I do not have diabetes and literally never thought that anything to do with blood sugar pertained to me or to ME/CFS (unless you also had co-morbid diabetes.) For the last several months I have been having episodes which I thought were either due to PEM or low blood volume and electrolytes. At the most extreme version, I would get shaky, dizzy, muscle twitches, mental confusion, hard to put words together, hard to walk straight, headaches, worsening of my breathing and even agitation. When these episodes happen, I usually cannot think of what to do and my husband forces me to drink water or Pedialyte and take salt stick tablets which usually helps a lot. People asked me all kinds of questions (if I thought it was my thyroid or adrenals or a med side effect or autonomic, etc) and I am sure that all of these play a role. Then @halcyon and @zzz (I hope you don't mind me mentioning you both) asked me if it could be due to low blood sugar and this had never occurred to me and I want to thank you both. My former naturopath had insisted I should not eat any sugar when she placed me on a strict diet back in June and lately I have barely been eating any food at all b/c it just feels like so much effort and energy that I do not have. This morning I was having a similar episode plus was freezing cold and could not regulate my temperature which had gone down to 97.2. I thought about the blood sugar hypothesis (and have no way to measure it) but drank a cup of decaf Ginger tea with both sugar and honey in it and rested and then felt so much better that I was able to eat lunch and wrap all the Christmas gifts for a family get together on Sat and my temp had gone up to 97.7 and freezing feeling is gone. Does this seem to match with low blood sugar and is that another sign of dysautonomia or of ME/CFS (in someone who is not diabetic?) Thanks for any info in advance and I appreciate and read everything!