Low blood sugar

[RachelJDH]

Has anyone been experiencing blood sugar crashes at times. Recently I have been having low blood sugar attacks mostly at around 5.00 when I am doing my afternoon dog walk. It results in most hypo symptoms and a blood test showed my blood sugar down to 3.6 mml. I told the rheumatologist during my telephone consultation. He said it must be something else and hypos were very unusual when not on diabetes meds unless I had pancreatic cancer (great bedside manner). I have since had a blood test which showed I was still prediabetic. I eat regularly and carefully (even tho I live next door to an artisan Baker whose donuts are gorgeous) but now have to carry an apple/sweet. My gp is going to contact a diabetes consultant for advice but thinks a CT scan would put my mind at rest (true but I hate hospitals). I am stuck on 12mg pred and going start leflunomide in a week or so after my covid jab.

[Rose54]

Hi

My blood sugars go down to 4 always around tea time.

I feel sick ,shaky dizzy and l leave it to long get a fast heart rate.

Pre diabetics last blood test so watching diet. Have lost a stone since May.

3 jelly belly babies and a sit down soon sort me out.I am sure mine is low blood sugar although Diabetic Nurse says 4 before meals is fine .

Rose

[RachelJDH in reply to Rose54]

Good idea. I am pretty sure it is just low blood sugar. Trying not to angst tho. 🤦‍♀️

[SnazzyD]

It’s good to have other causes ruled out but have you looked at your diet? Do you have anything at lunch or post lunch that could trigger a spike in insulin and a corresponding crash in blood sugar? By that I mean something high in carbs or possibly just not enough protein and fibre at lunch to even out your insulin release. For whatever reason you may be more sensitive to this at the moment.

[RachelJDH in reply to SnazzyD]

Good point. Lunch is normally homemade courgette soup, small wholemeal a piece of cheese. I will try sardines today and see if the extra protein helps. Thank you I know now to avoid sugar because the worst hypo was after a dread donut in the morning. Almost worth it tho!!

[PMRpro Ambassador]

If your pred is triggering the liver to release spikes of glucose from body stores that will also result in an over-production of insulin in response to combat it as the body is expecting a meal to follow and a requirement for more insulin but that doesn't happen. Exercise also tends to lower blood sugar so if that coincides it could go too low. And a sudden fall in blood glucose can trigger the symptoms of a hypo even when the blood sugar level isn't a low as you would expect.

Have you tried prevention rather than cure - eating something with a more sustained release when you set off for example? Koalajane found that her blood sugar rises at specific times relative to her pred dose and avoids eating then to avoid raising it even further. Maybe you can work out something similar but the other way round.

[RachelJDH in reply to PMRpro]

I think you are right, this is what is happening. What I don't get is this cannot be unusual but people who prescribe pred - "take it just like smarties my doc said" do not give you much advice about how to manage the poss consequences like lower carbs from the beginning to avoid weight gain etc.. cope with tiredness etc. Perhaps patients should write their own guidance. The amount of doctors who advise cutting dosage too fast is worrying ending up in a lot of patients yoyoing up and down. Thank you great intelligent advice ad always. X

[PMRpro Ambassador in reply to RachelJDH]

"Perhaps patients should write their own guidance"

We do - and impart it here! We also try to educate rheumies! A lot of stuff is coming out now that stemmed from experiences reported on here. Doctors are taught that weight gain with pred is inevitable - because we have tried various approaches, we know it isn't, It isn;t the sort of thing that

I don't think it is that common - it needs a set of circumstances to come together, If you weren't walking the dog at this particular time when your liver is living it up, it might not happen at all.