By Dino Pierce, CFT, CPT, RD, CDE
If you have been living with high blood sugars for months or years even itâ€™s common to experience the symptoms of hypoglycemia (low blood sugar levels) when your blood sugar quickly reaches recommended levels. The symptoms of hypoglycemia are (note that not everyone experiences all of the symptoms simultaneously:
- Hands shaking uncontrollably
- Feeling ill, sweating for no apparent reason
- Blurry vision
- Nervousness or anxiety
- Feeling weak or fatigue
- Heart palpitations
Over time your body has become accustomed to feeling or experiencing those high blood sugar levels and now its â€œnormalâ€ blood sugar level thermostat is set at â€œhigh.â€ Because of this new setting, the ideal blood sugar levels are being perceived as if they were dangerously hypoglycemic levels.
Growth hormone, cortisol, and catecholamines (specifically epinephrine or adrenaline and norepinephrine or noradrenaline), also known as the â€œfight-or-flightâ€ hormones, are all released in response to stress. When you are in this physiological state and your blood sugar levels are â€œnormal,â€ the body reacts as if you are having low blood sugar and is sent into â€œfight or flightâ€ mode as a response to the falsely-perceived stress of the normal blood sugar.
When this occurs the body releases the fight or flight hormones in a warning that something is just not right (thatâ€™s why the symptoms are present) and works to increase blood sugar levels to its erroneous â€œnormalâ€ setting. The â€œcounter-regulatoryâ€ hormones tell the liver to dump stored sugar into the blood stream (the liver can hold 100g of sugar) and cause the blood sugars to rise while making you feel horrible.
The dreadful feeling is the bodyâ€™s physiological way of warning you of the perceived low blood sugar. If you were to test your blood sugar during the perceived hypoglycemic event, youâ€™d find that your blood sugar level is not below 70mg/dl, which defines a true hypoglycemic episode.
It is for this reason we always recommend that you test before treating; you never know exactly what your blood sugars are until you check.
So how do I get back to feeling â€œnormalâ€ when Iâ€™m normal?
If you hold out during this counter-regulatory experience, you may continue to experience the dread and horrible feelings for quite some time. It is difficult to say how long itâ€™ll take, but eventually your bodyâ€™s blood glucose thermostat will reset so that you can feel â€œnormalâ€ when your blood sugar levels are normal.
While you may not like how you feel, you can â€œwait it outâ€ and rest assured that even though you donâ€™t feel good, your body has an ample supply of blood glucose if it is between 70 – 120mg/dl. Remember, a true hypoglycemic episode begins once you drop below 70mg/dl or â€” if you are pregnant â€” 60mg/dl.
Another approach is to take it slow; you didnâ€™t get from 70mg/dl to 300mg/dl or higher overnight. It took some time. If your blood sugar has been elevated for quite a while, you can slowly adapt to feeling â€œnormalâ€ when your sugars are normal.
Start by identifying the blood glucose level that you feel low at; set your target a little lower (about 30-50mg/dl) one week at a time to allow your body to adjust its blood glucose thermostat to the new target of 70 – 120mg/dl.
The worst thing that you can do is overreact and eat carbohydrates in excess, making your blood glucose levels spike. So if you are tempted, take this tip: eating just 5g of fast-acting carbohydrate (such as a glucose tablet) and drinking 10 – 16oz of water can shut off the counter-regulatory hormones, while only bringing the blood sugar up by about 15-20mg/dl, in as fast as 15 minutes.
Doing this will allow you to feel better and prevent a large surge in blood glucose levels while giving your body a chance to adapt, over time, to feeling â€œnormalâ€ while you gradually reset your blood glucose thermostat.
Once you have achieved this, ironically, you will immediately notice how horrible you feel when your sugars reach the â€œhighâ€ levels now that your thermostat has been reset for blood glucose success.
Blood Sugar Goals
Fasting and before meals:
Two hours after meals:
Less than 120mg/dl non-diabetic
(Less than 140mg/dl) diabetic
Four hours after meals and at bedtime (If four hours have passed since your last meal or snack):