My husband reported to me some problems he had been having in the early afternoon before lunch. He told me he got shaky (to the extent that other people noticed), dizzy and irritable.

We went to the doctor's office and were given a diabetic diet with a copyright date of 1980 because of the suspicion that he had low blood sugar problems. They tested his blood there as a random test to screen him for diabetes and he came out within the normal ranges.

Now. we've been following this diet as closely as possible. But yesterday he told me he had a donut at work (they brought them in and it was hard to resist after almost a month of no fun foods). Within 1 to 1 1/2 hours he felt shaky again and it didn't go away until he ate something. But then later in the afternoon he ate another one and had no problems. After questioning him further about that incident and the other incidents he had, it seems it only happens to him in the morning.

Could he be hypoglemic but only have problems in the morning?

I'm trying to get as much information as I can about this topic. We have a doctor's appointment coming up and I'm concerned about the following 1) that the doctor has said a glucose test (5 hour or more) is not necessary 2) that the diet we have been given is from 1980 and shouldn't he be using something more recent 3) if he has hypoglycemia is the diabetic diet what he should be on or should it be something different 4) have we screened out all other possible causes and 5) how can we make his diet so that he does have some foods that are dessertish from time to time so that it's easier for him to avoid the bad foods like the donuts.

We've been trying some atkins treats, and other desserts with splenda rather than sugar and that seems to be helping him a bit.

Your liver stores glucose throughout the day and then releases it in small amounts. Since his pancreas is working, it senses the glucose release and reacts by secreting insulin. With a damaged pancreas, it can release too much insulin. You don't really notice this problem during the day as there is a carb supply to counteract the insulin overdose. At night, there is no carb delivery so the only glucose being released is that from the liver. This is why some hypoglycemics only report lows in the morning.

In the early 80's, the talk was still that you needed to cut out sugars from your diet. They have since realized that it was carbs as a whole that affected your blood sugar. Carbs are made up of fiber and sugar. Fiber is digested and slowly absorbed so it doesnt affect your blood sugar that much but it does still affect it. A diet from the 80's will reflect that archaic way of thinking. When you deprive yourself of something, the craving only becomes stronger. I would ask for an updated diet or go to the ADA website to find out their current recommendations.

A random blood sugar is like a snapshot. It only gives a glimpse of what is going on. I would say that he DOES need a glucose test to be sure. I would also have them take a look at the pancreas to make sure that it looks normal. Sometimes rare situations like inflammation can cause strange blood sugars. I would increase the protein before bed to give him some help in the morning. He might even want to eat a high protein breakfast shortly after he gets up.

You can do a search for a hypoglycemic diet as the typical diabetic diet would not be appropriate. I would try to stay away from the simple carb breakfasts and get back in for a referral to a registered dietician. Good luck and I HTH

he should get a glucose tollerance test done to find out exactly what is happening

You're getting really strong advice here.

Your husband sounds like me some 12 yrs ago or so. I was just an ignorant, invincible teenager back then and ignored it until...

You should definitely have the checks recommended here done to be on the safe side. That being said, I am 99% sure that insulin resistance is indeed the problem. It's just so common now.

Fortunately, it can be controlled (I've done so for nine years). It just takes some sacrifice and discipline. Make sure that if you consult with a dietician that they are a specialist. And check with their clients to see if their situations have improved...a lot!

Some dieticians just spout dogma like, oh, diabetic diets from 1980 for example.

Beyond that, you asked some specific questions about treats and such. I love EAS carb control bars. Some taste better than others (They don't taste as good as donuts, though, sorry) but besides being low in insulin releasing carbs, they also contain a lot of glycerine, which is converted to glycogen in your liver without changing your insulin levels. Kind of like a free shuttle. Excess protein can do the same thing, too, but it takes a lot of energy.

Glucose from the liver (in typical nondiabetics, which he isn't yet) is a nice, slow, steady stream which is perfect for hypoglycemia. In fact, that has been one of my two main diet strategies (for myself in my current condition, not for a current diabetic) in the recent years. Send it to the liver without insulin, and let it leak out glucose from there...nice and slow.

Glycerine does this, protein does too and so does sorbitol (found in sugar free syrups), medium chain triglycerides (like in coconut oil) can also fill liver glycogen with minimal insulin response. BTW sorbitol accumulation is linked to neuropathy in those who are already diabetic.

My other main strategy is to eat extremely low glycemic index carbs, like fibrous vegetables. Again, very slow glucose release. This is simpler than what I actually do now, but he hasn't developed diabetes yet.

I know that this is kind of long, but It is likely that IR is the problem, and I wish I had spoken to someone who had beaten it, back when it happened to me.

I believe that your husband is absolutely in control of his own destiny, I wish you both luck.

Edit: Coconut oil has a sparing effect in liver glycogen, regardless...not too much of that (though I eat it regularly). Too many conflicting studies on triglyceride/cholesterol levels, etc.

Thanks for the advice! So far we've seen the primary care doctor and I believe he means well. It just didn't seem like he was going about it correctly. Do you think we should have him see an endo?

Another question......
He doesn't have a reaction every time he eats something like a donut in the morning. It seems sporadic. Could it be that he is in the process of developing it and some days are better than others? We kind of experimented with a donut this morning and he had nothing happen. We tracked his glucose and before the donut (about 1/2 before) when he woke up he had an 89. An hour after eating the donut (and nothing else) he had a 133. 2 hours after the donut, he had an 85 and 2 1/2 hours after the donut it went up to 93. We thought maybe if we tracked a reaction, we could take that info to the doctor and press for the glucose test. But, from what you have all said, we'll press for it anyway. Should it be the 5 hour or a longer one?

I would actually recommend the 3 hour one. His 2 1/2 hour blood sugar already showed signs of leveling out. The 3 hour is also 2 less blood draws so that might be a plus :eek:

I love primary care Dr's when a cold is your primary condition. They are a "Jack of all trades.. Master of none"... This means that most of their experience with diabetics is in the elderly and what they read in school. I would really recommend getting into an Endo as he will have the answers to what is going on. Good luck to you

Too true, Mindy.

Definitely see an endo...and yes, glucose control issues can be sporadic (it was for me, though it got progressively worse). I suppose it's feasible that the condition is "just starting", but it's more likely one of a laundry list of factors, some of which could have manifested themselves hours before.