My wife's struggle with hypoglycemia, advice needed

[Bobo08]

For about 4 months now, my wife has been struggling with hypoglycemia. It started a few months before that with what she described as "energy being turned off like a faucet". The cut-off time was initially near mid-day, then moved progressively closer to the start of the day.

When it became clear that she could no longer sweep it under the rug, she agreed to try moving to a ketogenic diet, which I had been following for many years with good results. However, the transition has not been smooth, to say the least.

In the beginning, we tried to transition quickly, with a diet of almost no carb, high protein, medium fat (she could not eat enough fat to qualify as a "high fat" diet in keto terms). It ended in just a few days with severe headache, dizziness and lack of energy.

For about 3 months after that, we tried to increase the carb to approximately 30g/day. However, her health continued to deteriorate to the point that she could not walk 600 m to the nearest shops. Her weight also dropped from 50 to 45 kg. In one instance, she passed out briefly in a massage shop.

So in the last 1 month, we increase the carb to 100 - 120 g/day, consisting of mostly tubers (purple yam, sweet potato, carrot) and non-sweet fruits (avocado, pumkin). It goes with plenty of bone broth, fatty meat. Biscuits and honey/sugar are kept on hand, but only for emergency hypoglycemia. The plan is to stablise her health enough and then decrease the carb little by little until achieving ketosis. It does help to stablise the situation, restore her weight. However, many things still remain to be worked out.

As I noted in the title, the main problem my wife is having at the moment is hypoglycemia, especially at night. She has even tried to eat every 3 hours to combat it. It usually helps during the day. But night time is a bit of hit and miss. Her energy is still very low, abeit better than at the lowest point. She has to be very careful about doing anything at all. Even a long taichi exercise can bring on hypoglycemia even though the latest meal is just 1 hour ago.

There is a long history of diabetes and cadiovascular problems in my wife's family. So it is safe to say that she is genetically predisposed to it. Before 4 months ago, she followed a typical Vietnamese diet (moderate to high carb (rice), moderate protein, relatively low fat).

So I would like to ask for any advice that my wife can apply to help with her health situation. Any experience from someone who was in similar age (late 40s) and health profile and has successfully transitioned to a low-carb diet, would also be appreciated.

This post was written by me, but has been read and approved by my wife.

 

[Laura]

I suffered so-called "hypoglycemia" for many, many years. In my case, it was actually hyperinsulinism.

I figured out a way to eat that made me functional and it wasn't exactly ketogenic. In fact, I don't do well on a ketogenic diet at all.

Generally, I would start the day with a lot of protein. Eggs and meat generally. I would also have a bit of carbs. Nowadays, that would be a slice or two of gluten free toast with no butter.

Coffee and tea has to be eliminated because it triggers insulin.

Lunch can be meat and veggies of any kind, stir fry or something, with plain rice though make the meat and veg about twice the volume of rice (or rice noodles).

Same for dinner: meat and veg with a carb like a plain steamed potato, some rice, or sweet potato.

Despite the glycemic index, some foods seem to be more triggering than others, such as corn. (maize)

With this condition, you can't just go cold turkey off of carbs. And some people do not do well at all on a keto diet. I have a genetic mutation that actually requires that I provide some carbs in order to feel functional.

Now I know that I can't eat eggs or nuts or any dairy at all, so I have had to eliminate those for other reasons than sugar. So just experimentally, your wife might try cutting those things out at some point. Otherwise, eggs are high protein and nuts are good if she can tolerate them.

Try to keep protein and veg snacks available at all times. She may need to snack regularly to keep her sugar stable.

In the past couple of years, my doctor prescribed metformin for me and it has been a life saver. It really helps to keep the sugar levels consistent and allows me a little more variation and leeway.

 

[Gaby]

When it's hard to control sugar levels with diet alone, usually a closer look it's recommended. Did your wife have a medical check-up and lab work? It might be the case that she needs a little help stabilizing her sugar levels, but that help might depend on blood test results and so forth.

 

[nicklebleu]

I agree with Gaby - your wife needs an insulin-producing tumor ruled out. Rare, but I’ve personally known two people with such a thing.

 

[Bobo08]

Thank you, everyone, for your responses!

Generally, I would start the day with a lot of protein. Eggs and meat generally. I would also have a bit of carbs. Nowadays, that would be a slice or two of gluten free toast with no butter.

Lunch can be meat and veggies of any kind, stir fry or something, with plain rice though make the meat and veg about twice the volume of rice (or rice noodles).

Same for dinner: meat and veg with a carb like a plain steamed potato, some rice, or sweet potato.

My wife's current diet generally follows that pattern. The differences are: 1) smaller breakfast, 2) tubers for carb, 3) meat + veggies : carb ratio is around 1:1 instead of 2:1, 4) smaller and spread out meals instead of main meals and snacks in between.

We will adjust it by adding more protein to the meals and snacks. I think the most important part is having snacks in protein and veggies instead of carb.

In the past couple of years, my doctor prescribed metformin for me and it has been a life saver. It really helps to keep the sugar levels consistent and allows me a little more variation and leeway.

When it's hard to control sugar levels with diet alone, usually a closer look it's recommended. Did your wife have a medical check-up and lab work? It might be the case that she needs a little help stabilizing her sugar levels, but that help might depend on blood test results and so forth.

I agree with Gaby - your wife needs an insulin-producing tumor ruled out. Rare, but I’ve personally known two people with such a thing.

We thought about this, but we have been reluctant to go anywhere near a hospital setting, especially when our city is a heightened state of hysteria due to the current Covid restrictions. Therefore, we plan to carefully follow the adjusted diet for another week to see if it helps. If not, I will take her for the checkup next week.

I forgot to include my wife's blood sugar levels in the previous post. She has regularly measured it with a home device in the last few days. The levels range from 4.8 mmol/L when she was in moderate hypoglycemia, to 9.5 one hour after that (having drunk some sugar water). When she was not in hypoglycemia, but generally tired , the level was around 5.7.

Again, thank you for your quick and caring responses! I will update here on how she's doing in the next few days.

 

[Laura]

She should never have ANYTHING with sugar, honey, other sweeteners or foods that are sweetened with any of those. Never, EVER while she is unstable. No fruit either.

 

[Bobo08]

Got it, Laura. I will always keep that in mind.

 

[Chu]

I'm sorry to hear this, Bobo!

We thought about this, but we have been reluctant to go anywhere near a hospital setting, especially when our city is a heightened state of hysteria due to the current Covid restrictions. Therefore, we plan to carefully follow the adjusted diet for another week to see if it helps. If not, I will take her for the checkup next week.

That's quite understandable! However, it seems to me that you are dealing with too many unknowns in order to be able to resolve the issue on your own. Does she have a GP? Or can you find one? They are usually a lot easier to go see, plus you avoid the "hospital setting", as you said. At least they would prescribe a proper bloodtest, and maybe help with a bit of medication (like Metformin, or another drug that may be good, of that will give you a clue as to what supplements would do the same).

If not a GP, an endocrinologist, to see about diabetes, insulin resistance, etc. Even infections can be a factor.

Keep us posted!

 

[Laura]

Got it, Laura. I will always keep that in mind.

Well, I should modify that. She should not eat anything sweet or sugary, but do keep orange juice on hand in case she has a sugar plunge. For a long time, I would check my sugar when I woke up, then every half hour or so after eating. I would check it when I felt hungry, etc. I can now map how I feel to what my sugar is doing and keeping it stable is a lot easier.

Here is a key: if the sugar never goes UP from eating sweets, then it also never plunges to the basement. So the trick is to never let it go up by avoiding simple carbs/sugars.

 

[Gaby]

We thought about this, but we have been reluctant to go anywhere near a hospital setting, especially when our city is a heightened state of hysteria due to the current Covid restrictions. Therefore, we plan to carefully follow the adjusted diet for another week to see if it helps. If not, I will take her for the checkup next week.

You can try adjusting for another week, but even if there's improvement, I would still do a general check-up with a blood test. She could go to a family medicine doctor or general practitioner.

It's understandable when you want to avoid all the hysteria, on the other hand, it's a tricky attitude that has fueled a lot of the "lockdown casualties" where preventive and diagnostic programs are not prioritized anymore.

 

[Scottie]

It's understandable when you want to avoid all the hysteria, on the other hand, it's a tricky attitude that has fueled a lot of the "lockdown casualties" where preventive and diagnostic programs are not prioritized anymore.

I just want to second the advice to get some hard data - i.e. blood tests.

I know things are a bit nutty where you are due to the Covid stuff, but there usually IS a way to do it. We've seen cancer patients here who didn't get the treatment they needed, and we've also seen super-fast treatment.

Last year right in the middle of lockdown, I was able to see a doctor at his wife's physical therapy clinic and get treatment for a bad sports injury. His normal hospital office was strictly verboten, but he made do. It may just take some careful navigating, phone calls, etc.

The one thing you DO NOT want is for a real 'emergency situation' requiring full hospitalization - at exactly the wrong time. I'm not sure how it works, but it seems that those people who seek treatment despite the nonsense going on seem to have the most success and the fewest worst case scenarios.

It's almost like not being too afraid and actively making that choice (while keeping your wits about you and 'following the Covid rules' as expected) leads to the most positive results. It makes sense when you think about it... If there's one thing that this stuff is supposed to cause in us, it's paralyzing fear. So, we musn't be afraid.

Well, maybe I should say: we should keep that fear in check while also acting with determination.

I hope you get Mrs. Bobo08 sorted soon!

 

[Keyhole]

I forgot to include my wife's blood sugar levels in the previous post. She has regularly measured it with a home device in the last few days. The levels range from 4.8 mmol/L when she was in moderate hypoglycemia, to 9.5 one hour after that (having drunk some sugar water). When she was not in hypoglycemia, but generally tired , the level was around 5.7.

Hi,

Just to clarify, has she actually been diagnosed with having hypoglycemia?

The reason I ask is because the above results are not consistent with genuine hypoglycemia (or even moderate). 4.8 mmol/l is a relatively normal reading which most people (that I have seen FWIW) feel fine cruising along at . Hypoglycemia caps off at around 3.9 (ish), and although it can be different for different people, 4.8 should ordinarily not be producing these symptoms outside of the context of another organic condition.

Many people wrongly attribute their symptoms to low blood sugar, when the problem is something different. It might respond positively to sugar, but it can be somewhat unrelated or having an indirect effect somewhere else down the line.

I agree with the advice above, that she should get this looked into with some more comprehensive testing looking at other variables

 

[Bobo08]

Hi everyone. We had a rough couple of days so I'm sorry for not replying sooner.

It seems that my wife's situation is getting worse. The early morning when she just wakes up is the worst time of the day. She has to drink a glass of sugar/honey water immediately before she can even sit up. During the day, she has to eat carb (mostly rice) every hour to keep her blood sugar in the 6 - 7 level (she measures it every 15 - 30 mins). Failing that, severe dizziness and headache quickly set in, which she becomes almost terrified now.

We went to a GP nearby today. It was a small one in a remote corner so they were very relaxed with Covid restrictions. The GP ordered a bunch of blood tests: Lipids, FBC, B12, Folate, E/LFT, TSH, Iron studies, HbA1c, cortisol, ACTH, insulin, FSH, LH, oestradiol, aldoesterone, renin, plasma metanephrines. We will go to get them done tomorrow morning. The results should be back early next week. The doctor said that she would probably refer my wife to an endocrinologist after that. We are trying to hang on until then.

The GP asked the same question as Keyhole. My wife said that 4.8 was the blood sugar level when she could measure it, i.e. after having something sweet. So the level at the worst would have been lower, but I don't know by how much.

 

[Chu]

Good. You'll have a lot more data when she gets the results. And I would go ahead and make an appointment with an endocrinologist if I were you. It never hurts to have a second opinion, and delays tend to be a bit longer nowadays, so you'd want her to be able to go as soon as she has the results.

Speedy recovery to your wife! Hang in there.

 

[Bobo08]

Some updates:

We have got the blood test results back, and they are all within normal range, or very close to nornal range. Some of the most important ones, in my opinion, are
* Glucose 5.7 ( 3.6 - 7.7 )
* S-Insulin 13 ( 3 - 15 )
* HbA1c (NGSP) 5.1 ( < 6.5 )
* HbA1c (IFCC) 32 ( < 48 )
* TSH 1.4 ( 0.3 - 3.5 )
* Cortisol am 331 ( 100 - 535 )

What was notable was that the blood was drawn at the time my wife felt extremely dizzy and tired (close to passing out). So it does appear that her condition is not diabetes, or hypoglycemia although sugar or carb do bring alleviation.

In the mean time, we also managed to arrive at a somewhat sustainable diet: 6 meals a day, spaced out by 2.5 - 3 hours; each meal containing (by volume) 35% rice noodle, 25% meat, 20% tubers and 20% raw macadamia together with enough bone broth. It seems to bring the best result so far.

One important observation we've made is that my wife is extremely sensitive to stress now. Any stress at all easily brings her to the brink of feeling fainted, and only lying in bed and a quick glass of orange juice will save the situation.

My current working hypothesis is that my wife is suffering from adrenal fatigue. The reasons for that are 1) She has a strong tendency to anxiety most of her life, 2) She suffered from a few months of exhaustion when we tried to transition her to a keto diet, and 3) Sugar helps to alleviate her bouts of dizziness.

So I will be reading up on what I can about adrenal fatigue. We have also made an appointment with an endocrinologist in 2 weeks. In the mean time, if anyone has any comment or advice, it will be much appreciated.