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Low Blood Sugars? Confused ENDO. ANY ADVICE appreciated!


Background: Relatively healthy 30 year old woman. TSH is 2.4. Managed Hashimotos well for 10 years. Always had low but within range A1Cs and glucose for as long as I can recall.


Last week for several days I had been having severe nonstop heart palpitations after eating (mostly carbohydrates). Finally it got so bad I could feel my heart struggling to pump so I went to the ER, and they referred me to a cardiologist. Cardiologist ran an echo in his office. Nothing was found but PVCs. Soon my heart monitor will be arriving and they will be looking at my PVCs but structurally I am in good shape.
The ER found nothing wrong in their huge patch of tests and xrays of my chest.

Then I spoke to my endo who has me wearing a FreeStyle 24 hour monitor because she had been concerned about several of my non fasting glucose readings for a few months.

From the last few days here is what the monitor is telling me:

When I wake up my blood sugars are in the mid 50s. After breakfast they hover around 76 or 82. They rarely ever go above 86 ever. Once a day they may hit 115 if I eat bread ..stay there briefly to go back down to the 70s. I am not on a specialty diet nor do I do keto. I usually eat a lot of fruit and seafood.

Once average my glucose monitor tells me my daily averages are around 75.

What do you think I have? Am I in a pre-diabetic state and my panaceas is just pumping out insulin?
My endo was confused even.
2 Responses
973741 tn?1342342773
Wow, I think a fast track to the endo would be ideal.  Could your primary help with that.  Hypoclgycemia can become a medical emergency. I believe, being diabetic would be a higher number, not lower. Clearly there is an issue with blood sugar regulation . People with diabetes can have hypoglycemia but I'm not sure there is any indication of that with you.  I think you need to be seen as soon as possible to unravel this.  https://www.mayoclinic.org/diseases-conditions/hypoglycemia/symptoms-causes/syc-20373685  There is something called reactive hypoglycemia.  In people without diabetes, hypoglycemia can result from the body producing too much insulin after a meal, causing blood sugar levels to drop. This is called reactive hypoglycemia. Reactive hypoglycemia can be an early sign of diabetes.  https://www.diabetes.org/diabetes/medication-management/blood-glucose-testing-and-control/hypoglycemia
231441 tn?1333892766

Blood sugars in the 80s are actually totally normal.  The fastings of 50 are on the low side.  Most adults rarely go below 70, though children can be considerably lower and readings in the 60s are not abnromal for them.

Paradoxically, you may do better on a lower carb, higher protein diet.  This is because by reducing carbs, you also reduce your panceas' insulin outputs... and it is the insulin outputs (maybe overproduction) that could be driving your nighttime and fasting levels so low.   You day time levels seem to be normal.

The low nighttime levels may also be due to an over response to fasting.  During fasting the liver produces glucose and the pancreas continues to put out insulin...  In your case it may be that the pancreas is putting out more insulin than the liver's glucose production requires and hence the low numbers.   You may find that a bedtime protein snack may help prevent you going so low overnight.  Protein can slowly convert to glucose but has relatively less impact on insulin levels compared to carbs...  you may also need to eat either breakfast (or a snack), again consider higher protein not higher carb, soon after waking to keep levels normal.

Many people who eventually develop diabetes do report early history of hypoglycemia... so continuing to watch blood sugar levels will be wise.

Hope this is helpful.
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231441 tn?1333892766
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