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Adrenergic Postprandial Hypoglycemia


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Well, this has been my second trip to the ER in the past two days. Each time its in the evening and it happens right after I eat dinner... my heart starts pounding and my blood pressure shoots up to 200/100 or more (from my average of 110/70).

I've been keeping a log of blood pressure and glucose for the past two days. I was doing excellent all day.. eating small meals, just relaxing and no exercising. My HR has been very stable at 105/65 or so all day.

Then in the evening I ate a large meal. 10 minutes later I felt HORRIBLE! Sweating hands, numbness, dizziness.. I checked my blood sugar and it was all the way down to 60!! AFTER I ATE! My bp increased to 210/110 and I had a headache.

So we packed up and went to the ER again. It took three hours but I went back to normal with no meds. My glucose returned to 100 and my bp went back down to about 120/75. They said I might have reactive hypoglycemia.

Anyone heard of this? Does it go along with POTS?

Well, aside from the hypoglycemia, I also wonder if anyone here with POTS gets this sick with high BP just after eating a large meal?

Thanks!

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Well, maybe your nervous system overcompensates for food digestion and raises your BP? That might be related to dysautonomia, definitely, if not simply for the abnormality in BP fluctuations itself. What have you been eating though? Could be a immune-reaction of some sort.

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As long as I eat only tiny little meals (a few bites is all i can tolerate) and no more than a (even smaller)bit of chockolate or other kinds of sweet things, iam ok! Otherwise i get exactly the same symptoms like you do. Years before i got diagnosed with POTS, my doctors first focused on my high BP, after another year has passed without any solutions, i was send to a specialist who focused on my low Blood sugar! For many month i had to messure my BP and my Blood sugar! Nobody could understand what was going on. Once the doctors even watched me whilest i had a real bad episode after eating something heavy. They saw my tachy, me shaking and the rest of the programm and still had no idea :-(. Now, many years later i just know that these are all POTS Symptoms! But like i said, it took ages for me to realize how all the different symptoms come together and when they appear.

As soons as you eat a meal, the blood goes to your stomach because thats were it is needed for digesting the food. The more you eat at a time the more blood is taken away from the rest of your body. If you eat sugars your blood sugar first goes high but after a short time it crashes down again to a lower number then you started from. Healthy people can adjust to them sort of things automatically, but with us its a different story. Thats why i always make sure, that i eat them sort of foods that keep the blood sugar somewhere stable and never eat to much at a time. There are also some kind of foods that make the blood pooling worse, i try to avoid them as well.

Hope that helps you a bit.

carinara

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Guest tearose

RichardInAz,

Well, I don't think I've yet personally said welcome on board so this it my welcome too!

How long have you known you had POTS?

Are you aware that even on meds or using compression and hydration that there will be times when you cannot compensate for your dysfunctional autonomic nervous system?

Are you feeling the effects of the heat and humidity? Are you having trouble sleeping well?

Not that you should put off going to the ER if you have serious and dangerous symptoms, but you may find you have to figure out the "solutions" more on your own. I think you are getting very close to finding your answers.

Why and how are you checking your blood sugar? Do you have diabetes?

I don't normally check my blood sugar although my pcp has noticed some variations over years of blood work. I think it comes from how long I was waiting in the waiting room to see him and how long it had been between snacks!

anyway,

It sounds like you do well with small frequent meals but get sick after a large one. And, your blood sugar goes haywire after this meal and causes higher bp too. I don't take my bp or sugar level after a large meal but have experienced a drugged out feeling after eating a large meal. I get horribly sleepy to where I can't talk or drive and must just sleep. So, I do not eat any large meals!!! I do know my heartrate goes up after eating because I am always using my heartrate monitor. I haven't regularly taken my bp after eating, I'll take it now for your research...95/61 hr 104 and I am in the just after eating small breakfast muffin mode. My bp was 79/47 hr 45 upon waking.

I feel human when I get my bp to the 110/70 range. This should be in another two-three hours.

Back to your symptoms, do you feel very sick and then decide to go to the ER? I only go to the ER if I am at "9 or 10" on the how serious is this? grading system from 1-10. I wonder if you are worried about the numbers you are seeing OR if you are worried due to how your body feels. Experience has taught me to trust my instincts. If you feel something serious is happening then get it checked out with your PCP thoroughly. The ER is good for helping us "not to die" but not is NOT good for helping us "to understand and manage".

I hope you can avoid the ER today!!! Try some light soup and 1/2 a sandwich for supper tonight.

Let us know how you do today.

best regards,

tearose

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Guest tearose

Update, I am nearing the end of my hydration morning ritual and my stats are now:

bp 102/67 hr 94

I now feel I can do some floor leg exercises and then make my way safely down the hall to shower (sitting on shower chair), compress, dress and start my day. Will probably be 11:30 then.

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Guest Sandy Sims

GAWD I LOVE THIS BOARD!!!

It's SO great to be able to say, "ME TOO!"

I first thought my entire problem was blood sugar--and got a finger stick meter at the pharmacy (anyone can do this--no RX required unless you want insu to pay for it). I later figured out that my blood sugar wasn't somuch the problem as the fact that when I ate a sugary or large meal all the blood rushed to my tummy and I got SICK! Sometimes shakiing like a mixmaster, throwing up, thinking I was going to die sick. I too made a trip to the ER--just to be over it before they even got to me. How embarrasing!!! Soon figured I'd have to watch this or I'd get a "record" at the ER and not have them when I needed them. ARRRG! Another thing to think about!

In my case my pulse would shoot up to 130 or so--my BP hit the floor--or sometimes the EXACt opposite would happne--who knows why?But it's all about your body going into overdrive. I know i can NOT eat sugar--nor large meals. It just is!!!! If I screw up--then I just go lie down and wait an hour--a miserable hour. I take my blood sugar, and my BP, and try to wait it out. It DOES pass. The only thing that helps is trying to move my legs around a bit while laying down--stretch--keep things flowing as best I can. And drink a bottle of water--NOW!

Also, the IV they probably ran on you in the ER is a HUGE help to get some blood volume up. The at home way to do this is to drink a bottle of water -- and eat some salt if BP is low.

If you just HAVE to eat that "special" meal that's heavy or sugary add LOTS of water and eat it slowly--stopping when you feel ill.

WHOA!

I'm no doctor!!!

EXCUSE ME!!!

Backing up here, let me say this is what works for me. What I'm suggesting can't hurt you--it's just moving, eating healthy small frequent meals, limiteing sugar and caffiene and drinking water. (oh and I also can't handle MSG and most fast food I love-- RATS no Big Mac's and Chinese food!!!)

Sounds too simple for something that feels like I'M DYING HERE!!

But it's what works for me --tho it is only that.

Has taken almost 3 years now to get an even partial handle on this. I have hyperadrenalPOTS/dysautonomia. If you get a dx of hypo glycemia the drugs may not work right due to your hyper adrenal troubles. They'll put you on several small meals a day anyway--so why not try it yourself and see what happens. I HATE eating this "healthy" crap all the time. But @#$# it if it doesn't work.

I hope this helps--so sorry you had a bad patch--I DO know how scary it is! Hang in there! I hear you and feel for you!!! <smiles>

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Ditto. Get the same thing. Was tested for diabetes a while back when I thought what was happening was due to low blood sugar. Sure enough, the blood sugar drops to 60 about an hour after ingestion of the sugar solution. But I was told this was normal in "healthy young women". Ok, sure.

Tested the blood sugar for a while, and it seems to be low after eating, so I do what everyone else does, eat small meals and eat often. Though, I can and DO cheat. As long as it's a balanced meal, I'm fine (knock wood).

If I eat too much then I get shaky and have diarrhea and am generally uncomfortable. Lasts about an hour or two. My BP will be high then (160/100+) and I just have to wait it out.

Such fun what our bodies do to us.

One other thing, I never eat dessert until about an hour after the meal. It keeps my blood sugars more normal, I think. I also don't drink soda often (max 1/2 can once a week) .

Sara

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I think hypoglycemia is one of those common misdiagnosis that POTSers run into. I got it many times before I found a POTS specialist. But my blood sugar was never below 50. (60 is NOT hypoglycemia, although it's on the low side of normal.)

Yes, my blood sugar was often around 60 or 59 right after a meal.

But I never had the fluctuation in blood pressure that you mention experiencing. My bp is usually low-ish, but regular. Do you NCS? I mean, maybe your bp is disregulated by your dysautonomia. We don't all have the same kind of dysregulation. My HR is way wack, but not my bp.

Did you try eating small meals? Eating a large meal can trigger POTS symptoms, fainting, etc. in some of us.

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not sure how long you have been dx but tip NUMBER ONE is to eat small, low to medium carb meals with protein balance. Don't know if you are diabetic or why check blood sugar so much. Mine can rise on standing (as can my cortisol) and both will LOWER when I recline..just part of the ans and gravity issue with POTS. Then again I have dealt with this for 18 years and found out the ANS stuff in 1998.

But I would strongly suggest reading the tips here on the main DINET site. Postprandial issues are one of the first things I read about many years ago on another site when first dx. Here is a small cut and paste of an article. Also HEAT can worsen the food deal as well..and shunting of blood to gut afterr a meal..unless you have been told for various reasons to go to ER, as somebody else posted, it's best to figure out your own triggers and avoid them but if you feel your life is threatened, or COURSE call 911.

Postprandial hypotension. A problem that almost exclusively affects older adults, OR those with autonomic nervous system dysfunctions, postprandial hypotension is a sudden drop in blood pressure after a meal. Just as gravity pulls blood to your feet when you stand, a large amount of blood flows to your digestive tract after you eat.

Ordinarily, your body counteracts this by increasing your heart rate and constricting certain blood vessels to help maintain normal blood pressure. But in some people these mechanisms fail, leading to dizziness, faintness, and falls. Postprandial hypotension is more likely to affect people with high blood pressure or autonomic nervous system disorders,

Post prandial issues with blood sugar both high and low, can happen as well.

Eating small, low-carbohydrate meals may help reduce symptoms.

I also have to eat most all my meals with FEET elevated or reclined...this helps my stomach to relax and be able to enjoy small amounts of food,

I have hyperadrenergic pots and had a gradual onset after REALIZING, I had mild ANS issues my entire life.

Good luck.

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I have had similar symptoms after eating--both bp and hr going up. I agree with what others have said--hypoglycemia is a common initial misdiagnosis b/c POTS symptoms can mimic this. As others have also said, I find/found I could reduce these symptoms with smaller, higher protein meals and drinking more fluid with my meals. Also adding salt to my food. Talk to your doctor about the salt, especially since you are experiencing high bp.

The med that worked most for me was a low-dose SSRI. You may need a beta blocker. These are commonly prescribed for POTS. Again, you would need to talk to your doctor, preferably a specialist in autonomic dysfunction.

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Hi!

I wanted to add that although for different populations and not all drs necessarily agree on one number, but overall normal glucose is 70-150 mg/dL and under 70 mg/dL (for some 60 mg/dL) is considered hypoglycemia. Once you get to somewhere around 45 mg/dL your brain is likely not getting enough glucose. So, in most populations I am not sure that numbers in the low 60's and below would not be considered hypoglycemia. I think that this is the point where most drs. would say that some treatment (food/meds etc) should be started to avoid it getting lower. So, it is not necessarily smart to ignore it as low normal, especially with other symptoms other then the low number (tremor, faint, hot etc). For some though this may be there normal at some points of the day if they do not have other symptoms etc.

I am wondering what some who have mentioned it mean, by a misdiagnosis of hypoglycemia? If it is low and hypoglycemic, it is hypoglycemia. It may be reactive hypoglycemia or post-prandial, but it is still low. I do agree that many of the symptoms match between the two and if the glucose is not tested one can just assume it is low blood sugar because the person hasn't ate etc., when they really have POTS or autonomic dysfunction.

Hypoglycemia can be part of dysautonomia, it is not necessarily one or the other. It can happen due to a haywire ANS and/or hyperadrenergic responses.

I also have hypoglycemia issues, both post-prandial and fasting and watching what I eat etc. Mine is more of a response to excessive adrenaline etc. I test mine when I am symptomatic to tell me whether or not my symptoms are likely due to low blood sugar or something else like dehydration. I don't think that testing your blood sugar is a bad thing, but like all things in moderation. It doesn't necessarily have to mean carrying a kit with you at all times and check it five times a day (or less prescribed), but as a healthy response to the symptoms you have to decipher if it is a blood sugar issue, dehydration, lack of electrolytes, forgot your meds etc.

Hope that helps! ;)

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i get a drop in blood sugar, drop in blood pressure and tachycardia and i bad blood pooling, all with eating low carb, and no fat and no sugar! eating so so little brings on all the adrenaline symptoms and its just a nightmare and takes too long to get normal again, and it all leaves me so so drained and beaten up! i have to lie down right away and i am always hungry because i can only so so little! the beta blockers help the tachcardia but i so wish there were meds to take for the low sugar and low blood pressure and i eat so much salt and drink alot of water too! at least its nice to know i am not the only one with these problems, i really hope we all get some relief since its more than cruel not to be able to eat!

Radha

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  • 12 years later...

I know this is a decade plus old post, but I have significant post-meal symptoms (body heating, nausea, sympathetic activation) to the point that I only really eat one meal per day, but never really thought to take by BP post meal when my body feels like it's on fire. 

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Hypoglycemia after meals is known in POTS patients:

https://www.endocrine-abstracts.org/ea/0041/ea0041ep235

Glucose intolerance is also being found in lean POTS patients. They found 50% of lean POTS patients have glucose intolerance in a small study. This is happening to me right now. I have zero family history of either types of diabetes with a zillion relatives (for example, I have 50 first cousins). It must be the POTS:

 

 

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@toomanyproblems - hypoglycemia and glucose intolerance have been a problem for me since childhood, and both run in my family. So does POTS ( runs in the women of the last 3 generations ). I seem to get severe and sudden drops in blood sugar when I eat high sugar meals ( like pancakes with syrup ), with symptoms of sweating, hunger and weakness. When checked during these symptoms my sugar has been as low as 54. I know the symptoms and can stop the attacks right away by eating easily digested sugar along with some protein and carbs ( grapes or juice with peanut butter or cheese seem to do the trick fastest ). Yes, my autonomic specialist conformed that this is quite commonly related to autonomic dysfunction. 

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9 hours ago, Pistol said:

@toomanyproblems - hypoglycemia and glucose intolerance have been a problem for me since childhood, and both run in my family. So does POTS ( runs in the women of the last 3 generations ). I seem to get severe and sudden drops in blood sugar when I eat high sugar meals ( like pancakes with syrup ), with symptoms of sweating, hunger and weakness. When checked during these symptoms my sugar has been as low as 54. I know the symptoms and can stop the attacks right away by eating easily digested sugar along with some protein and carbs ( grapes or juice with peanut butter or cheese seem to do the trick fastest ). Yes, my autonomic specialist conformed that this is quite commonly related to autonomic dysfunction. 

I feel like I'd like to start a new topic on this. The glucose intolerance isn't something that seems to be known. I've been experiencing it since at least the end of last summer when I for some reason decided to check my blood glucose. I used to have glucoses in the range of 45 all the time. It was considered at the time to be from my adrenal insufficiency. Now my gastroparesis keeps my sugars up for prolonged times post prandial. I really don't know if I ever drop too low anymore because my emptying time is so random.   

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13 hours ago, Pistol said:

@toomanyproblems - hypoglycemia and glucose intolerance have been a problem for me since childhood, and both run in my family. So does POTS ( runs in the women of the last 3 generations ). I seem to get severe and sudden drops in blood sugar when I eat high sugar meals ( like pancakes with syrup ), with symptoms of sweating, hunger and weakness. When checked during these symptoms my sugar has been as low as 54. I know the symptoms and can stop the attacks right away by eating easily digested sugar along with some protein and carbs ( grapes or juice with peanut butter or cheese seem to do the trick fastest ). Yes, my autonomic specialist conformed that this is quite commonly related to autonomic dysfunction. 

This is exactly what set me off yesterday, pancakes (gluten free) with syrup. However, I was set off the day before by eggs or whenever I have an early in the day meal (or to a lesser extent, even if I don't). I've never considered blood sugar could plummet after eating, especially after eating sugar. Then again, I don't even know because while I deal with severe sweating and weakness, I certainly don't have hunger. My sympathetic/fight or flight is in full blown activation. My body wants to empty out (nausea, drynesss) rather than take more in (hunger). Maybe I should try to force something in and see what happens, it's just such an odd concept to me that sugar can cure what sugar may be causing. 

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@MTRJ75 - that is why with dysautonomia it is recommended to eat frequent small "snacks" rather than actual meals. I follow this regimen and find that as ong as I keep something in my stomach all the time I have less hypoglycemia and less dysautonomia symptoms

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Yeah, I know @Pistol and that's generally the way it goes, but even something as small as a couple of eggs early afternoon will set me off. It's not taking much. Also, I'm nauseous most the time and unable to prep meals for myself when often, so I eat when it's available. I'm basically accidentally intermittent fasting without seeing the benefits. 

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@MTRJ75 I’m so glad you brought this up. I started having glucose instability when I started propranolol last summer. If I eat carbs in morning like cereal I absolutely crash about an hour later with post prandial glucose in 50s and diarrhea (sorry TMI).  Needless to say I don’t do that anymore. My doctor said it is reactive hypoglycemia but it definitely came on with propranolol. It also feels like dumping syndrome but endocrinologist said no. My A1C is normal. Now I only eat protein first meal and i eat before i get hungry, it’s helping. That is interesting that eggs make you symptomatic too…

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On 7/16/2021 at 4:02 PM, CJ65 said:

@MTRJ75 I’m so glad you brought this up. I started having glucose instability when I started propranolol last summer. If I eat carbs in morning like cereal I absolutely crash about an hour later with post prandial glucose in 50s and diarrhea (sorry TMI).  Needless to say I don’t do that anymore. My doctor said it is reactive hypoglycemia but it definitely came on with propranolol. It also feels like dumping syndrome but endocrinologist said no. My A1C is normal. Now I only eat protein first meal and i eat before i get hungry, it’s helping. That is interesting that eggs make you symptomatic too…

Someone else originally bumped it, not me. 

I'm not even sure it's a sugar thing now. Might just be that any little stimuli causes my SNS to erupt (eating, moving, sunlight...)

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  • 1 month later...
On 7/15/2021 at 2:24 PM, Pistol said:

@MTRJ75 - that is why with dysautonomia it is recommended to eat frequent small "snacks" rather than actual meals. I follow this regimen and find that as ong as I keep something in my stomach all the time I have less hypoglycemia and less dysautonomia symptoms

  1. Would you mind sharing what you eat and how often?
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