Hypoglycemia/low blood sugar

[lh22]

Hello all,

I wonder if anyone would be so kind as to give some advice about this issue.

Recently, I have been struggling with my blood sugar. I wake up feeling ravenous, and sometimes I wake up with a headache/migraine/visual disturbance. It tends to get better after eating something. I've noticed I get hungry and tired very quickly and have to eat every 2-3 hours. Sometimes I suddenly crash and I have to eat something and lie down most of the day. I also can do hardly any exercise (even gentle walks) because my blood sugar drops so quickly and I feel tired/hungry.

My most recent blood test shows my TSH is very low, T4 is mid range and T3 is just in upper quartile. Vit D is low-mid range (am taking supplement of D3+K2), Hb is slightly low (thalassemia trait), folate and B12 are mid-high range. Serum iron is mid to high range but Ferritin is almost above range.

I also monitored my blood glucose for 2 days and my levels are on the low end, having been pre-diabetic before taking T4. Seems to go quite low (60s/70mg/dL) between meals. I have been on 100mg T4 since Oct 2019, and 20mcg T3 since August 2020. However I have been taking T3 very occasionally for the past month because I noticed I was getting headaches/energy crashes more regularly.

Does anyone have any ideas as to why these energy crashes/blood sugar drops happen? Is it a problem with my pancreas/liver/adrenals/all of them?!

Thank you in advance for your help 🙂

[SlowDragon Administrator]

I have been on 100mg T4 since Oct 2019, and 20mcg T3 since August 2020. However I have been taking T3 very occasionally for the past month because I noticed I was getting headaches/energy crashes more regularly.

It’s ESSENTIAL to take EXACTLY same dose T3 everyday

If you are stopping and starting T3 that will completely mess up your endocrine system, in particular your adrenals

Any thyroid test is only a true reflection of what’s happening if it’s done 6-8 weeks after being on a constant unchanging dose of levothyroxine and T3

Do you normally split your T3 into 2 or 3 smaller doses per day. Many people find that it’s essential to take this way

Suggest you try 10mcg at 7am, 5mcg at 3pm and 5mcg at 11pm

Do you always get same brand of levothyroxine

How much levothyroxine were you taking BEFORE T3 was added

Taking almost any dose of T3 will completely suppress (turn off) your own thyroid. So it’s essential to be taking high enough replacement dose

Headaches is common hypothyroid symptom when starting on T3 (probably because of sudden drop in TSH)

T3 is not easy to manage

All four vitamins need to be optimal

[lh22 in reply to SlowDragon]

Thanks for the reply SlowDragon.

When I last tested, I had been taking a steady dose of T4 (100mg) and T3 (10mcg in morning and 10mcg midday) for 6 weeks.

I've had headaches/migraines related to blood sugar since my teens (now in my 30s). The strange thing was when I was really hypo, I hardly got any headaches, but of course I had other bad symptoms - extreme fatigue, weight gain, pre-diabetes, insomnia, high cholesterol, feeling tired all the time. All these symptoms got somewhat better, but the headaches/migraines seemed to get worse a few weeks after taking T3. Still have fatigue and hunger.

Yes I always take same T4 brand. Was on 100mcg before taking T3 and still am.

My Endo suggested I get some tests to check pancreas function - insulin, glucose - as well as 9am cortisol.

[SlowDragon Administrator in reply to lh22]

On day before blood testing.......Last 10mcg dose needs to be split into 2 x 5mcg and last 5mcg taken a maximum of 12 hours before test

So if last dose T3 was nearer 21 hours before test that’s a false low Ft3 result

What were the actual results and ranges on TSH, Ft4 and Ft3

Many many members in T3 find taking last 5mcg at bedtime gives deep, sound sleep

[lh22 in reply to SlowDragon]

FT3 - 3.8 (2.0-4.4)FT4 - 1.01 (0.93 - 1.7)

TSH - 0.018 (0.27 - 4.20)

I think I took my last dose of T3 about 18 hours before the blood draw.

Also, my HDL cholesterol is 37 (>50). Does that affect anything?

I just seem to have energy crashes out of nowhere - I think my Endo wants me to rule out anything more serious like an insulinoma, before addressing it.

[Hypopotamus]

I have had similar symptoms for decades, particularity as regards waking up feeling so bad. I now eat a little something regularly throughout the day, and always have something sweet and fatty, eg a peanut butter sandwich, before I go to bed, and feel so much better in the mornings. I also sleep much better than if I go to bed without it.

[lh22 in reply to Hypopotamus]

Thanks for the reply

Are you on thyroid medication? And are you able to do physical activity? My blood sugar seems to plummet when I do any physical activity- I have a bit of a fatty liver so just wondering if it's not functioning as well as it should still. I used to be a bit of an exercise addict and now I hardly go for a walk even 🙁

[Hypopotamus in reply to lh22]

Yes, I am on NDT from Thailand. I was diagnosed hypo 30 years ago although I had been for at least 12 years before that. I find that if I exert myself too much, and get too warm, I do 'crash', and take some time to recover. So I am careful if I go for a longish walk or cycle ride, not to tog up too much, even though I generally feel the cold. Having ME for as long as I can remember, I have learned to do the 'right' amount of exercise.

[thyr01d]

This may not be relevant to you, but since it might I'm mentioning it. My mum used to suffer from migraines, she found that it was when she needed 'starch'. If we took her buttered toast right at the start of an attack she would recover. I don't know enough about blood sugar levels to know if doing this would work for you.

[lh22 in reply to thyr01d]

Thanks for the reply

I had the beginnings of a migraine as soon as I woke up this morning, which for me is an aura and feeling tired, and I quickly took some oral glucose. My aura went away and I didn't get the usual searing headache that follows. So it's definitely blood sugar/fasting related. Sounds like your Mum has a similar trigger.

I've been looking into non diabetic causes of hypoglycemia, and most are related to the pancreas and liver. I think my symptoms are related to the liver because being hypo causes a sluggish liver, which is one of the main organs (along with the pancreas and adrenals) involved in maintaining stable blood sugar. Will have to get it checked out though.

[Carmela99]

Hi yes I have had Hashimotos for well diagnosed for 11 years but 14 total...and I get the hypoglycemia symptoms exactly as you have described...it is worse when my tsh is out of range for “my normal” which is .8/.9 and I’m extremely sensitive to any change in levels! I was well medicated and had my symptoms under control until after having my daughter...I also had to move states and change doctors etc during this time-but I’ve been trying to regulate my tsh bavk to where it should be for two years now. Recently I finally got on a higher dose but tipped a bit too far to hyper...when hyper around .7 I am ravenous abd my blood sugar drops about two hours after eating...it is terrible!! I feel like I’m constantly having to eat...I get light headed, blurry vision and strangely my thyroid gland also feels tight like it’s swelling when it drops...a weird symptom I haven’t heard anyone else say they have but mine has reacted that way for years.So maybe you are a bit to hyper right now? I think you said your tsh was low?

For me, I cut back 26mcg of synthroid a week hoping to balance closer to .9 and am watching my refined sugar and caffeine intake very close as my levels balance.

I carry those little non refrigerated bottles of apple juice with me and RX bars or peanut butter if I’m home for quick fixes between meals...usually 50 calories or so of apple juice with a bite of PB or a low glycemic bar boosts me back up!

I feel your pain!! But it gets better (Doesn’t go completely away for me at least but livable) when your levels are right for your body!!

[Wired123]

Have you considered buying a continuous glucose monitor? It’s about £70 and you can see your blood glucose on your phone throughout the day. Gives you a lot of info about what’s really going on in your body and also the impact of different foods.

[lh22 in reply to Wired123]

Thank you for the reply

I will definitely look into this - would make things clearer about what's going on.