Low Blood Sugar and what to do

Hi. Not sure if this is the correct folder to raise this under. Maybe the moderators can move it if it should be elsewhere.

I have been over 6 weeks on LCHF food plan and so far managed to maintain my BG fairly well, apart from a few hiccups. I have a question re what to do when the BG gets to 3.1 or lower.

I used to get all sorts of hypo symptoms once my BG fell to 4 or lower. But now I seem to be able to cope quite well below 4.

It could be due to the other meds I am on due to my Autoimmune condition (Methotrexate and Prednisolone). I am diabetic due to the Prednisolone.

Today I saw my specialist and was told that there is active inflammation which would also explain my excessive pain. So he has increased the Prednisolone from 10mg to 20 for one week then down to 15 mg. I decided today to take the extra 10 mg when I came home.

I usually take the Pred with breakfast. It then takes 3 hours before it starts raising my BG levels and I take Insulin before Breakfast and Before lunch to manage this. Currently 30 units each time.

When I came home from the specialist visit my BG was low but not too low. I took the pred and decided to watch the BG to see what impact. I was quite surprised when a few hours later my BG had dropped to 3.1. As it was dinner time I had some roast chicken and a LCHF mashed cauliflower from a LCHF recipe site. Then took my BG again right after dinner and it had jumped up to 6.1 which can't have been the food but must have been the pred kicking in.

So my question is ... what does one do when the BG falls too low. Is 3.1 too low? When does it get dangerous? And if I were to take some Apple juice (pre-LCHF diet solution) with Jelly Beans would that throw me out of Ketosis?

Thanks

p.s. staring at a freshly picked bowl of figs LOL but they are very high in sugar too.

Hi Inge. Have you discussed reducing your insulin requirements with your doc ? As you are aware, the less carbs you eat, the less meds you need. 3.1 is lower than I'd like to be. The UK has quite stringent laws regarding testing and driving a car. I could not drive if my levels were that low. Do you have similar rules in Australia ? If you needed to raise BG levels quickly, apple juice, orange juice, cola or jelly babies work a treat. Your 3.1 jumping to 6.1 may have been your meds kicking in or could have been a liver dump. Difficult to say. It's still early days and your body is adapting.

mo1905 wrote:Hi Inge. Have you discussed reducing your insulin requirements with your doc ? As you are aware, the less carbs you eat, the less meds you need. 3.1 is lower than I'd like to be. The UK has quite stringent laws regarding testing and driving a car. I could not drive if my levels were that low. Do you have similar rules in Australia ? If you needed to raise BG levels quickly, apple juice, orange juice, cola or jelly babies work a treat. Your 3.1 jumping to 6.1 may have been your meds kicking in or could have been a liver dump. Difficult to say. It's still early days and your body is adapting.

Thanks mo1905 for your reply. If I use the usual remedy for hypo (as you listed above) will that throw me out of ketosis?

My doctor is fairly easy on me adjusting my insulin. When I first started on LCHF to avoid Hypos I reduced my insulin quite a bit but gradually have had to put it up again. The pattern for me is:
7am BG is between 7 and 8 and so I take 30 Units of Insulin. Then breakfast and my Prednisolone which was 10mg until today.
by 10am my BG is between 4 and 5  but after that it rises rapidly and unless I inject around 11:30/ 12 it would go above 10. So just before lunch I take another 30 units.
That keeps things fine in the afternoon. I have only seen once or twice where it falls below 4. And as I mentioned, previously I would get severe Hypo symptoms (shakes, sweating, confusion) when my BG came close to 4. That it could drop to 3.1 and I didn't feel a thing worried me. At the moment I am doing frequent monitoring and if needs be I can inject more insulin if it rises too much.

Today was a bit different. I injected 30 units at 11 ( BG was close to 8 ) and had a very early lunch due to a specialist appointment. Then at 2pm I took another 10 mg of Prednisone and expected by 5pm the BG to start rising.
2pm it was 3.8 and I had a snack. 3:45pm it was 6.4 and luckily I took it again at 5:30pm when it was 3.1 and I had dinner. After dinner it was 6.3 then 6pm it was 6.7 and 9pm 7.6

Not game to take any more insulin so will live with the issue that I will wake up with high BG in the morning. Hopefully by tomorrow things will be back to normal.

I am sure we have similar driving laws here. I have been too ill to drive so my husband drives me everywhere so no issues at the moment.

Hypos do frighten me as I was having a lot of hypos last year when they started me on Insulin and prescribed a mixed insulin. Since I take Novarapid I am more in control and I no longer had the hypos.

Not having any symptoms does freak me out because in the past I would run for the jelly beans and a snack because of the shakes and the cold sweat.

Treating an occasional hypo will not throw you out of ketosis. Be careful not to over treat though. This is a common mistake made by many and can lead to widely fluctuating levels for many hours afterwards.
You seem to be comfortable adjusting your insulin and have pretty much got things sort of under control. I never make adjustments on one-off readings. I would only adjust if I saw a pattern begin to develop. So, the occasional 3.1 is fine, if it becomes regular, adjust again. The biggest danger of regular lows is losing hypo awareness which you also mentioned. Again, hopefully this was a one-off. If not, the advice generally given is to run you BG levels a little higher than normal for a week or so. This usually helps.

Thank you sounds sensible. Considering I am on increased Prednisolone it is bound to make a difference and then in one week I drop it again by 5 mg so it could take a few weeks for things to settle again

Hi Inge!

I think things will be much better when you can get prescribed a slow acting Basal insulin as well,should help with the higher fasting BG's whilst allowing you to reduce your fast acting Novorapid dose whilst you're following low carb high fat...I'm a slow,late onset type 1 and just about holding good and stable levels on basal only eating 25 grams of carbs a day(Recently dropped from about 30-50 grams a day) so don't really experience hypo's as such but below 3.5mmol I do feel 'Low' with some mild symptoms and correct with a Jelly Baby or with a bit of fresh orange juice and it's never dropped me out of ketosis but as It's rare for me and i'm not on fast acting I'm not really the best person to advise.

Best wishes

Paul

with a fluctuating BG because of the steroids and insulin, I would treat lows below your normal base BG or under 4 with glucose,

Paul wrote:Hi Inge!

I think things will be much better when you can get prescribed a slow acting Basal insulin as well,should help with the higher fasting BG's whilst allowing you to reduce your fast acting Novorapid dose whilst you're following low carb high fat...I'm a slow,late onset type 1 and just about holding good and stable levels on basal only eating 25 grams of carbs a day(Recently dropped from about 30-50 grams a day) so don't really experience hypo's as such but below 3.5mmol I do feel 'Low' with some mild symptoms and correct with a Jelly Baby or with a bit of fresh orange juice and it's never dropped me out of ketosis but as It's rare for me and i'm not on fast acting I'm not really the best person to advise.

Best wishes

Paul

Hi Paul. I think you are right but I won't see my Endocrinologist for 4 months now before I can talk him into this again. He refused last time because things were looking so good in his opinion that he was not at all worried about the high fasting BG and thought that maybe that would correct itself if I simply "continued doing what I was doing".

Good to hear that you have yours under control I look forward to mine stabilising.

This current attack by the Wegener's Vasculitis is a real bummer as I hate going up in the Steroids. I was convinced from March i would go down even more until I was off them altogether. But sadly it's the nature of the beast to keep waking up

It's actually very rare for me too to drop so low. It has taken a mammoth effort to get below 5 this year. What freaks me out more than it being so low is the lack of symptoms. I don't check my BG every hour normally however as you can see by the figures I posted there was a wild swing of up and down a couple of times at half hourly intervals yesterday

Thanks for your advise. I feel more confident using the Jelly beans now or the apple Juice I carry on me.

you may find that ketogenic <50g carb LCHF will provide some protection against low damage, because the brain is running on 60% ketones. you may have an altered hypo symptoms
it's a good idea to treat 4 as a hypo
http://www.coconutketones.com/pdfs/CahillGF_CerebMetab_1980_p234-242[1].pdf

https://www.youtube.com/watch?v=GC1vMBRFiwE

j wrote:you may find that ketogenic <50g carb LCHF will provide some protection against low damage, because the brain is running on 60% ketones. you may have an altered hypo symptoms
it's a good idea to treat 4 as a hypo
http://www.coconutketones.com/pdfs/CahillGF_CerebMetab_1980_p234-242[1].pdf

https://www.youtube.com/watch?v=GC1vMBRFiwE

Thanks for the links I will check them out. I am running at around 20 mg of carbs a day at the moment. Ketones are quite high.

the lchf diet should be starting to settle and your body use to it, after the 6 weeks you've been on it
I would start a spread sheet on your BG, meals, insulin and steroid.
then look back and try and find patterns. as has been said you may find separate basal/bolus insulins a better way.
are you getting cheap strips through NDSS?
you should be able to see your endo or diabetic clinic if required ..
I'd ring for some phone advice on how to access what's available and talk with the diabetic asdvisors/councelors there ..http://www.diabetesaustralia.com.au/

j wrote:the lchf diet should be starting to settle and your body use to it, after the 6 weeks you've been on it
I would start a spread sheet on your BG, meals, insulin and steroid.
then look back and try and find patterns. as has been said you may find separate basal/bolus insulins a better way.
are you getting cheap strips through NDSS?
you should be able to see your endo or diabetic clinic if required ..
I'd ring for some phone advice on how to access what's available and talk with the diabetic asdvisors/councelors there ..http://www.diabetesaustralia.com.au/

Hi J. I live in Australia. I get practically free testing strips so that's not an issue I use quite a lot. i have been writing down everything in my journal and created a spreadsheet for my diabetic specialist. I may try and do some analysis on what things are impacting my BG but mainly it's the Prednisolone. I stick to fairly strict low carb food with enough fat and protein. Had to reduce the protein amount initially.

Now that the steroids have been increased I will have to see what impact they have

Thanks for your help with this. The below 4 for BG is very rare for me. In fact i am having problems keeping things below 6 half the time

I'm aussie too, what would be best is to get on to a pump..

second..what would be good is to work out the effect of the steroid dose on your BG, the length of time and the peak.
you could then try and match it to one of the insulins

j wrote:I'm aussie too, what would be best is to get on to a pump..

second..what would be good is to work out the effect of the steroid dose on your BG, the length of time and the peak.
you could then try and match it to one of the insulins

Never thought about a pump. But then I always thought that my diabetes was going to be temporary and thought I would be off the steroids very quickly. I was dead wrong. Then I expected my BG to go down as the dose of steroids went down. Again ...didn't happen. I started with 40 mg daily of Prednisolone early last year by end of December I had managed to get down to 10mg but that did not reduce the amount of Insulin I needed in fact that kept going up

I did a fair bit of research today. I am suffering from a form of Vasculitis called Wegener's which is when the Blood Vessels get inflamed. Today I read the inflammation causes the sugar to rise and I seem to have it spread through the body so I am now not surprised the insulin requirements didn't go down.

Then another thing I had a massive abscess under one of my larger molars and I ran around with that for at least a year before I had the tooth taken out. Mainly because I was worried due to the steroids and immunosuppressive drugs I felt the hole may not heal. Well, early January that was pulled out. And fixed the sensitivity of my lower teeth. Must have all been referred pain from the abscess. I still have some pain in the upper molar on the same side so that may well need to come out too. I read today that dental inflammation is another thing that makes your blood glucose rise.

So now the Wegener's is flaring which means I have inflammation throughout my body. Guess I can't totally blame the Prednisolone. I have had this current bout of pains since mid-January so no wonder it has been such a battle to get my BG under control. Now the steroids are up again I will just have to be patient. At least I am getting lots of practice with the LCHF diet

there is also a wegeners forum that may help
http://www.wegeners-granulomatosis.com/forum/forum.php

j wrote:there is also a wegeners forum that may help
http://www.wegeners-granulomatosis.com/forum/forum.php

Thanks J. I belong to that one and the Australian FB group also. They have been my lifesaver. However I needed help with the LCHF side of things from a diabetics perspective hence I have joined this forum as well. Not all people on Steroids become diabetic. And not many are on the LCHF diet. So I needed some extra support

lchf is easy..no sugars, no starches

it’s a long page and a few good video’s
http://www.dietdoctor.com/lchf

http://lowcarbdiets.about.com/od/lowcarbliving/a/Food-Cravings.htm

you can also google atkins induction for food lists and recipe ideas, free on net, no need to buy book

Hi Inge ..... sorry to hear " the Wegener's is flaring which means I have inflammation throughout my body ".

I know many here, who are diabetics, are helping you but I just wanted to say Hi and stick with it - I'm sure you'll come through.

I send you my good wishes,

All the best Jan

Thanks, J and Jan. I have been following a number of prominent dieticians and medical professionals who attended an LCHF Conference Downunder late last year. Was all very interesting stuff. Among them Dr. Stephen Phinney who co-authored the new Atkins book which I bought as an ebook more to study the meal plans and recipes for ideas.
Some interesting talks. If anyone is interested in following up here is the link: Lowcarb Downunder Conferences. They also have a facebook page and are building up a list of medical professionals in Australia willing to support patients who are on the LCHF diet plan. I will also check out the links above. I seem to have been researching this since I started. It may be easy, but there is a lot of science behind it to learn so you can defend yourself. Especially when you are dealing with an army of specialists. I was happy to also see that there was a conference at the local private hospital where I was diagnosed last year so hopefully all of my specialists at least got to hear about it The FB PAGE had another link to stored Videos by Dr. Phinney. Dr. Phinney Conferences at the EPORTH
Thanks again for all your support Inge.

As your body adjusts to lower BG levels the hypo threshhold lowers. When mine was very high I would get hypos in the high 4s, but as it lowered I could get down to 3.2 without any reaction.

I never really had that much in the way of hypos, my sugar levels tend to run on the high side rather than low. I've had maybe a dozen over the 17 years I've been diagnosed, and usually when trying some different diet or regime. But even when I was just water-fasting a few weeks back it didn't go below 3.6.

As a just in case, I keep a small pot of honey and a spoon on my bedside table, and have half a spoonful or so or I would eat a square or two of 85% choc. I would never go overboard with the sugar and end up with a rebound hypo, but give my liver just enough to lift me out of it.

AliB wrote:As your body adjusts to lower BG levels the hypo threshhold lowers.  When mine was very high I would get hypos in the high 4s, but as it lowered I could get down to 3.2 without any reaction.  

I never really had that much in the way of hypos, my sugar levels tend to run on the high side rather than low.  I've had maybe a dozen over the 17 years I've been diagnosed, and usually when trying some different diet or regime.  But even when I was just water-fasting a few weeks back it didn't go below 3.6.

As a just in case, I keep a small pot of honey and a spoon on my bedside table, and have half a spoonful or so or I would eat a square or two of 85% choc.  I would never go overboard with the sugar and end up with a rebound hypo, but give my liver just enough to lift me out of it.

Good idea re the chocolate. But I guess it's ordinary chocolate not 75% cocoa?

I was getting hypos for many years before I was ever diagnosed diabetic. Happened usually when exercising. I would have to carry food with me. Guess I was pre diabetic even then ? But they also happened at home because I would run to the fridge and have anything I could find. In those days I had the symptoms and never measured my sugar (apart from when the GP sent me for tests) so I have no idea how low the sugar was. Last year when I became Diabetic I would get the hypo symptoms when my BG went close to 4. I had them several times a day sometimes until they took me off the Novamix insulin and gave me the Novarapid which I was better at controlling.

Hi Inge - Eddie and I always have the 85% chocolate but because we enjoy it as a low carb treat, just a square with a coffee is great.  

Hopefully @AliB or someone else can reply to your question re the % chocolate and hypos.

Take Care and .......

All the best Jan