My blood sugar is acting weird

In My Humble Opinion
1

Just FTR, yes, I have a doctor’s appointment next week. But I still want to know if this ever happened to anyone else, and how it progressed.

I have had reactive hypoglycemia for at least 20 years, maybe longer. What that means is that I have to be really careful about eating refined sugar, and eating big meals. If I eat sugar, even a small amount, on an empty stomach, or a large amount any time, or eat a big meal, it makes my blood sugar drop, sometimes precipitously. My normal resting blood sugar is about 76, which is low, but still normal. Eating a piece of candy can make it drop to 40. Before I do heavy exercise, I need to eat something like nuts and whole milk (or a power bar made for diabetics), it can drop really low as well.

Sometimes, if I go too long without eating, I get shaky and dizzy. Then I need something with a little unrefined carbohydrate, a lot of protein, and zero refined sugar. It resolves in about five minutes, especially if I drink water.

That’s all my normal, and I’ve been dealing with it for years. I check my blood sugar after meals, after strenuous exercise, and before bed.

Lately, it’s been doing something weird. It drops after eating sugar, just like always, but before it does, it spikes. I’ve never had spikes before.

I’m heavier than I was when I was first diagnosed, but I’m not overweight, so I don’t think I could have type II diabetes; however, my father’s family has a history of adult onset type I diabetes, and it doesn’t seen to have a lot to do with weight. Some people developed it after having been overweight for years, but some people who developed it were of normal weight. Most people were in their 60s, and I’m 49.

A little more frightening, my father died of pancreatic cancer.

Does anyone else with hypoglycemia have spikes? Does anyone with diabetes remember this happening? anyone with diabetes have it progress from hypoglycemia?

I already pretty much don’t eat sugar, but in the last week, as soon as Purim was over (it was “cheating” over Purim that made me notice this happening), I completely cut out sugar, and started following diabetic exchanges. The spikes have stopped happening-- my highest blood sugar has been 102, which is still high for me, but I was having spikes as high as 130.

Right now, my resting blood sugar is about 83, which means that following the diet has actually brought the mode up a little, which is probably good. Not only have the spikes stopped, but so have the “shakes,” because I’m carrying food with me and eating on a schedule. This I should have done years ago.

I’m kind of hoping that the doctor will just tell me to keep doing what I’m doing, and come back in a month, maybe with a written food diary, and my glucometer ready to hook up to the computer. I really, really hope she doesn’t want a pancreatic biopsy, but because of my father, that’s in the back of my mind.

2

I have reactive hypoglycemia. Doctors have told me that it is the same as being insulin resistant, and inevitably progresses to type II diabetes–the only question is how soon. Following a moderately low-carb diet will put it off as long as possible. Perhaps your time is running out?

3

I’ll be lucky if it progresses to type II diabetes, because that can often be controlled with diet. What is common in my family is type I diabetes. The pancreas works fine for about 60 years, then up and quits.

I don’t know why I have reactive hypoglycemia, but one doctor called it “insulin dumping.” My pancreas over-reacts to the signal to release insulin, and releases too much. The only thing to do is to eat in such a way an to keep the signal low. I can’t treat low blood sugar with glucose, like a diabetic, because that will just cause greater insulin release.

4

Yes, insulin dumping, to my understanding, is insulin resistance. Women often have it due to PCOS.

5

I don’t have PCOS.

6

As a Certified Diabetes Educator, I will say that reactive hypoglycemia is considered to be predictive for type 2 diabetes. You do not have to be overweight to develop type 2, though that’s very much the norm. My husband went from reactive hypoglycemia to type 2 in his late 40s, and that’s not an uncommon pattern.
However, if you have a family history of LADA, then it could very well be that. LADA isn’t really type 1, but it ends up in the same place.
Do see your doctor and get checked. Adults with LADA can be treated with type 2 meds for a while before they need insulin, and it’s worth it to catch it early on. Make sure your doctor knows the family history so they can run the right bloodwork; the wrong tests won’t catch the autoimmune factors that are part of type 1 and LADA, just the elevated blood sugars.

7

Addendum (missed the edit window)
Insulin resistance and Type 1 diabetes/LADA are not mutually exclusive. I’ve worked with plenty of type 1 diabetics who developed very significant insulin resistance. There is a reason endocrinologists have started prescribing metformin for some type 1 patients.

8

Can you get an ultrasound of the abdomen? Non-invasive. Just in case the pancreas is acting up. Not a doctor, just a scientist, but your history doesn’t sound good.

9

Hmm. I’ve been reading up on LADA. I’ve also been reading up on A1C. My last level was 4.9, which was high for me, and that is apparently not a bad thing, because levels below 5.0 have been associated with liver disease, and higher mortality, although no one knows why-- albeit, maybe it’s a predictor of later autoimmune problems in general. Sigh

I have had several glucose tolerance tests in my life, and they always do a fingerstick along with each blood draw. Once, when my sugar dropped to 40 halfway through the test, the technicians called my doctor, who told them to call off the test and send me home. Another time, my blood sugar was 25 at the end of the test. They sent me to the emergency room, ordered food for me, and wouldn’t discharge me until my sugar was up to 70.

Anyway, my sugar seems to have stabilized pretty well half-assing this diabetic diet I looked up on the internet, so I have high hopes that my doctor is just going to refer me to a dietician to do the diet right.

Not eating sugar isn’t hard at all when I’m scared shitless that it could hurt me. I just had my period, though, coincident with Purim. We’ll see how the next one goes. There’s always sugar-free candy.

10

In addition to GythaOgg’s excellent advice, I would add:

You mention you have a doctor appointment. I hope this is an endocrinologist you are seeing.

Low blood sugars can be very dangerous. If you have insurance you may be eligible for a CGM (Continuous Glucose Monitor). This may be initially denied, but if the authorization is submitted with enough evidence of hypoglycemic episodes (a printout of your meter) and other documentation (physician’s notes), it may be approved. Even if denied a second time, your endocrinologist can to a peer-to-peer appeal over the phone. (My point is to not give up on seeking authorization).

Note: with a CGM you still must do old-school fingersticks.

Good luck!
mmm

11

No, it’s my GP. I don’t have an endocrinologist. But my GP is good about passing me along whenever something a little weird comes up. If she thinks I need to see one, she’ll send me to one.

I have insurance. If my doctor wants a CGM, my insurance will almost certainly allow it, but I will probably have to go through a glucose tolerance test again, since I haven’t have one in years. They’ll probably make me get my A1C checked again.

I tested A LOT yesterday, and following this diet even half-assed seems to be working. My range yesterday was 82-112. I know 112 is a little high, but I didn’t get much exercise, because I was sitting at home obsessing over my diet and doing fingersticks. I usually get a lot more exercise.

Before I started half-assing the diet, I was getting spikes as high as 150 1/2 hour after eating, then down to 70 an hour after eating (and sometimes a bad headache along with it).

I think I have inadvertently been triggering headaches by going too long without eating. I thought because I wasn’t getting the shakes and didn’t feel dizzy, or hungry, I was OK. But I haven’t had the hint of a headache either. Of course, a couple of days isn’t really long enough to know. I really hope that even if I get sent to an endocrinologist, I also get sent to a dietician.