Everything you need to know about low blood sugar

Welcome to my June Newsletter

Having just got back from a fantastic two weeks in Greece, I’m ready to rock and roll for the rest of the year. There’s nothing quite like no cars, laptops, some great food, swimming and good company to give you a real physical and psychological boost and also a great shot of Vitamin D.

Following on from last month’s newsletter on diabetes, this month I am focusing on (non diabetic) hypoglycaemia or low blood sugar. Nearly 60% (I know, a huge percentage!) of my clients have poor blood sugar control and it’s a topic that recurs over and over again, particularly in fatigue syndromes, and mental health. It’s crucial in our day to day 21st century lives that we have stable blood sugar throughout the day but, more increasingly, we are dependant on stimulants to get us through our hectic lives and that just feeds the cycle and leaves us worse off than we were before. So, if you feel you get tired, anxious, shaky, irritable, and have low energy at different times of the day, read on……

What is low blood sugar?

It is a term to describe a condition where there is an abnormally low level of glucose (sugar) in the blood. Recurrent episodes tend to occur within 4 hours of eating a high carbohydrate meal in people who are not diabetic. It’s possibly caused by excessive insulin triggered by the carbohydrate meal. The causes are still open to debate.

How does the sugar in the blood drop?

The most common cause of this is when a person goes hungry for a long period of time, or is in a state of fasting. Basically, the body needs food to keep it all functioning correctly, so if a person is fasting, the body doesn’t have the necessary fuel, so the sugar levels drop. An over secretion of insulin by the pancreas can also be a possibility as insulin facilitates the transport of glucose from the bloodstream into the cells, especially those of muscle and fatty tissue, and causes glucose to be synthesized in the liver.

What are the other causes of low blood sugar?

•Diabetes (but for this newsletter we are assuming that this is not the case)
•Pregnancy
•Fasting
•Strenuous exercise
•Alcoholism/ Binge drinking
•Insulinoma
•Hereditary enzyme deficiencies
•Hormone deficiencies
•Liver disease
•Hereditary fructose intolerance
•Galactosemia
•Growth hormone deficiency
•IGF-II producing tumours

Please do not let this list worry you, most people have low blood sugar due to a high sugar, high carbohydrate diet.

Here is a typical scenario:

•You eat or drink excess sugar (the average American consumes well over 100 lbs/yr.).
•The body releases insulin to store the sugar, however the insulin response is excessive.
•About 2 hours later, so much sugar has been put into store that there’s not enough left in the blood, and you get a low-blood-sugar emergency.
•Symptoms such as weakness and mental fog begin.
•The body responds to the emergency by dumping adrenaline into the system.
•More symptoms follow from the high adrenaline, such as racing heart, anxiety, etc.
•The roller coaster rises and falls causing an imbalance in all the hormones and often results in ongoing symptoms.

There are some people who experience this state even if they’re not fasting, and the blood sugar drops irrespective of their food intake – this condition is referred to as reactive hypoglycaemia. There has been quite a bit of research done on this subject and many researchers and experts have come to believe that this condition is mainly caused by the lack of a hormone called glucagon. This hormone is the one that is mainly responsible for keeping the levels of sugar in the blood stable. There are others who have a different opinion though. Some believe it’s caused by too much insulin production, tumours in the body or being too sensitive to epinephrine. The debate is still on! Stomach surgery or hereditary fructose intolerance are also both believed to be causes, albeit uncommon, of reactive hypoglycaemia.

What we do know is that low blood sugar is very common, particularly with the high sugar in our diets. It can be diagnosed by a doctor who will do a 6 hour glucose tolerance test. (see below for more info). Our blood sugar should be somewhere between 3.6 and 6.2mmol but this can vary from person to person. The speed in which the blood sugar drops can also make symptoms worse. Many years ago, I got something akin to reactive hypoglycaemia after eating a certain sweetened form of soya yoghurt – I happen to have a blood sugar monitor in my clinic and after an hour of ingesting the yoghurt, my blood sugar would go to 9.0mmol, shortly after dropping to 3.6mmol. I can’t tell you why, but the speed of the low blood sugar made me feel very jittery, anxious and odd. It’s never happened again and I’ve never eaten those yoghurts again. I always eat protein at each meal now, which helps. But it does show you how some people can be quite sensitive to high sugar foods, and of course in our diet there is a lot of hidden sugar – particularly as some of you know, my pet peeve, glucose fructose syrup and corn syrup.

Low blood sugar/hypoglycaemia symptoms usually go unnoticed because they tend to occur as a result of improper diabetes medication, and people are liable to think of them as symptoms of diabetes or may disregard them altogether. Proper knowledge of hypoglycaemia symptoms is important, as the long-term effects are quite serious

Common symptoms of low blood sugar

The following is a short list of specific symptoms: Generally, it is difficult for people to notice the problems immediately or at all, since hypoglycaemic symptoms are common in other illnesses, and as such, the person involved may be wrongly diagnosed as suffering from things other than hypoglycaemia. The difficulties in finding a correct analysis are further aggravated by the similarities between hypoglycaemia symptoms and most neuropsychiatric disorders such as schizophrenia, clinical depression, and insomnia. Fortunately, the effects of hypoglycaemia are generally temporary and will disappear once properly treated. I get a little worried listing symptoms and people tend to panic – please don’t but these are some of the many many symptoms of low blood sugar, which can of course be caused by other health issues as well:

• dizziness
• sweating
• vertigo/dizzy spells
• light-headedness
• sweating
• phobias
• anxiety
• restlessness
• headaches
• depression
• drowsiness
• nervousness
• irritability
• violent outbursts
• OCD
• inability to concentrate
• forgetfulness
• tremors
• flushing
• craving sweets
• increased appetite
• rhinitis
• nausea, vomiting
• panic attack
• crying spells
• night terrors
• numbness/coldness in the extremities
• difficulty in speaking
• confusion/abnormal behaviour
• convulsions/temporary amnesia
• weak rubbery legs
• tremor or trembling
• arm twitching,
• jerking, or cramping of a leg muscle
• waking after 2-3 hrs sleep
• tinnitus – ringing in the ear, due to high insulin in about 70 % of tinnitus

Tips for avoiding low blood sugar:

If you believe you are suffering from reactive hypoglycaemia or low blood sugar problems, you need to change a few of your daily habits:

•Following a specific hypoglycaemia diet is the most important one.
•Basically you should be eating up to 5-6 small meals throughout the day, and each meal should not be spaced more than 3 hours apart. This ensures that your sugar levels remain stable and do not fall drastically.
•Remove all alcohol, canned and packaged foods, refined and processed foods, dried fruits, sugar, white flour, sweet fruits, and juices like grape and prune.
•A personal choice, but I would remove molasses and honey as well.
•Eat a diet high in fibre, and combine protein with carbohydrate at all meals.
•In a low blood sugar reaction, eat something that combines fibre and protein like cheese on a cracker.
•A regular exercise routine is a must – this helps to steady blood sugar.
•Eat one to three hours prior to exercise.
•Stress is a major factor in hypoglycaemia as it affects adrenal function and blood sugar levels. Practice stress reduction.
•Great tip: Avocadoes contain a 7 carbon sugar that depresses insulin production which makes them an excellent food choice.
•Caffeine, alcohol and smoking can cause profound swings in blood sugar levels.
•A diet that avoids food with lots of sugar in it is a must, as this prevents the sugar in your body from going too high or too low, and causing a lot of spikes.

Much of this needs to be tailored to your individual needs. If you need help with this, do come and see me – tel: 01323 737814.

Testing for Hypoglycaemia

For those patients of mine who have problems with balancing their blood sugar, I sometimes recommend them to take their blood sugars after a meal or when they have symptoms. This can help a little but is not completely accurate and the strips for the blood sugar monitors are not available on prescription unless you are diabetic.

Another way of testing for hypoglycaemia is the Glucose Tolerance Test (GTT). The person being tested is required to fast for 12 hours, then have a drink with a super-high sugar content – a disaster plan for someone with hypoglycaemia. The blood is then tested every 30 minutes over 6 hours. The test however can be unreliable as it is frequently done in an inadequate way or is misinterpreted, because the rate of drop in blood sugar is ignored. The lowest glucose level is important, but the rate of drop is just as important. Falling too rapidly from high-normal to low-normal represents poor regulation and will give symptoms. Because of these testing problems, hypoglycaemia is best diagnosed by its symptoms.

What is needed here is a low to medium GI diet (see below for details). It’s fairly easy to identify foods that you should obviously avoid like cakes, biscuits sweets etc. However, there are foods that raise your blood sugar levels due to the high level of starch in them which then, in turn, converts to sugar so be aware of those as well e.g. raisins, dates, dried fruit. If you think that dried fruit is a good snack, think again if you have blood sugar problems, it’s very high GI, and contains a lot of concentrated sugar.

THE GLYCAEMIC INDEX

The glycaemic index is the measure of the power of food to raise blood sugar after being eaten. For balanced blood sugar, you should aim to eat foods that are low GI or medium GI and avoid foods that are high GI.

This is a list of some basic foods. For a more detailed list, its best to buy a book! I have written in bold the foods that are surprisingly high on the index and, if eaten, should be eaten with protein to slow down the release of sugar.

LOW GI – 55 or less
MEDIUM GI – 56-69
HIGH GI – 70 or more

Sugars
Glucose 100
Maltose 100
Honey 75
Sucrose 60
Fructose 20

Fruits
Apples 38
Bananas 59
Oranges 44
Orange Juice 46
Raisins 64
Watermelon 72

Vegetables
Beets 64
Carrot – raw 31
Carrot – cooked 36
Potato – baked 85
Potato – boiled 70
Parsnips 97
Chips 75

Grains
Bran cereal 42
White Bread 70
Wholegrain Bread 65
Corn 59
Cornflakes 84
Porridge 46
White Rice 98
Brown Rice 58
Rice cakes 82
Wheat cereal 67

Legumes
Soy Beans 18
Lentils 28
Baked Beans 48

Other
Ice cream 61
Milk 34
Nuts 13
Chocolate 49
Yoghurt 33

Some useful supplements to support low blood sugar (please do not self prescribe)

Brewers yeast – aids in stabilizing blood sugar levels.

Chromium – vital in glucose metabolism – essential for optimum insulin.

Vitamin B complex – important in carbohydrate and protein metabolism and proper digestion and helps the body tolerate foods that produce low blood sugar reactions. Vitamin B1 helps in the production of hydrochloric acid.

Zinc – needed for proper release of insulin.

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