggests a glucagon issue. Hm...

I also find that i can eat brown rice. I would eat about 1/2 cup uncooked, which is about 1.5 cups cooked? brown rice with chicken/vegetables and the like and have no issues on good days. I would eat it rather quickly too, about 15 minutes. Which is interesting. Although on bad days i feel weird right after eating.

Another weird thing is on bad days my blood sugar is pretty normal still. Like mid 5s and at least high end 4s like 4.8 4.9. Even though i feel nervousness and such almost throughout the day. Barring that i am most probably mildly reactive hypoglycemia IF i am even hypoglycemia, is this even possible? To feel nervousness when not eating the whole day sometimes?
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replied May 23rd, 2008
I noticed these two days my BG seem to be strangely high even after eating brown rice.

Today i had 10mmol/l (180) 1 hour after i ate 2 cups of brown rice. 2 hours after was 7.9. Im starting to think i may be pre-diabetic.

Strangely enough, it was never this high two weeks ago. It went up to 7.7 an hour after eating at most. However i was eating brown rice also. Hm.
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replied May 23rd, 2008
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Your body is adjusting. Hypoglycemia is considered a prediabetic condition. Just watch it, being high for a short period is no danger. If it's like this by next year, then you start to rethink your diet.
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replied May 24th, 2008
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shawn604 wrote:
I noticed these two days my BG seem to be strangely high even after eating brown rice.

Today i had 10mmol/l (180) 1 hour after i ate 2 cups of brown rice. 2 hours after was 7.9. Im starting to think i may be pre-diabetic.

Strangely enough, it was never this high two weeks ago. It went up to 7.7 an hour after eating at most. However i was eating brown rice also. Hm.


Those aren't diabetic readings, they're perfectly normal after eating.

I think, if I can quote my endocrinologist correctly, blood sugar readings above 11mmol are warning signs and can be considered borderline.

If you're worried about diabetes, go to your doctor and ask for a glucose tolerance test. But with the readings you gave above, 5-8mmol two hours later is perfectly normal and your doctor isn't likely to be worried about diabetes.

You seem to be monitoring your blood sugars very closely, be careful with that. You may want to relax a little. To me your blood sugars seem fine, they're not going much (if any) higher or lower than normal.

But you do need to stick with your doctor until the cause of your diarrhea etc is found.
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replied May 24th, 2008
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180 is normal? I'm sorry, have to disagree with you there. I have a chart given to me by my endocrinologist that shows starting at 140 after eating as prediabetic.
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replied May 24th, 2008
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We'll agree to disagree and leave it to the professionals then Wink
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replied May 24th, 2008
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This is from the national diabetes council, but I will agree that doctors disagree!
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replied May 24th, 2008
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If his blood sugar was 140 in a fasting test, there'd be a slight concern. Here it's 8mmol (144) that's the bench mark, but 140 is close enough. If a patient having a GTT has a fasting sugar of 144 or over, the test isn't done. Maybe that's the value you're referring to.

According to my endocrinologist the bench mark for diabetes concern is 11 (198), I'm sure that's at any point not necessarily fasting.

However, in this case his blood sugar of 142 two hours after eating, wouldn't be a concern at all. 180 is a little high at any point, it is close to the mark, but we don't know what exactly was consumed and when. If I drink a sugar drink my blood sugar shoots up to 240 after an hour, but that wasn't a concern - it comes down quickly enough.

If there is any concern for pre diabetes then he should ask his doctor for a GTT and let them decide. Now if it was 180 two hours after eating, there might be a concern as his blood sugar hasn't dropped back down, indicating diabetes. And to be honest, from what he's said, I don't think his problem is blood sugar related at all. Diarrhea and purple nails? Yes, he needs to continue to see his doctor, relax a little, leave them do their job and try not to become obsessed with his blood sugar levels. If readings were as low as 50 or as high as 240 then I'd agree he may have a problem - but they're not.

PS my husband is American and has been type 1 diabetic all his life, he was actually a research subject in the University of Minnesota. He's only recently moved to Britain so is up to date with American guidelines. As far as we're aware, there's no significant difference in bench marks and guidelines.
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replied May 24th, 2008
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Oh, you guys must have a different system there then (god, when will it end?). Here, prediabetes (meaning just that you have the potential to get diabetes), is read as anything above 140 to (I think) 200 1.5 hours after eating. So 240 would be considered really, really bad if it keeps happening, leading to diabetes according to what they go by here.
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