High Blood Glucose Levels

[brucemillar]

Folks

I am now eighteen months post op (Transhiatal esophagectomy) for OC and doing really well. Regualr readers here will know that I have been left with fairly severe Hypoglycemia which is linked (by some) to late dumping. This is under control with drugs (Acarbose) and a careful very low sugar diet. I also check my blood glucose levels on regular daily basis. This has ensured no repeats of my previous collapses and bouts of unconsciousness.

Now here is the problem that I want to understand.

On days when I have traveled to work in the City, my Blood Glucose levels are staying "higher" than normal for the entire day. They are not at a dangerous high but my norm is between 4 & 5 Mmol. On days when I have traveled to the City, they are staying between 7 & 8 Mmol. This makes me feel light headed and shaky. That in turn causes it's own stress as I fear I will pass out on the tube or the train. I have made no changes to my diet apart from possibly eating less on these days. I would have expected the "eating less" to cause lower levels and not higher levels?

I have now way that I am aware of the lower my levels? My issue to now has always been that they suddenly drop to less than 2 Mmol where I then have to take Glucose or collapse. So lowering is a new thing to me.

I am convinced it is related to my change in work pattern as the readings only change on these days.

Does anybody have any suggestions to help me keep my levels between 4 & 5 ?

Bruce

[jay2908]

Hi Bruce,

You could try eating a slightly unripe banana before you leave for work, or any slow release low GI snack.

It could also be the anxiety of having to travel to work and commute or the fact that you are more mobile after eating on those days, so that the food moves through your system a little quicker then when you are at home. Do you get the same symptoms when you travel on the train and tube to somewhere other than work, possibly whilst with a friend?

Something 'stodgy' and low GI, will physically slow the transit of your digestion, so it more of a potential plumbing solution for when you're more active.

I hope that helps a bit.

Jay

[chris_usa]

Stress hormones cause an increase in blood sugar (part of the body preparing for "fight or flight"). I wouldn't think higher cortisol levels would cause an increase of this magnitude, though.

My main question would be the timing of the testing, which can show great variability. The other question is whether your HgA1c test shows in the normal limits. This is a test to show recent past overall blood glucose levels, and can serve as an average level for the past.

[strangetimes in reply to chris_usa]

Hi Bruce - interested in your posts as I have episodes which I assume are caused by late dumping and maybe are like yours .

Mine are very random but after much thought I think the main triggers are stress ,tiredness , physical activity,fluid intake .

I have had several attacks when making a journey/travelling . V.odd and v.inconvienient .

I came across this article posted on here some 3 years ago and wonder if it's worth studying ?

med.virginia.edu/ginutritio...

Also wonder if some input from diabetes specialists might help you ?

As for me ,I'm off to see a neurologist soon as my attacks feel very much like seizures . But I'm sure they're triggered by late dumping so ...

[brucemillar]

Thank you all for your replies and pointers. I feel that there is an entire field that warrants some further investigation. That is Hypoglycemia that is being bundled in with Dumping Syndrome. Almost all the medical people I have sought help from have immediately referred to to my issues as "Late Dumping". I am sure that it is, in the same way that I am sure a Ferrari is a car and so is a Mini. By dismissing it as "late Dumping" it means that the specific issue "Hypoglycemia" is (a) not really discussed in our recovery and (b) can go untreated.

When my Hypo's led me to collapse and fracture my spine in two places!! Then the medics treated it as a single issue being caused as a result of my surgery. Had that not been the case I am sure that I would have continued to collapse and possibly suffered an even worse fate than my cancer had in store. Full marks here to James Gossage (my surgeon) who did recognise the issue and did get me referred to specialist Gastroenterologist's and dietician's.

So now it is manageable but it is always there.

I suspect that the hypo's cause the anxiety which increases the hypo's, which drives increased anxiety which leads to the light headiness and feeling of imminent collapse?

What I have failed to figure out is why is my blood sugar varying so much day to day or more specifically, morning to morning. I have really worked hard on consistency in my diet in an effort to stabalise this. But I am failing somewhere. Now I wonder if it is not my diet that is the trigger but my mental state?

The fear of passing out on the Tube or the Train is never far from my mind. It's kind of irrational and I know this. I recognise the symptoms and have the antidote so why do I worry.

How can I lower my blood glucose without crashing it? If I find it sitting at 8ish I know that I need it to be at around 5ish to feel normal. Raising it is not an issue.

[AoifeMcC in reply to brucemillar]

I am a type 1 diabetic and have been since I was a child. I also had the stage 3 surgery when I was 32 in 2007 after having chemo first. I still have issues with severe low blood sugars since the surgery and have been very ill with them on several ocasions.

It might be a good idea if you spoke to a diabetic doctor too and see if he can inreract with your gastro team.

For me if my blood sugar is 7-8 I would not have as many issues with it for a short period of time, it is safer than a blood sugar of 2. I do find that stress and other things cause it to go higher.

I had my two children within 5 years if being diagnosed with oesopghageal cancer.

[brucemillar in reply to AoifeMcC]

Thank you for your reply. That is very interesting. I have struggled with my GP(s) who seem not to recognise anything to do with OC or the surgery! and certainly will not recognise Hypoglycemia as a condition of a non-diabetic. For over a year they refused to prescribe NHS prescription blood testing cassettes. Or the testing machine. I had to fund this myself at over £100pm. If they do prescribe medication for any other issue. They ignore the hypo's as I am not a diabetic.

[Hidden]

This is a tricky problem, and I completely sympathise. I suspect that the diabetics world would be able to offer good advice. Would it be connected with absorption of glucose through additional exercise / physical activity / travelling fatigue perhaps? But this is complete speculation.

[brucemillar in reply to Hidden]

Alan

I have done some more digging and uncovered some "interesting" theories and facts.

* There does appear to be a direct link between stress level and blood glucose levels.

* There are also many links between things that we would normally consider: decaffeinated and caffeinated coffee also appear linked (but this is less clear) Is it the caffeine or the coffee? But there is evidence that "coffee" and caffeine are linked.

* Excercise/physical activity is linked.

I have a stressful job and commute on the South Eastern Trains. That is a stress all on it's own. I like a coffee and had resorted to drinking de-caffeinated coffee, believing it to be less harmful to my condition.

I also believe that I have what is referred to as "chemo brain". My short term memory is shot and my spelling & typing (normally good) are now a chore with me having to make constant corrections.

Everything is a compromise. Cutting back on one thing brings issues to another. Adding to that thing ruins something else.

Never practise your gold swing on the golf course!!

[Hidden]

And, indeed, the glucose : insulin level probably fluctuates very significantly according to time taken since last eating.

You advice could be the answer to my golf handicap problem!

[brucemillar]

Alan

Indeed I also looked at timings of my tests/readings. For me being sure not to collapse is a real must as collapsing previously caused very significant damage to my spine.

It was really the timings that highlighted that the risk times were when I am working the City. These are the days where I will have to commute via train & tube. Interestingly, this week I have had to drive everyday using the M20/M26/M25/M4 Joy. My readings have not altered significantly, despite setting off at 5:00am each day and returning home 21:00 each night. That suggests that in getting the train and stressing about the possibility of a collapse is causing the issue?

[strangetimes]

Could the fact that there's less physical movement ehen driving sitting as opposed to waiting on a platform ,moving about ,walking to work tec be a factor ?

[brucemillar]

So I have now decided that they way forward for me is to seek a wearable blood glucose meter. Unfortunately the NHS do not Hypoglycemia as an issue unless, you are a registered diabetic/ This means that they will not prescribe the required equipment preferring instead to spend money hospitalising and dealing with the fall out hypoglycemic episodes. Worse still I can find no help within the NHS as I not registered as diabetic. My surgeon and gastroenterologist both describe my symptoms as "severe hypoglycemia" and both accept the results of this could prove fatal. But they can do no more to help.

Yesterday my blood sugar plummeted from 6.2 to 1.8 in less than seven minutes as I waited for a train in Victoria Station. I felt the on-set of the hypo and took glucose (which stopped the collapse). No apparent reason for this drop apart from the heat.

What to do to get help?