At least, I’m going to call it hypoglycemia for convenience. You’ll see why later.
The first time I spontaneously got dizzy I was 12 when I tipped my head sideways to see into my desk. Although I don’t remember circumstances, I do recall having very occasional dizzy spells from that time and into university, at which point they became a little more frequent. I’d usually go home and have a rest, which sometimes helped and sometimes didn’t. Someone suggested it was low blood sugar but it didn’t seem likely because I was sometimes dizzy after a meal.
When I eventually went to the doctor, he diagnosed vertigo, meaning “I spontaneously get dizzy sometimes” and advised me not to move my head around too much. Uh, thanks. He was wrong, but in fairness it took me years of experience and a few other doctors and finally a particularly knowledgeable and helpful school nurse to figure it all out.
A couple of years after this most unhelpful of diagnoses, and after I’d graduated and moved to a different city, I’d been struggling with diet generally. I’d moved away from home with my boyfriend and neither of us were very interested in cooking. I generally ate food cooked from scratch rather than convenience food, so I was having trouble figuring out what the problem was. There had been dizziness, one occasion of an inexplicable sensation of nervousness, feelings of nausea, and no doubt other symptoms I’m forgetting. I went to the doctor, who said it sounded like hypoglycemia, though he didn’t order any tests. Just as well because the test is a glucose tolerance test in which you consume a sickly sweet glucose drink and then have blood tests every half hour for 2, 4 or 6 hours. As a needle-phobic, I was happy to give that a miss. His advice was to eat more meat and drink more milk to increase protein intake, but I found this challenging because I preferred to go more vegetarian and I was off milk at the time. So I attempted to manage my blood sugar through diet, albeit with limited success.
A few years later, when I was teaching English in Japan, I often struggled with low energy, low mood and difficulty focusing. One morning I was having a tough time. I’d made friends with the school nurse and her assistant; both of them had pretty good English but mostly they were nice, and I enjoyed being around them. So feeling unable to focus on work, I retreated to the nurse’s room and as we were chatting I told her I wasn’t feeling all that well, so she asked some questions. The main thing was dizziness and feeling generally blah. What kind of dizziness? This was the first time anyone had asked that question and I wasn’t sure how to explain it. Was it a sensation of going up and down like on an elevator, or was the room spinning horizontally? It was the up-and-down type.
This concerned her because up-and-down signifies high blood sugar, while horizontal spinning is typical of low blood sugar. It was very troubling to her, a nurse whose supervising doctor specialised in diabetes, that I should be having high blood sugar in the morning. Ah, I said. I ate something very sweet for breakfast. But from then on I paid attention to the type of dizziness and it was always pointed to low blood sugar.
I continued to struggle with blood sugar issues in Japan, so when I got back I consulted a nutritionist. Doctors don’t really get any instruction on nutrition, but some nutritionists aren’t much better. When this person encouraged me to eat things like Cheez Whiz and diet soft drinks, I knew I was unlikely to going to get any useful information out of her.
Anyway, since then I’ve just continued to treat it as hypoglycemia and try to figure out what works for me through trial and error.
If you consume sugar and a short while later your blood sugar is actually lower than it was to start with, that’s reactive hypoglycemia. The science is still somewhat unsettled on the precise mechanism, but one theory is that when the sugar is consumed, the body overproduces insulin. Insulin’s function is to lower blood sugar but here it kind of freaks out, and then you crave sugar. If you succumb to that craving, your blood sugar bounces up and down, and generally wreaks havoc.
Because I haven’t had the test, I’m not certain that this applies to me, but my current doctor says they don’t really do the glucose tolerance test for this anymore. And I know from experience that if I were to have a coke or even orange juice without eating some real food at the same time, it would fuck me up, so I probably do have reactive hypoglycemia.
But this isn’t the only issue for me.
Low blood sugar before meals
I also get low blood sugar before a meal, but since this isn’t provoked by consuming sugar, it can’t be reactive hypoglycemia. I suppose it’s just a normal low caused by my body burning off whatever I ate last. In other words (though I hate the term), it includes being ‘hangry’.
There’s another issue at play — I don’t really feel hunger and instead I eventually get low blood sugar symptoms. At first I thought this was an inconvenient coincidence, but now I wonder if I’ve actually learned (or was taught) to ignore hunger and if so this would be part of the cause of my blood sugar woes.
Even so, my low blood sugar symptoms seem to be more sudden and intense than what most people experience.
Symptoms of low blood sugar
Low blood sugar can cause a variety of symptoms. These are the ones I’ve experienced:
- mood: from irritability, through grumpiness and foul temper, to full-on meltdown (crying etc.)
- cognition: brain fog; my natural indecisiveness gets worse to the point of complete inability to make a decision (including, inconveniently, what I want to eat or where); inattentiveness; sensation of nervousness
- stomach: I’ll get a sudden feeling not of hunger but of void, which quickly turns to nausea (though I’ve never thrown up)
How I try to avoid low blood sugar
Avoiding reactive hypoglycemia is pretty straightforward: no sweets outside of mealtime, and especially no sweets as a meal. This includes sweet drinks such as soft drinks or fruit juice.
Avoiding low blood sugar at other times is more complicated because of my largely absent sense of hunger.
In general, I need to eat proportionately less carbs and more protein and fat than other people seem to need. If I eat carbs, I opt for complex carbs (e.g. rolled oats, brown rice, potatoes) instead of refined starches or sugars, but some carb-centric meals are best avoided (e.g. pizza, pasta). (You can get an idea of the effect of a given food on blood sugar by checking its glycemic index, but in general the less processed the better.) I eat meat, and dairy is a big part of my diet (full-fat everything). I eat on a schedule and frequently (breakfast, lunch, afternoon snack, supper, bedtime snack).
All of this becomes more complicated when I’m travelling because I don’t necessarily have access to a fridge, I can’t cook for myself, and I may be stuck with someone else’s schedule (especially on planes!). You can get carbs in any vending machine but protein is much harder to source. New restaurants are mostly a source of worry: will I be able to find something to eat here and will it be served before I have a crash? Do I have the language skills to figure out the menu and advise of my dietary issues? If I’m travelling, I don’t go anywhere without emergency rations.
As a result, travelling (or even going out to a new restaurant, or having a social event that centres food) causes me some low-grade worry. Will I get what I need when I need it? Dipping into my emergency rations around people is awkward because sometimes I sense they think I should share.
How I deal with low blood sugar when it happens
If I sense that my blood sugar is just a bit low and I can’t eat real food immediately, I’ll go for protein and fat (e.g. nuts). If it’s a little lower, then I’ll add something sweet (e.g. nuts plus chocolate, chocolate almonds). If it’s more of an emergency situation and my blood sugar has fully crashed, then I go for something sweet, preferably liquid because the sugar starts being absorbed into the bloodstream directly from the mouth (e.g. soft drink, fruit juice).
If my blood sugar is low enough that I feel I need some sugar right now, then sugar is the first step and real food is the next step. Real food doesn’t work as a first step in an emergency because it takes too long to be digested — I’ll end up having a full on blood sugar crash while I wait for the food to kick in. Not fun.
Blood sugar issues are inconvenient and become more of a hassle the farther away from home I get. I get anxious about it when I travel but I’m more relaxed if I have a travelling companion who understands my issues and can problem solve when I’m not able to. It’s not all negative though: it forces me to eat healthy food on a regular schedule, which is not the worst outcome. Uncontrolled hypoglycemia can encourage development of diabetes, so managing the issue through good diet is long-term self-care.
Notes on dizziness
The nature of the dizziness can be diagnostic (too bad my doctors didn’t know that). I’ve experienced the following:
- low blood sugar: feels like the room is spinning, a horizontal feeling
- high blood sugar: feels like you’re on an elevator, a vertical feeling
- benign paroxysmal positional vertigo (BPPV): sudden and rather violent dizziness, provoked by changing the position of your head, can be calmed by moving your head back; results from crystals spontaneously forming in the semicircular canals of your ears and then interfering with the messages that the liquid and cilia in the canal send to the brain about position and movement (I’m certain that this is the first dizziness I experienced at age 12, and as of fairly recently it has become chronic)
- extreme tiredness: to me feels like non-directional wobbliness; confusingly, the dizziness can happen even after I’ve slept, if the tiredness was bad enough (in university, I think I had both this and low blood sugar dizziness – the doctor’s mistake was thinking that there was only one kind of dizziness and thus one cause)
Notes on fatigue
In Japan I struggled with fatigue, at any time of day. At the time I assumed that my fatigue was all blood-sugar related, but I underestimated how exhausting it was for me to be surrounded by a different language and culture all day. I should have been eating a different balance of food, more of it, and having more naps. Fatigue is a difficult symptom to work with because a huge number of issues can cause it.