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Comment by candiddevmike | Hacker News Reader

I've been suffering from hypoglycemia for a good part of my life, and recently the episodes have started to become a bit more frequent (a bad hypoglycemia episode is like an incredibly horrifying panic attack). Trying to figure out WTF is going on with me has been daunting, everyone tells me to eat more sugar or more complex carbs which just seems to repeat the cycle. No one wants to test me, or knows what to test me for, and right now I'm fighting to get a CGM so I can tie things with a food diary. Everything seems to revolve around food, but it's hard to figure out what's "bad food".

Curious if anyone has had something similar.

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I occasionally get hypoglycemia. For me, it tends to be worse if I eat a lot of sugary foods the day prior and then go through a prolonged period of not eating. Like if I eat ice cream at night and then skip breakfast.

One trippy thing to try is to go on a keto diet. When your body is in ketosis, it stops using glucose as an energy source, so you shouldn't get hypoglycemia. It's actually a strange feeling. In my case, my energy level feels much more constant throughout the day.

This is what my wife did and it worked for her. She used to crash hard when eating a higher carb diet. She would hit in the 60s. After switching to keto it was more modulated and stays in the 80s.

Had great results with Keto but was effectively impossible to maintain -- too many cheap carbs, and lots of them too delicious to ignore.

Like, the keto pizza just isn't the same

You don't need a CGM, just get a GM. I had a case where I wanted to see the effect of foods, and the feeling of blood sugar levels that change during the day. I thought of going through one of the brands to get one but the per month price was decently high. The other issue with CGMs is they're for people with high blood sugar, so they're more tuned to high levels, not low levels you'd have from hypoglycemia, so I'm not sure how accurate those numbers would be. Besides, it's 15 minutes late and doesn't test the blood sugar directly (got this info when asked nutritionist friend who helps people with CGMs).

Getting the normal glucose meter was great. The poking of the needle barely causes an effect, and you can get pretty ingrained with numbers. The first couple weeks with the thing I went through tons of tests, before meals, various times after meals, and then if the sugar level was high, meaning over 130 for me, I'd go for a 10 minute walk and could see and feel that the numbers dropped to the low 100s so quickly. At this point I can tell decently well what level my number is.

The glucose monitor with poking stick is really great. Better, faster, cheaper, more trustworthy data than the current continuous monitors out there.

excluding cost (i recognize that’s a big con), is a traditional glucose meter really better? You have to plan/remember to take your readings. SUPER awkward if on the go with friends for example. I’m also not really seeing the big deal if it doesn’t measure the actual blood reading. Unless you’re trying to do a scientific study. A CGM is good at spotting large changes in blood sugar - that’s really all that matters for the average person that’s trying to learn what foods / activities bother them right? For example “i ate X and 15 min later my blood sugar spiked, maybe i should avoid X.”

It’s also harder to see how quickly your body responds to light exercise unless you carry your poking stick with you lol.

Maybe i’m missing the bigger picture?

I found it was better. I didn't mention this in first comment, but nutritionalist friend got me a couple test CGMs after I'd been using normal GM with blood samples for a few weeks. I'd check them both at the same time, and many times the CGM was quite off, both on the super low and super high. There were points where I'd look at the CGM, see the number, feel that it was probably way off, and then test the blood and see that my feeling was correct.

Your example is definitely the thing I wanted both glucose monitors for. The CGM didn't seem that great at the giant spikes. With the GM, I'd test numbers right before eating, then 10 minutes into eating, 20, 30, etc. Sure it involved poking my finger, but those were much more informative. than the 15 minutes CGM time frames and the fact the those numbers weren't close to as correct as the blood GM.

True about the light exercise unless you have the poking stick with you. What I did was have an internal treadmill in my apartment building. Example would be test 20 minutes after food, see and feel a 140 reading from the GM, go down and walk for 10 minutes, come back up add see and feel the drop to 100. Learning the feels has been invaluable, and the CGM wouldn't have gotten me the same quick time information that I could trust compared with real time from the direct source.

very interesting. thanks for sharing your experience!

I had a similar problem, and in my case it turned out to be reactive hypoglycaemia.

It means that my body is insulin resistant, and when I eat anything that raises my sugar levels, the body starts pumping out more and more insulin till it reaches a point where the sugar levels fall below normal. So the body is hit by bad effects of high sugar, and then with bad effects of low sugar.

In my case the solution was to avoid sugars and refined carbs in breakfast. As Indians our breakfast contains a lot of carbs.

If I have eggs for breakfast, I can pretty much anything the entire day and not feel it. On the other hand if I have pancakes with syrup, I know I am in for an episode of hypoglycaemia.

Also if I have sugar or refined carbs, having a fibre supplement (psyllium husk) with it helps.

Overall adding more salad and protein is what I would recommend if you also have this.

PS: For diagnosis go to an endocrinologist.

Perhaps I can share my personal experience. I have always felt tired/ crashed after having sugary foods. Sugary cakes & chocolate can leave me feeling pretty unpleasant. It might have been workable if eating more restored my mental state, but it didn't.

I figured this out in my twenties, stopped eating convenience food with sugar (cookies, sweet crackers, instant noodles, breakfast cereals), and instantly felt better.

I eat a high-protein breakfast of multigrain toast, avocado, cottage cheese, red onion and ham.

When you eat decent food with protein and vegetables you won't have cravings any more for sugary rubbish.

I snack on roast nuts (no peanuts), eat slightly more often and, for a pick-me-up in the afternoon, eat a small sandwich/ piece of sushi/ etc.

I am occasional only with desserts, cakes and ice-cream; typically only after dinner. Quality makes a big difference; quality cakes for example are mainly eggs, butter, chocolate and a bit of sugar whereas cheap cakes are sugar sugar sugar, refined flour and artificial flavours. Protein and fat seem to help stabilize the effects of dietary sugar on my blood sugar levels and mood.

My personal experience, YMMV.

I know a guy who had that. Turned out these actually were panic attacks after all. Finger-prick blood sugar test told the story, and anxiety meds fixed it right up.

Hypoglycemia actually causes a panic attack, so symptoms are the same.

I don’t know if this helps at all but there’s some ways to get a GCM from the private industry without needing a prescription, such as Nutrisense. I paid about $150 a month for it though.

To me, that's a lot of money for a piece of plastic. I get that it's a medical device and needed lots of testing etc, but Nutrisense seems like too much "value add" to justify what they charge for it. Hopefully I can get a prescription and get this all covered by insurance.

even presciption is expensive. You can buy it on amazon in india but thats still like 80$/month.

CGM's are fairly recent technology and they're all very expensive right now

According to Wikipedia, first CGM was approved in 1999. That may be recent for medical devices I guess, but it still seems like they're charging a lot for 20+ year old tech...

i know abbot and dexacom have been battling out patent fights in courts for years. probaly has something to do with it.

CGMs have improved a ton in the past 20 years, becoming less intrusive and easier to use.

We pay a lot more than $150 for all sorts of tech that is far more than 20 years old. But if you could make it for $20 or $30/month, that would be a serious innovation and perhaps you should try to start an advanced medical device company.

The "disposable" electronics in these are also extremely interesting. They're cost-reducing the hell out of these devices. Even in the last few months, one vendor replaced a cheap chip (TI RF430) with even cheaper custom silicon. They are not standing still!

> To me, that's a lot of money for a piece of plastic

It’s a medical device with wireless electronics, a mechanism to insert a sensor filament into your skin as painlessly as possible, and a lot of R&D went into making it. It’s not just a “piece of plastic”

The companies charge overhead to have a doctor write a prescription. You can try to find someone who will sell you one from India or another country, but by the time you pay international shipping you’re not saving much.

Regardless, don’t expect it to be all that informative for your condition. If you’re having episodes of hypoglycemia with symptoms, you don’t need a device to tell you that. CGMs are most useful for conditions without overt symptoms, where you need a device to expose the subtle changes. If you’re having episodes, just log that.

> Hopefully I can get a prescription and get this all covered by insurance.

There is a near zero chance that insurance will cover a CGM for curiosity or for diagnostic purposes. If it’s not indicated for a condition and there aren’t significantly powered studies readily available, it’s not something insurance would be interested in.

If you aren't diabetic you could pay for something like Nutrisense or Levels to get enough monitors to cover about 2-3 months of activity, learn what triggers spikes, and then cut it. What you see in those three months is pretty much what you are going to see going forward unless you were to make a significant lifestyle change and stick to it (going to/from carnivore/omnivore/vegetarian, cutting out alcohol, etc...)

I used Levels for about 3 months and I saw the same thing over and over again, it was obvious when I was being good about my eating, it was obvious when I went out for happy hour. I learned a couple things, mix a little fat or protein in if you are consuming carbs to blunt the spike, the alert to "take a walk to blunt the spike" is never long enough unless you go for an hour or more. Another year or two of wearing it wouldn't change any of that.

Unless your PC says for your condition of X we are going to try and get your glucose level to never go past Y and see if it fixes it, a CGM for non diabetic people is something you can timebox to 3-ish months, get the data, and get out for under a $1000 one time investment.

I've had it since I was a child. Am 40 now. I get hypoglycemic episodes (confirmed many times with a glucose prick test - symptoms are loss of mental focus, cold sweats, shaky hands, overall fatigue and lethargy, voracity to eat), solved easily by eating carbs / sugar. No doctor has been able to provide an explanation or even cared that I brought it up. it is not consistent either, I can be eating the same things in same schedules, some days I get it some days I don't. When I tend to get it though, it is in clusters. Like I get it frequently for a couple months, then nothing a couple months. Sometimes it goes away for a year. Then comes back. Most frequently I get it a couple hours after eating fruit on a semi / empty stomach.

I had nocturnal hypoglycemia. My blood sugar would drop precipitously while I slept and then I’d get a rush of adrenaline, which would bring my glucose up and wake me up. A doctor told me to drink apple juice before bed. Bad idea. Here’s how I fixed it: low-carb diet and exercise. My theory was that the problem wasn’t low blood sugar, but poor blood sugar regulation. Glucose regulation is a negative feedback system, and by eating large amounts of sugar or carbs, all I was doing was giving my system a temporary spike, which would lead to instability and a big drop later. So I cut out all carbs. That stabilized it a lot. Then I started exercising more. That really helped. And then strangely enough, meditating for twenty minutes before bed also seemed to have an impact.

Now, I’m in better shape and can eat some carbs, but only in relatively small amounts. If I eat fruit, I’ll usually go for a walk immediately, so I don’t get as much of a spike.

It’s also worth noting that I have PTSD, which is strongly linked with endocrine dysregulation, so maybe that’s some of the underlying cause.

The result of all this is that my glucose is now very steady and I’m not having the drops while I sleep. Of course, no doctor advised me to do any of this. This is all n=1 “nonsense” that “evidence based” medicine would ignore.

Not hypoglycemia, but I have IBS. Doctors usually run some basic standard health panels, everything comes back pretty close to normal, they tell me I look super healthy, and that if a food bothers me, don't eat it. It took me two years of this to start to have an idea of which foods bother me, but no doctor has been helpful with figuring out what is going on with my body or why so many foods bother me.

For me it's seemingly food intolerance to starch and sugar. About 4 days after consumption I'll get depression and suicidal ideation. I'll ruminate over work and whatever stresses me will be amplified.

For example I walk with a friend in the forest and shortly aware that I don't know where I am will turn into "he'll kill me" freakout... assistance dog would notice if something was off, and he's happily sniffing around and enjoying himself.

I know very little about hypoglycemia (though I’m naturally prone to sugar lows rather than highs) and your problem is likely more complex than diet.

That said, wouldn’t it be better to be doing the opposite of what you’re being told, and cut down on carbs (both simple and complex) to eat more protein and fat which body can use to slow-release blood sugar for a longer duration? (For routine diet I mean - obviously at the onset of an attack you’ll want to consume sugar).

Have you looked into the glycemic index of what you eat?

The glycemic index (GI) relates to the effect food has on the glucose levels after consumption: high is more severe than low. Vegetables have a low index and sugary foods a high one. Surprisingly white bread and cornflakes also have a high index, and other foods we would not describe as sugary.

Maybe the 'bad food' turns out to have a high index.

Have you thought about trying keto?

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