Feeling low sugar before lunch? How to stop diabetes medication energy crashes

 

Written by: Dr Saptarshi Bhattacharya

Source: https://indianexpress.com/article/health-wellness

A patient of mine described his blood sugar fluctuations despite being on medication and a physical activity routine. “I walk 10,000 steps daily. I take metformin 500 after dinner but I experience an energy crash and low sugar levels before lunch and evening. What does it indicate?”, he asked me.

How many of you have gone through similar experiences? Symptoms mimicking low blood glucose before lunch and in the evening while being on drugs suggests a possible mismatch between physical activity, meal timing and medication. It indicates that the current regimen may need review and adjustment.

Understanding Low Blood Glucose (Hypoglycemia)

Hypoglycemia occurs when blood glucose levels drop below 70 mg/dL. Symptoms include shakiness, dizziness, sweating, hunger, irritability, confusion or even loss of consciousness in severe cases. Given your proactive approach to managing diabetes with exercise and medication, it’s crucial to understand why these episodes might be happening.

Possible Causes of Low Sugar Levels

1. Medication review: Metformin works by decreasing glucose production in the liver and increasing insulin sensitivity, but hypoglycaemia is an unusual side effect of metformin. Among the medicines used for treating diabetes, the sulfonylurea group of medicines and insulin carry a risk of hypoglycemia. Review with your doctor that you are taking the right medicine. Also, ensure that you are not taking some indigenous supplements which are sometimes mixed with drugs that can cause hypoglycaemia.

2. Reactive hypoglycaemia: Reactive hypoglycemia refers to a drop in blood glucose occurring 2–4 hours after a meal. It is usually related to an exaggerated insulin response in early stages of diabetes following carbohydrate intake, particularly meals high in refined carbohydrates and low in fibre content. Blood glucose may fall to low levels before lunch or in the late afternoon or evening if you have a snack rich in simple carbohydrates in between your meals.

3. Diet and Meal Timing: Infrequent meals or not adjusting food intake with exercise could lead to hypoglycaemia.

What Does This Indicate?

Your body is signalling that your current diabetes management plan might need tweaking. Your doctor might review your medicine requirement. Hypoglycaemia is not a usual complication of metformin but still this might require a relook. Additionally, some medications can slow carbohydrate digestion and help in such situations.

Eating smaller, balanced meals with complex carbohydrates, protein and healthy fats can help stabilise blood glucose levels. Regular blood glucose checks and strategic snacking before exercise or when you feel low can help manage hypoglycaemia.

The primary reason behind reactive hypoglycaemia is insulin resistance, mismatch in insulin secretion timing and blood glucose excursion following food intake. Weight loss can help decrease insulin resistance and consequently such episodes.

Preventing Hypoglycaemia

Always monitor blood glucose levels. Regular checks can help identify patterns and triggers. Eat balanced meals complete with complex carbohydrates, proteins and healthy fats. Drink water throughout the day. Eat a snack before or during prolonged exercise. Carry glucose tablets; it’s better to be prepared for hypoglycaemic episodes. Given your proactive approach to managing diabetes, it’s essential to work with your healthcare provider to adjust your treatment plan.