Symptoms and Emergencies: When to Ask for Help

And how to know when to go to the ER

As you learn to work with the Revero personalized diet and your Revero care team, it’s always important to understand symptoms so you know when you need immediate (and local) help. One of the only shortcomings of our virtual platform is that we can’t physically examine you, though through video calls we can often see an issue you describe. 

Still, you’re in charge of yourself, and if you experience an emergency, we hope that you’ll be able to know when to urgently contact us and when to call your primary care provider or 911. This article will help you identify them. 

When to Urgently Speak to Your Primary Care Doctor

If you experience any of the following symptoms, you should immediately contact your primary care doctor who is local to you:

• Pain and tightness in your chest
• Difficulty breathing
• Burning or pain on urination
• High fever, sore throat, worsening cough
• New and severe pain

What To Do If You’re Sent to the ER

If you’re ever referred to the emergency room by your primary care provider, your Revero provider, or an acute event that requires hospitalization, please message your health coach with this information:

• What hospital are you in, and what is the address and ER phone number
• Who is a contact person that we can message for updates
• Your Revero health team will stay in touch with your care team at the hospital and do what we can to continue supporting you!

Low Blood Sugar, Hypoglycemia

If you develop very low blood sugar, these are some of the signs and symptoms that you may experience:

• Trembling or shaky feeling
• Sudden perspiration and feeling cold
• Anxiety and worry
• Sudden craving or appetite
• Blurry vision and loss of detailed vision
• Fatigue

Other people may notice that you’re acting confused, angry, hard to awaken from sleep, or even have a seizure. 

If you experience any of these, make sure you don’t drive until you are stable and feeling normal again. It is surprisingly easy to have poor judgment or lose consciousness from low blood sugar. Check your blood sugar to see if low blood sugar is causing your symptoms.

Many factors can cause low blood sugar:

• Skipping meals or waiting much longer before eating
• Drinking alcohol
• Heavy exercise
• Changes to your sleep schedule also impair glucose regulation

The most common reasons are imbalances between medications and diet. As your blood sugar drops toward normal because of your low-carb diet, it’s easy to overshoot normal and end up low if your medications aren’t adjusted quickly enough. Exercise can also cause this, particularly if you’re not used to exercising. 

• If your blood sugar level is below 50, you should consume some carbohydrates to bring it back up. That can be glucose tablets you keep for this reason, or a piece of fruit, for example. If you’re close to passing out, the tablets are safer as you can dissolve them in your mouth. You wouldn’t want to choke on a piece of apple because you passed out. 

• If your symptoms and blood sugar still don’t improve, have some more, but if there’s no improvement after several minutes or you’re getting worse, call 911 or seek care right away. 

• When your symptoms improve, eat a meal (a Revero-approved meal is ok at this point) to help further stabilize it. 

Take notes about what medications you took and also estimate the times of last eating, meds, and symptoms. Your Revero coach will review these with you to help prevent future episodes. 

If your blood sugar is about 70, you still shouldn’t drive as it could drop further. Have some glucose tabs or fruit, and check your levels every 15 minutes. 

Again, if it keeps dropping and gets to 50, follow those instructions above. The same recommendations apply otherwise; eat some real food when you feel better, and take notes about what just happened. 

Elevated Glucose Levels and Ketones

While it’s extremely unlikely when following the Revero personalized diet, we would like you to understand Diabetic KetoAcidosis or DKA. This is a condition that results from extremely high ketone levels and very high glucose, at the same time. Often it results as a side effect of diabetic medication.

Here are the values you may see when testing your ketones with your urine strips:

Ketone Strip Readings:

• 0-.5  mmol/L: Trace ketone levels
• .5-1.5 mmol/L:  Low ketone levels
• 1.5-4.0 mmol/L:  Moderate Ketone levels
• 4.0-8.0 mmol/L:  High ketone levels
• 8-16 mmol/L: Very high ketone levels

Urine ketone testing helps provide a general indication of ketosis, however higher or lower numbers don’t always reflect the level of ketosis. Their accuracy and reliability can vary based on several factors:

1. Hydration levels: The concentration of ketones in urine can be affected by how much water you drink. Dehydration can lead to higher ketone levels in urine, while overhydration can dilute them, making it harder to get an accurate reading that reflects the true state of ketosis.
2. Timing: Ketone levels in the urine tend to be highest in the morning and after periods of fasting. Testing at different times of the day can yield different results.
3. Type of Ketones: Urine ketone strips primarily measure acetoacetate, one type of ketone body. However, the body also produces beta-hydroxybutyrate (BHB) and acetone, which are not detected by urine strips.
4. Adaptation Period: When you first enter ketosis, urine ketone levels may be higher. Over time, as your body becomes more adapted to using ketones for energy (keto-adaptation), fewer ketones may be excreted in urine, potentially leading to lower readings despite being in ketosis.

However, if you have type 2 diabetes, there is a small risk of developing diabetic ketoacidosis (DKA), if your glucose is very high and your urine ketones would also be positive.

Here are symptoms of DKA: 

• Stomach/Abdominal pain
• Nausea/Vomiting
• Breath smells fruity
• Excessive thirst
• Frequent urination
• Feeling very weak
• Feeling confused or disoriented
• Blurry vision
• Rapid heartbeat

If you experience symptoms of DKA, alert your Revero coach and provider as this may require urgent medical attention and a referral to urgent care or ER

Blood Pressure Issues

Elevated so that systolic is over 160 OR diastolic is over 100:

• Make sure you didn’t forget to take your blood pressure meds.
• If you feel OK, message your health coach to inform them.
• If your head hurts badly please call your primary doctor immediately.
• If you develop pain in your chest, vertigo, have a severe headache, signs of a stroke, or difficulty breathing please call 911.

If your blood pressure is low, but you feel fine:

• Make sure you haven’t been skipping your water.
• Add a pinch of salt to your water.
• Message your health coach.

If your blood pressure is low, and you’re dizzy or your head hurts:

• Drink some water with a pinch of salt.
• Get horizontal; lie on your couch, bed, or floor.
• Review if you’re been skimping on sodium.
• If you get worse, call 911, then message your coach.

Digestive Distress

Diarrhea:

• Message your Revero coach to discuss.
• If you also are passing blood, are in a lot of pain, or also have a high temperature, call your primary doctor or 911. 

Constipation:

• Message your Revero coach.
• Review your hydration.
• Remember that constipation is not defined by frequency (within reason) but by consistency. A dry hard stool that is hard to pass is constipation. Having a bowel movement that is comfortable every two or three days isn’t constipation. When you reduce the volume of fiber you’re eating, your body will not have as much stool to pass, so keep that in mind too. 

Nausea:  

• Message your Revero coach and keep them informed.
• If you also develop a fever and are vomiting, and can’t stop, contact your primary care provider immediately.

Muscle Cramps:

• Message your Revero coach for advice.

Dizziness

• This could be due to low blood pressure (see section about that).
• If blood pressure is normal, reach out to your primary care provider
• If you have dizziness and also can’t speak clearly or can’t see clearly, or have other signs of a stroke, call 911.

Signs of Stroke:

If you’re experiencing any of these, with sudden onset and worsening, call 911:

• Slurred speech but normal blood sugar
• Loss of use of one side of your face
• Drooping, drooling on one side of your face
• Loss of use of one hand, with it drawing up into a ball or sudden numbness
• Inability to protrude your tongue straight ahead (this is a very sensitive test)

Headache that progressively worsens, particularly with vision changes or one enlarged pupil: contact your primary care physician immediately, or 911.

Swelling and Fluid Retention in Your Legs:

• Legs that are both swollen, but you feel OK: contact your coach. Contact your primary care provider if it keeps getting worse.
• One leg swelling and turning red and hard: contact your primary care provider or 911

Headache

• If it isn’t a severe headache, or is easily relieved, please notify your Revero coach
• If your headache worsens or is severe, and doesn’t improve with over the counter meds, get in touch with your primary care provider immediately

If you’re concerned you are experiencing a medical emergency, please contact emergency services near you by calling 911.