Hypoglycemia with Hashimoto's

[Jefner]

Anyone now have hypoglycemia issues that they never used to have and track their levels with a monitor?

I understand is common with hashi's. Seems to be more noticeable with me this year. Just trawling through old posts to see if I could find others and came across a post I made 2 yrs ago about it.

I asked my GP at that time to do a full blood panel and check my Hba1c and the results came back prnt.sc/vxJ6JDAwvvsg so no action.

Hypoglycemic symptoms also mimic typical anxiety symptoms. It's always been a problem for me when I approach my GP about stuff as she always puts everything down to my mental health/anxiety issues and never looks outside the box which is exactly what she didn't do when I approached her back in 2015 on recommendations on here to test for Hashi's. She just looked at me, smiled and said "you don't have Hashi's", until I went away and proved otherwise by private testing.

I know my own body and I know a lot of you feel I am paranoid/overthinker, and you are probably right but this disease is an absolute minefield of imbalances, still so much to learn and try but to be honest it became too overwhelming for me so I just stick to the basics now. I do feel I experience hypoglycemia (especially on waking) except NO hunger pangs or tingling lips.

feeling hungry -dizzy - anxious - -sweating - shaking/tremors - tingling lips - heart palpitations - feeling tired or weak - blurred vision - feeling confused - feeling sleep even on waking - difficulty concentrating - easily irritated, tearful, moody

Can't bear the thought of eating as soon as I get up but I have to now try and force something down within the hour. Some of the symptoms do alleviate around half an hour after having a high protein breakfast. This issue has been more prominent the last couple of years; especially this year. Before being plagued with all this crap, I never used to feel like eating until I had been up at least 2-3hrs and certainly never had any symptoms telling me I needed to. These days I can't go as long as I used to without HAVING to eat something every couple of hours or so, or I get more shaky and dizzy etc., and for some reason a bit of cheese seems to do the trick and settle me within half an hour or so.

Was thinking of buying a blood glucose meter to monitor things and if it shows up a real problem then I have some ammunition to go back to my GP with so she could probably trial me on one of those flash monitors that the NHS now uses which tracks your levels 24/7 and where I can better manage my levels. There are so many available and not all are accurate from reviews I have been reading, but the lady who responded on my post 2yrs ago uses a Betachek C50, and reviews for that seem to be pretty reasonable.

Just another Hashi thing to look into

[Regenallotment Ambassador]

yep done the Libra link thing via Zoe. 6 weeks. It was really useful.

Showed up I have reactive hypoglycaemia. I kinda already knew but to have it confirmed was very helpful.

I generally avoid all processed sugars, very rarely eat cake, biscuits etc. not even GF ones and feel blooming awful if I do.

I don’t eat bread, pasta, not even GF alternatives, have a low but no no carb diet. I choose skin on potatoes and squash beets and roots for my carbs. I have quinoa and buckwheat and wholegrain rice too. But not much.

Eating higher protein meals helps me.

[Jefner in reply to Regenallotment]

"yep done the Libra link thing via Zoe. 6 weeks." - what is that?

reactive is the other way I believe where you get symptoms after you eat. I actually feel better usually after something to eat. I can feel myself slipping usually and I start to get the shakes and stuff.

Unfortunately because I literally have no pleasures in life I partake in chocolate every day although it's Green & Black's 85% dark organic choccy. I usually have a few pieces after each meal and sometimes I was finding I was getting through a whole bar a day so that isn't helping (except my Ferritin levels) so I am trying to cut back on it now. Even though it's straight after some protein and not on an empty stomach, it's probably not helping either? I get so much nausea with the anxiety I just don't want to eat half the time but my diet is what I grew up on, meat and veggies. Have been sprinkling some crushed chia/flaxseeds on my scrambled egg on toast that I always have for breakfast. I am not sure even eggs suit me tbh.

Years ago we used to have a great sandwich bar next door to the office and I went through a phase of egg mayo sandwiches every day but by Wednesday I felt sick so I left off them and felt better and rarely had eggs after that. Years later and since changing my diet cus of the Hashi's, my appetite is poor compared to what it used to be but I know I need a protein breakfast but can rarely face it so have an egg every day scambled with tumeric sprinkled on top and some cold cooked chicken on the side or a slither of cheese, because I just can't see to find anything else that is light and easy to eat. Maybe eggs are unknowlingly a problem for me as well. There is so much going on I have no idea anymore

I just cannot be bothered or have any motivation to cook meals from scratch, I just usually have some of my cold cooked chicken or fish with steamed veggies which takes around 10mins total time. In fact I don't think I eat enough anymore.

I keep buying fruit like raspberries, blueberries and alike but end up throwing them away due to rotting because I just can't face them. Not had any fruit for months now

By the time I get up my breakfast is at lunchtime and then my lunchtime around 4pm when I have one small slice of gf bread with, sometimes a bit of cheese or cold chicken again and green leaves on top with a bit of branston pickle. Not really a meal is it Evening meal is usually around 8pm where I have my steamed veggies and chicken/fish and then around midnight I will have another toasted slice of gf bread with a bit of chicken on. Seems late night my when anxiety wears off a little I don't get feel so nauseous so get the munchies. After that I may have a couple of my GF Rosemary crackers with some coconut oil spread on them.

[Regenallotment Ambassador in reply to Jefner]

The Zoe programme, as part of it you wear a Libre link continuous glucose monitor (like diabetics wear) for weeks. I didn’t get on brilliantly with the rest of the programme but this bit was really interesting for me.

[Jefner in reply to Regenallotment]

never heard of that programme, just had to look it up. Funnily enough I have just been looking at purchasing one of those that give continuous readings which I am pretty interested in, even if it's just for a week or so on the same routine, am sure it would give me some incline, not cheap though, around £40-50. Gonna phone them tomorrow and ask the best one for me

[Judithdalston in reply to Jefner]

Abbott who produce the Freestyle Libre2 continuous blood glucose monitor offer free monitors to ‘diabetics’ ( presume they mean people who will go onto need the CBG longer)…anyway can get 2 weeks of info of what your BG is doing. I am diabetic with hypothyroidism, obviously not quite the same as your self diagnosed hypoglycaemia, but have you had another HbA1c test in last 2 years as your last test was barely ‘normal’? I do wonder whether you are eating too little carb.for eg at breakfast when you say you feel hypoglycaemic on waking yet by midnight when you are eating toast, crackers you feel better. I can’t explain how cheese improves how you feel. 85% dark choc has very little carb.content so 2 bits( depending on manufacturer) gives about 5 g carb. only…not enough generally even to undo a ‘hypo’ for me, but eating a whole bar in one go would be equivalent of a ‘normal’ plate of food. You are right that brain use and anxiety can alter your BG…try getting a free Libre.

[Jefner in reply to Judithdalston]

what do you mean by my last test being barely normal. I have no understanding unfortunately. How do I get a "free" one. I read you need to fit a certain criteria for that?

There is one on amazon but the reviews don't appear to be that good

amazon.co.uk/Abbott-Freesty...

looks like I can also get one here much cheaper westlondonpharmacy.com/prod...

Rather than pee about trying to get my Gp to do anything I can also test my HbA1c with a home finger prick test fromthe diabetes site. I think it's worth doing and would you be able to interpret my results?

[Judithdalston in reply to Jefner]

Sorry from memory 2 years ago your HbA1c was one up from non diabetic range, or did I misread/ misremember, so it might have altered since. Just go to the Abbott’s (UK) site itself to look for free monitors…they might have changed it over the last 12 months or so as they have other similar devices for non diabetics they are rolling out in US not sure they have reached UK. You used to have to click a box to say you were ‘diabetic’, you are surely being investigated for diabetes or some such..perhaps the criteria seems more strict now, but worth a try. The price seems to have doubled in a year!

[Jefner in reply to Judithdalston]

found this on the South Tees NHS website for reference prnt.sc/oRF5jRZt-qWw.

and I just ordered another HbA1c test via the Diabetes UK website to do at home, no point approaching my GP at this point, she just puts everydown down to my poor mental health and health anxiety issues

[Hypopotamus]

I know that I have to eat often to keep myself from feeling unwell. Intermittent fasting would be impossible for me!

[buddy99]

Although I have not measured my blood sugar in situations where I have encountered sudden weakness, shakiness and fatigue, etc., I'm pretty sure I temporarily was hypoglycemic. It most often happens when I "exert" myself, like on a hiking trip or at the gym. It is fairly unpredictable and was much more common when my thyroid hormones were not optimal. The reason I think that it is hypoglycemia is, that, when I eat candy, the situation improves. I try to remember to always have something sugary with me when I plan on being physically active. I do not know for sure whether the lack of thyroid hormones is/was the cause or whether it is just coincidence, but I am assuming that they had some influence.

[CyclingMummy]

I did Zoe a year ago before I was diagnosed with hypothyroidism. The glucose monitor is the Freestyle Libre 2 monitor, which you can buy on its own, and the Zoe app uses the Freestyle app for scanning the monitor to get the readings. I was surprised by how much of my day I was spending with the monitor telling me I was hypoglycaemic. I never had any really really high sugar peaks, but I was waking repeatedly at night and that seemed to correspond with my blood sugar being really low. I found seeing the blood sugar response to each meal really quite fascinating, and it might help you, but you could do that at lower cost (£50 ish) by just getting a Freestyle Libra monitor.

Zoe analysis suggested my blood sugar response was excellent but my response to dietary fats was poor and my gut microbiome was poor, and suggested lots of foods that would be beneficial. I have since started treatment with Levothyroxine, started supplementing various vitamins and gone gluten free. I have no idea now whether my body’s response would still be the same, and I’m wondering about saving up to retest once my bloods show my thyroid hormones and vitamins are in a more optimised place.

[Judithdalston in reply to CyclingMummy]

I am a great Zoe supporter, but do wonder how much 20+ years of hypothyroidism/Hashi, plus no gallbladder and knackered pancreas ( with type 3c diabetes) have affected my gut. Zoe suggests a good diet means you don’t need supplements, even somewhat controversially vit D, but my diet is the ‘80% optimal’ as suggested by Zoe but I have to consume supplements of vit D, B12/B complex, ferritin ( heme), folate plus zinc, Mg etc etc and then the blood tests indicate they are struggling below ‘‘optimal’ levels as indicated on the forum. …recently discovering I cannot even dissolve the cellulose outer capsule on my B complex! Oops gone off the post subject, but from my experience hypothyroidism, and its treatment, go hand in hand with BG levels…GP just decided to reduce my levo.from 100 to 75 mcg( I do take T3 15 mcg too daily) and within 1-2 weeks had to raise my basal insulin by 10% for eg, while trying higher T3 dosing that too sent my BG much higher.

[Andie222]

Hi Jefner. Yes every morning about 2 hours after breakfast my blood sugar drops to about 3.8-4.0 and I feel weak and shakey. Food (preferably sugar) fixes the problem and I've learnt to eat before it gets too bad. My GP isn't interested because it doesn't go down to 3.0. I think there is also a link to my low cortisol. It's a nuisance because I can't skip snacks, let alone main meals. I'm always thinking about food and it's amazing I'm not overweight).I used a monitor at home for a few weeks. I've no way to test the machine's accuracy but it was helpful to see the daily pattern.

[GlowCoach Administrator in reply to Andie222]

What do you have for breakfast that makes this happen?

[Andie222 in reply to GlowCoach]

Granola. But I've found that cereal keeps me going longer than most. I've tried porridge or Weetabix (before I was gf) and my blood sugar drops quicker.

[GlowCoach Administrator in reply to Andie222]

Even granola is quite carb heavy. You could try scrambled eggs - no toast! Might help.

[Andie222 in reply to GlowCoach]

Nice idea but unfortunately I'm allergic to egg. 😞

[GlowCoach Administrator in reply to Andie222]

Whatever you can tolerate thats higher protein then.

[Judithdalston in reply to Andie222]

Curious, and apologies if I sound like I’m now on Diabetes Uk forum but what do you eat for breakfast?

[JumpJiving in reply to Andie222]

Jefner If you haven't already done so, I would suggest getting an early morning (8-9am) cortisol test (blood, not saliva) done, to rule out adrenal insufficiency (one form of which is auto-immune and often seen alongside other auto-immune conditions).

If the result comes back low, you'll then want a referral to an endo to get an ACTH test and a short synacthen test done (they often skip the ACTH test, but you really want this done if you have low cortisol and NICE guidelines say it should be done so do insist).

[Jefner in reply to JumpJiving]

morning cortisol is included on my thyroid tests, they don't come back low, all around 9am

April 2024- Cortisol (Random) H 534.0 6am - 10am 166 - 507 nmol/L

July - Cortisol (Random) 264.0 73.8 - 507.0 nmol/L

3rd Sept - Cortisol (Random) 191.0 73.8 - 507.0 nmol/L

25th Sept - * Cortisol (Random) 314.0 73.8 - 507.0 nmol/L

I think April came out really high because my anxiety was debilitating due to finding out my FT4 was over range

[JumpJiving in reply to Jefner]

    Jefner - If those are all around 9am (the time assumes that you aren't working night-shift, jet-lagged, or suffering from serious insomnia), then you should get them investigated promptly. Whilst not horribly low (mine was 39nmol/L at the end of last year), anything below 300nmol/L at 9am should result in follow-up testing, and 191nmol/L is definitely in territory where you will be feeling the low cortisol. Anything below 100nmol/L should result in being admitted according to the NICE guidelines (although often they put you on hydrocortisone and kick you out until they have time to do the required follow-up testing, which at your levels should include ACTH and SST).

Cortisol follows a circadian pattern. Although simplified, the usual explanation is that it peaks early morning and drops as the day goes on. If you have a low level at 9am, by evening time your level will be very low.

Are you using any steroid-based medication (inhalers etc), or are you on oral contraceptives or HRT? If the answer is yes to any of those, do not change until you have been seen by a doctor. Oral contraceptives or HRT may be elevating your cortisol, and stopping either may result in your cortisol level dropping significantly, leading to adrenal crisis.

Do you have any unusual skin pigmentation?

[Jefner in reply to JumpJiving]

stop scaring me by saying I need to go into hospital, absolutely no chance lol. My morning cortisol levels are not low and I found this on the Oxford University NHS Hospital site prnt.sc/63eyr5hfogUe .

My private Endo back in 2016 did lots of tests on me and scans. Had an acth test done, Dexamethasone suppression test which showed full suppression, scans and alsorts of tests I have been on a low dose hrt patch for a few years which needs attending to again but put on the back burner due to trying to get get my FT4 and FT3 levels in order. No unusual skin pigmentation

I actually feel at my best late at night when my anxiety usually wears off which is normal which is called diurnal variation apparently. I can feel really well sometimes around 2am

[Jefner in reply to JumpJiving]

just been having a look round for a possible cortisol test that I can at home because I am agoraphobic and found a hair test cortisol that measures your levels over the past 3-months. Found that a little unbelievable so found a bit more info

pmc.ncbi.nlm.nih.gov/articl...

[JumpJiving in reply to Jefner]

 Jefner

I'm not sure how reliable finger-prick tests are for cortisol, let alone anything based on a hair sample (well outside my knowledge, and almost certainly not going to be accepted by a typical endo). ACTH has to be done in a medical setting unfortunately - the blood draw for ACTH has to go on ice and get to the lab in about 15 minutes. I don't know if it's possible to get a district nurse to do a SST in a home setting, but even if possible I wouldn't recommend it - it's rare, but a small number of people do react to the SST test. SST involves a blood draw, an injection, and then one or two more blood draws, the first at 30 minutes, the second optionally at 60 minutes. At least it's not an in-patient thing, but I understand that agoraphobia will make it difficult.

Despite the NICE guidelines saying that patients should be admitted if early morning cortisol is below 100, most of us are not admitted (beds too scarce, and endo's seem to ignore NICE when it suits them). At 191nmol/L, they wouldn't admit you, but they would almost certainly prescribe hydrocortisone until the ACTH and SST can be done. You definitely don't want your HRT patch to run out whilst your cortisol levels are around that figure. Stopping HRT can result in a drop in cortisol level of well over 100nmol/L - I've read of people dropping around 150nmol/L (I don't know how much that differs if using a patch, but would prefer to play safe than assume the drop is smaller).

The link that you included with the reference intervals says to consider a SST for levels in the range 100-400. That's a wider range than normally quoted, 100-300 is more common. For 191nmol/L, I would strongly advise getting it done. Unfortunately, depending on where you are in the country, there can be quite a waiting list.

[Jefner in reply to JumpJiving]

i never mentioned a finger prick test for cortisol and don't need to anyway as that only checks for morning and that's included within my thyroid test anyway. You are forgetting about my end September result which was much higher

[CoeliacMum1]

So I’m 58 and ever since my mid teens I have had what thought hypoglycaemia… it wasn’t until probably around age of 49 that had I given it any attention re checking in with GP.

You can apparently still have hypoglycaemic episodes with “normal “ and high blood sugar … as explained in my experience below.

As you describe the sweating, dizziness almost going to faint type reaction I’d get periodically but not all the time a few times a year not even every month.

I had a few health issues at 47 (autoimmune conditions diagnosed) and about age 49 once these things calmed down, I asked for blood sugar to be looked at, my GP did a fasting one at first it was done alongside fasting cholesterol.

I was surprised that GP said my blood sugar was high at 40… and HBa1c was done 3 or 4 months later… that came back ok like yours 37

I have had yearly check ever since getting to look at my notes, I saw I was down as prediabetic from this GP. I saw few years later other GPs and have had said I wasn’t, my Blood sugar did creep up to 39 and once 40 in 2020 …I was still getting these hypoglycaemic type episodes still but also it’s been 35 too with these episodes …so in 2021 I had appointment anyway with my endocrinologist and was having a short synacthen test (SST) as he was thinking I had adrenal issues as I have apparently poly glandular autoimmune disorder (multiple conditions) he added in a glucose tolerance test which I passed ok and said I wasn’t insulin resistant and no pre-diabetes but said I still need to watch that HBa1c too… he wasn’t overly concerned.

Now I have read various levels with different doctors and seem to use different scales (and changes in other countries) although with NHS once hit 42 it is pre-diabetic range but some seem to put 37 in this bracket as being high …Surely there’s a universal rule but I have seen medics mention 37 being high and causing problems when most NHS GPs say it’s normal… maybe this is more a pre, pre diabetic area they see🤷🏻‍♀️

I asked the GP who labelled me as pre diabetic and she said I nearly was when questioned and she expected me to be next time I was tested, however my next test was much lower… I still have annual tests due to this being on my notes… which isn’t a bad thing really… she explained to me you can still have hypoglycaemic episodes and is likely more often as someone gets towards this higher end bracket which she considers is around 37 it doesn’t take much to jump higher is all that was said.

This year I started a 6 month course of Decapetyl injections for endometriosis to see if my conditions could be improved and rule out if hormones playing a part of it … it does state these can cause several health problems including increased blood sugar and my blood sugar jumped from 35 in May 2023 to 42 in May 2024 so I have officially got 1 reading in that range now and my diet hasn’t changed and I’m more active if anything. I will have to see what May 2025 brings me … but hypoglycaemia can occur even with normal and high blood sugar.