Blood sugar of 45 - how concerned should I be?

[LizzyBee]

My 18 yo dd's blood sugar yesterday was 45. I'm a little freaked out, because we weren't expecting her to have bloodwork, so she wasn't fasting. She had breakfast about an hour before the appt.  She's going to college in a month, and if she has a low blood sugar event there, I'm not sure anyone would recognize what's going on.  Should I get a medical bracelet for her?  Or am I totally overreacting?

 

Thanks!

Elizabeth

[Wabi Sabi]

You are not overreacting. I would be quite concerned. Your daughter needs to talk to a doctor ASAP, imo. 

[Monica_in_Switzerland]

I discovered in college that I was hypoglycemic.  Once I knew that, it was pretty easy to deal with by making dietary changes- protein with each meal, protein/fat rich snacks, etc.  I would not get her a medic ID unless she is actually diagnosed with something and is unable to control it herself.  I would follow up with the blood test to find out what's going on. 

 

 

[LizzyBee]

I emailed her doctor to make sure she knows that dd wasn't fasting and ask whether more testing is warranted. I know for an official dx we would need to see an endocrinologist, but what kind of tests would a family doctor want to run before making that referral?  Or is one reading of 45 sufficient for a referral?

 

She eats cheerios and milk every morning for breakfast. (not my choice - my opinion is that cereal is junk food)  Is it possible her blood sugar had already spiked and then plummeted by the time she had the labs drawn?  I know adding protein will even out that response, so I'll start cooking up some breakfast meats on the weekend for her to eat during the week. I'm sure the caf at college will have breakfast meats daily, so I'll tell her to make sure she has some every morning. She won't eat eggs or cheese. She'll eat yogurt, but only the kind with a ton of added sugar.

[Jean in Newcastle]

What did the doctor say?  A reading of 45 1 hour postprandial suggests to me that her fasting was even lower.  Either that or her breakfast caused her sugar to spike and then plummet.  What did she eat for breakfast?  A bloodsugar of 45 is pretty low, though kids tend to have lower bloodsugars than adults do.  Is she eating protein with her meals?  

[Cakes]

Just google hypoglycemia and make some dietary changes (as well as following the advice of her Dr)

 

Limit sugar and refined carbs.  Add protein and fat to every meal. Snacks should always be balanced as well, for example never just an apple but an apple with almond butter or some grapes and some nuts. 

 

At this stage is it very simple to deal with but if she continues her current diet (which has contributed to blood sugar dis-regulation) she will experience greater health issues later in life.

[LizzyBee]

What did the doctor say?  A reading of 45 1 hour postprandial suggests to me that her fasting was even lower.  Either that or her breakfast caused her sugar to spike and then plummet.  What did she eat for breakfast?  A bloodsugar of 45 is pretty low, though kids tend to have lower bloodsugars than adults do.  Is she eating protein with her meals?  

 

We were posting at the same time. I think I answered all your questions in my previous post.  I haven't heard back from the doctor yet. The labs were yesterday, and we just got the results online about an hour ago.

 

I am so freaked out that this is happening right before she leaves home.  She'll be about 3.5 hours away.

 

ETA: Doctors initial response online was to make sure dd isn't skipping meals and she suggested eating 4-6 smaller meals instead of 3 big meals. I don't know if she realized that dd had eaten breakfast, so I emailed her to let her know that dd wasn't fasting when the labs were drawn.  DD doesn't ever skip meals and she wakes up hungry. She won't shower or anything until she has breakfast, which makes me think this has been going on for awhile and we didn't know it.

 

Do we need a prescription to get a home blood testing kit?  Would it be a good idea to monitor her blood sugar for a couple weeks to get an idea of whether it's always low or if this is a fluke?

[Laurel-in-CA]

48 is really low--as in eat NOW or you faint. Normal range is 70-120 an hour after eating. She shld have protein at every meal for more stable #s....and, yes, it would be an idea to check her sugars regularly (timing as per your dr.) for a few weeks. Dr. should be able to prescribe a home kit and test strips.

[freesia]

I emailed her doctor to make sure she knows that dd wasn't fasting and ask whether more testing is warranted. I know for an official dx we would need to see an endocrinologist, but what kind of tests would a family doctor want to run before making that referral?  Or is one reading of 45 sufficient for a referral?

 

She eats cheerios and milk every morning for breakfast. (not my choice - my opinion is that cereal is junk food)  Is it possible her blood sugar had already spiked and then plummeted by the time she had the labs drawn?  I know adding protein will even out that response, so I'll start cooking up some breakfast meats on the weekend for her to eat during the week. I'm sure the caf at college will have breakfast meats daily, so I'll tell her to make sure she has some every morning. She won't eat eggs or cheese. She'll eat yogurt, but only the kind with a ton of added sugar.

That is very low even if she was fasting. Another possibility is that the cereal and milk spiked her blood sugar, her body reacted with too much insulin which dropped it (this is pre-diabetic pancreas behavior, as it wears out the pancreas).

 

She absolutely needs to see a doctor and start eating protein with her carbs. She can have meat or nuts instead of eggs or cheese or just learn to eat them (I had to learn to eat eggs and plain yogurt when I became pre-diabetic. ) Sometimes you gotta do what you gotta do and she's old enough to understand that.

[freesia]

What did the doctor say?  A reading of 45 1 hour postprandial suggests to me that her fasting was even lower.  Either that or her breakfast caused her sugar to spike and then plummet.  What did she eat for breakfast?  A bloodsugar of 45 is pretty low, though kids tend to have lower bloodsugars than adults do.  Is she eating protein with her meals?

When I taught a diabetic girl I remember giving glucose tablets at 55.

 

At 45 I would insist on a referral.

[freesia]

We were posting at the same time. I think I answered all your questions in my previous post.  I haven't heard back from the doctor yet. The labs were yesterday, and we just got the results online about an hour ago.

 

I am so freaked out that this is happening right before she leaves home.  She'll be about 3.5 hours away.

 

ETA: Doctors initial response online was to make sure dd isn't skipping meals and she suggested eating 4-6 smaller meals instead of 3 big meals. I don't know if she realized that dd had eaten breakfast, so I emailed her to let her know that dd wasn't fasting when the labs were drawn.  DD doesn't ever skip meals and she wakes up hungry. She won't shower or anything until she has breakfast, which makes me think this has been going on for awhile and we didn't know it.

 

Do we need a prescription to get a home blood testing kit?  Would it be a good idea to monitor her blood sugar for a couple weeks to get an idea of whether it's always low or if this is a fluke?

You don't need a prescription. Go to Walgreens. They are behind the counter at the pharmacy. I would do fasting am, and then one and two hours after eating each meal. I would track at least 2 weeks.

[Lara in Colo]

Stop the cereal in the morning--- worst thing ever! Cereal makes my blood sugar spike and drop.-- but after a long fast (overnight) you wake up really low.

Usually when I get that low, only things that are simple carbs will pass my lips-- the thought of protein will make me barf.  So in the morning she can start with a glass of chocolate milk (made with hershey's syrup- so you can control the amount of sugar)  then about a half hour later, have some eggs and bacon. 

Before she goes to bed-- have a snack-- cottage cheese, string cheese, milk etc... this will help prevent the morning lows.

 

So-- always have milk ready for her-- if she is in a dorm, get her a mini fridge and keep it stocked with protein-- string cheese, ham, milk, (chocolate syrup for emergencies) 

 

Things to have in her purse--- peanuts, Lara bars, zone bars, trail mix, beef jerky

 

a simple rule to follow--- all simple carbs (flour products and desserts and some fruits, potatoes) NEED to be countered with fats and proteins. 

 

Coconut oil is FANTASTIC to keep you going-- a couple of tablespoons will give her energy for hours and keep her from spiking.  I add it to my morning coffee (in a blender it is like a cappuccino).

It will also help kill off any yeast growing and reduce the sugar cravings.

 

 

 

[Butter]

I have hypoglycemia.  45 is not especially low for me after eating.  I'm perfectly functional at that point.  Normal, non-fasting, is generally mid-50s to mid-60s for me, but 40s are not uncommon.  My fasting blood sugar level is actually higher than after meals.  Was she having symptoms?  I know when my blood sugar is going to crash.  I have about 15-30 minutes of warning with minor symptoms and if I don't eat in that time I end up shaking and nauseated and for the rest of the day I feel icky.  When I'm symptomatic my blood sugar is usually in the 30s.  So what I would worry about is making sure she knows if she's going to have a blood sugar crash.  Since she wakes up and eats immediately, I'd guess she's been naturally taking care of herself.

[LizzyBee]

I have hypoglycemia.  45 is not especially low for me after eating.  I'm perfectly functional at that point.  Normal, non-fasting, is generally mid-50s to mid-60s for me, but 40s are not uncommon.  My fasting blood sugar level is actually higher than after meals.  Was she having symptoms?  I know when my blood sugar is going to crash.  I have about 15-30 minutes of warning with minor symptoms and if I don't eat in that time I end up shaking and nauseated and for the rest of the day I feel icky.  When I'm symptomatic my blood sugar is usually in the 30s.  So what I would worry about is making sure she knows if she's going to have a blood sugar crash.  Since she wakes up and eats immediately, I'd guess she's been naturally taking care of herself.

 

Waking up hungry, getting irritable when hungry, and occasional headaches are the only symptoms I know of that may be related to this. I am going to ask her if she has dizzy spells. She is my non-complainer, non-attention seeker, which is part of why I am concerned about her taking care of herself on campus. I could see her sitting in class crashing and not wanting to do anything about it lest she draw attention to herself.  Avg class size is 18 and some classes are limited to 15, so it's not like she'll be an anonymous face in a large lecture hall.

[Laurie4b]

Regular Cheerios only have 1 g of sugar per serving, 20 g carbs, and 3 g. fiber. Milk has some natural sugar, too, but if that level of sugar/carbs causes a huge plummet, there is a problem. 45 is low for fasting. I have a diabetic family member and 40 is a very low reading, as in "eat now or you'll be in danger."

 

I would get a home glucose monitor and ask your doctor for a referral to an endocrinologist. If you tell the endo she's leaving in 3 weeks, they may try to expedite the appt. If they can't, call every day to see if there's been a cancellation. That's how I've gotten into see someone weeks earlier than I otherwise would have.

 

 

[Cakes]

Regular Cheerios only have 1 g of sugar per serving, 20 g carbs, and 3 g. fiber. Milk has some natural sugar, too, but if that level of sugar/carbs causes a huge plummet, there is a problem

It is not just about the amount of sugar in a food, it is about the glycemic load, how fast the food converts to sugar in the body. Cheerios come in at a whopping 142, comparable to a pastry. Any refined carb will be high.

 

Here is some info:

The glycemic load is based on glycemic index but uses standard portion sizes rather than 100 grams of carbohydrate. The formula used for calculating glycemic load is:

GL = (GI x the amount of carbohydrate) divided by 100.

 

So, if an 8 ounce glass of skim milk, which contains 12 grams of carbohydrate, has a glycemic index of 46, the glycemic load is:

GL = 46 x 12 ÷ 100 = 5.52

 

Generally speaking, the ranking for glycemic load is as follows:

 

Low = 10 or less

Medium = 11-19

High = 20 or more

Remember, the lower the glycemic load for a food, the lower the rise in blood glucose after it is eaten.

 

And a link....

http://www.lowglycemicload.com/glycemic_table.html

[Kathryn]

I was told at the endo that fatty meats like sausage and bacon don't count for protein in terms of regulating blood sugar.

[LizzyBee]

I was told at the endo that fatty meats like sausage and bacon don't count for protein in terms of regulating blood sugar.

 

Not surprising with all the additives. Maybe I'll make her try scrambled eggs again.

[Cakes]

I was told at the endo that fatty meats like sausage and bacon don't count for protein in terms of regulating blood sugar.

Fat and protein both help to regulate blood sugar. It is true that those foods would fall under the fat category (as would nuts, seeds, olives and avocados), but they do still help to minimize blood sugar spikes.

[Cakes]

If she struggles with breakfast foods, maybe try a smoothie.

 

A good combination is a handful of greens (spinach, kale etc...but alternate days) 1/2 c frozen berries, vanilla protein powder, 1/2 c coconut milk and 1/2 c filtered water. I also add hemp seeds, chia and some liquid cal-mag-zinc and omega 3. But start simple and find something palatable that is easy yet minimizes the blood sugar spike. Avoid the temptation to add too much fruit to make it sweet, that defeats the purpose!

 

If she likes eggs a frittata is a great option...sauté up some veggies, add some meat, eggs and top with salsa if she likes it or a little bit if cheese. That is a very stable (blood sugar) start to the day. Even leftover quiche is awesome and can be made ahead specifically for breakfast.

[LizzyBee]

If she struggles with breakfast foods, maybe try a smoothie.

 

A good combination is a handful of greens (spinach, kale etc...but alternate days) 1/2 c frozen berries, vanilla protein powder, 1/2 c coconut milk and 1/2 c filtered water. I also add hemp seeds, chia and some liquid cal-mag-zinc and omega 3. But start simple and find something palatable that is easy yet minimizes the blood sugar spike. Avoid the temptation to add too much fruit to make it sweet, that defeats the purpose!

 

If she likes eggs a frittata is a great option...sauté up some veggies, add some meat, eggs and top with salsa if she likes it or a little bit if cheese. That is a very stable (blood sugar) start to the day. Even leftover quiche is awesome and can be made ahead specifically for breakfast.

 

I have some vanilla powder, coconut milk, chia seeds, and a vitamix, so I could try that. I don't have spinach and kale right now, but I have some peaches which are a low carb fruit. I have some rainbow chard, but I'm think it's too fibrous to work well in a smoothie.

 

I'm guessing if the caf at college serves smoothies, they're going to be full of sugar, so not a good option. :-(

 

[Momling]

I have highish fasting glucose (like 100-110) and did a 2-hr glucose tolerance test that dropped to the 40s about an hour after the sugar drink. My endocrinologist said she sees it sometimes especially with women with PCOS. She thought it was a reactive hypoglycemia but wasn't super concerned.

[umsami]

As somebody who used to work for Johnson & Johnson, the monitors are cheap…where they get you is on test strips.  For that reason, I recommend getting the Walmart brand. I think it's called Relion.  Test strips are reasonable in cost, and it uses a small sample size.

 

 

[LizzyBee]

Thanks for all the support. I bought a meter on the way home from work and we'll try it out in the morning. If we get normal readings for the next few weeks, I'll feel a whole lot better about sending her off to college. And if not, she now knows what the symptoms of a sugar crash are and that she needs to make some dietary changes to better regulate her sugar.

[Laurie4b]

It is not just about the amount of sugar in a food, it is about the glycemic load, how fast the food converts to sugar in the body. Cheerios come in at a whopping 142, comparable to a pastry. Any refined carb will be high.

 

Here is some info:

The glycemic load is based on glycemic index but uses standard portion sizes rather than 100 grams of carbohydrate. The formula used for calculating glycemic load is:

GL = (GI x the amount of carbohydrate) divided by 100.

 

So, if an 8 ounce glass of skim milk, which contains 12 grams of carbohydrate, has a glycemic index of 46, the glycemic load is:

GL = 46 x 12 ÷ 100 = 5.52

 

Generally speaking, the ranking for glycemic load is as follows:

 

Low = 10 or less

Medium = 11-19

High = 20 or more

Remember, the lower the glycemic load for a food, the lower the rise in blood glucose after it is eaten.

 

And a link....

http://www.lowglycemicload.com/glycemic_table.html

 

That table is much higher than any others I've seen for Cheerios. Most of them say the glycemic index (not load)   is 74. Glycemic load is 15. For example, the University of Sydney site: http://www.glycemicindex.com/foodSearch.php http://www.gilisting.com/2004/05/glycemic-index-breakfast-cereals.html

 

But a bigger question that I would have is that the Cheerios weren't consumed alone. They were consumed with milk. Don't foods consumed together combine so that the glycemic load is some kind of combination of all of them? Isn't that why diabetics are told to consume fat and protein with carbs?  I've never seen how that is calculated, since most of the time, we're not eating individual foods , but eating a combination of foods.

 

 

 

[trulycrabby]

In nursing school, I had a patient whose blood sugar was in the low 40´s. I remember her very well because I caught her while she was fainting after the blood draw.

 

Just adding my voice to those urging you to take her to the doc. She is probably fine but needs to learn to stabilize her blood sugar.

[Momof3littles]

Ask about the possibility of insulin resistance. Any chance she has symptoms of pcos? You can be insulin resistant without pcos, but most women with pcos are insulin resistant to some degree.

[ocelotmom]

Yes, I'd be concerned about that. Normally blood sugar should not be that low even with fasting because the liver releases glucose when levels drop to keep them within the ideal range. So a reading that low could indicate a more general problem.

 

Also, having blood sugar that low and not having significant symptoms is worrisome because it means that she'll have very little warning and chance to intervene before it becomes dangerously low if it drops further.

 

I would pursue it further with the doctor, and do blood testing at home to get a better idea of what is going on (maybe that one reading was inaccurate, or just a fluke), how her blood sugar levels respond to different types of food, and so she can learn to identify how she feels when her blood sugar is low.

[LizzyBee]

I only know for me, that if I eat cereal for breakfast, I'm STARVED shortly after. My blood sugar plummets.  Frankly I don't know how the daughter can stand that feeling.  It's awful!

 

Milk actually has quite a bit of sugar and carbs in it.  I don't know which milk she had, but 1%, for example, has 13 grams of sugar for one cup. 

 

But overall I have found it to be true that having enough fat and protein with carbs helps.  A lot of people don't seem to realize what the sugar and carb content for a lot of foods is though. 

 

She drinks whole milk, so it has 8g of fat and 11g of sugar per cup.  I'm the same way about cereal - it makes me hungry. I don't eat it often, but my husband buys it. This particular dd is a creature of habit and it will be hard to break that habit. We've discussed that this is a very serious thing and she needs protein with every meal.

[LizzyBee]

Yes, I'd be concerned about that. Normally blood sugar should not be that low even with fasting because the liver releases glucose when levels drop to keep them within the ideal range. So a reading that low could indicate a more general problem.

 

Also, having blood sugar that low and not having significant symptoms is worrisome because it means that she'll have very little warning and chance to intervene before it becomes dangerously low if it drops further.

 

I would pursue it further with the doctor, and do blood testing at home to get a better idea of what is going on (maybe that one reading was inaccurate, or just a fluke), how her blood sugar levels respond to different types of food, and so she can learn to identify how she feels when her blood sugar is low.

 

I bought a meter on the way home from work yesterday. Her blood sugar was 60 when she woke up and 78 an hour after she ate this morning.

 

[JoJosMom]

Stop the cereal in the morning--- worst thing ever! Cereal makes my blood sugar spike and drop.-- but after a long fast (overnight) you wake up really low.

 

I agree.  My diagnosis is severe reactive hypoglycemia.  I go really low if I have a carb heavy meal.  On the other hand, I handle fasting just fine.  And, yes, that number is really low, but I would make a point of asking her how she felt.  That may give you some insight into how long she's had the problem.  For example, my OB had me do the three hour glucose test when I was pregnant with DD (and I shouldn't have complied, but live and learn.)  When she saw my final number, her reaction was "Were you conscious???"  I told her the truth, I felt pretty bad, but I'd had worse episodes.  So apparently the body can learn to cope with some pretty bad situations.  The glucose monitor is a great idea so that she can learn how her body reacts to way that she is eating.  And I think that seeing a doctor is an excellent idea. 

 

Best wishes for her and you.

[mommymilkies]

I am diagnosed hypoglycemic.  40s, for me, isn't even symptomatic most of the time.  I would highly suggest a physician referral and cutting back on refined carbs.  NEVER eat without some fat and protein and avoid sugar as much as possible-cheerios are just filler and would definitely make me crash. 

[Lara in Colo]

For instance-- I over extended myself today (working on a project and got busy) when I slowed sown I realized I was more tire than I should be given what I had been doing.  Food sounded yucky so I knew I was low.  I had some cottage cheese and pears (canned).  That gives me the sugar I need now and the protein I need later-- in a few minutes food will sound good again. 

 

When I first discovered my blood sugar issues-- I bought a glucose meter and several packages of strips and I tested myself all the time.  When I was feeling good or bad or weird or angry or had a headache-  I learned what each "feeling" meant with regards to blood sugar.  What "too high" feels like and what I ate to get there  (granola and yogurt is a no no for me).

 

I did this for about 2 months and stopped-- I had a good idea what my body was doing and what caused it to react this way. 

 

After about a year later-- I did it again-- my body had become more sensitive to sugar in some cases and less in others  (I can have cereal at night, but sugar tea is a no no)  ( I can consume more "bad" things when I am sick - with almost no issues)

 

One unexpected thing--- fake sugars don't spike or lower my blood sugar-- it makes it unpredictable.  What would make me 'better" doesn't work, what makes me sick either makes no difference or makes me VERY sick.