Low blood sugar in a type 2?

[marleemacd]

Hi there,

I was hoping you wise and experienced folk might be able to help with a query.

Is it possible to get your blood sugar down a bit too low? I've started to find fasting readings in the 3s. Looking back I can see that a couple of months ago they were 5s and 6s, with the occasional 4.
When I'm at work (undemanding desk job) my 2 hour post lunch reading can be a 4 or a 3.

I'm a Type 2 taking metformin 1000mg a day, since diagnosis 6 months ago I've lost 50lbs - my consultant thinks the weight loss is the main factor in the change in my HbA1c (from 9.5% to 5.9%) I don't count carbs but gave up potatoes, rice, pasta, milk, fruit, all the usual suspects.

When I was diagnosed I was in hospital with breathlessness and told I had DKA, but I also had a pulmonary embolism. Initially I was thought to be a type 1, so I did take insulin for a while, and came to be familiar with hypos. As a 1, I was told that "4 is the floor" and I should always act by taking some glucose. I read that as a 2 on metformin I wouldn't experience hypos, and my point is, sorry, finally I get to it....I don't feel anything at all when my readings are in the 3s. When it's a fasting reading I'm always about to eat breakfast anyway. Should I be worrying about these lows? Should I pay more attention to my readings as opposed to just seeing them as "doing fine" Am I likely to find that my next HbA1c (January) is much higher because I'm missing so many highs? Is it also inevitable that the liver will dump glucose when the blood sugar level is too low?

I'm sorry to ask so many questions and give a long explanation, hope I've made sense.

Cheers

Marlee

 

[jopar]

Hypo is an blood sugar reading below 3.9/4 mmol/l by definition...

In an non-diabetic or a diabetic that is taking metformin, the individual may experience the some of the symptoms of 'hypo' but the body is able to stablise it self and bring the blood sugar back to normal levels..

For insulin dependant or T2's that use certain oral medication that stemilates the insulin production, hypo's can be dangerous indeed, beccause the body has excess insulin in it, that needs glucose to work on, it doesn't switch off, but burns it self out... This means that when they body hits hypo, the body can't naturally recify and stabilise the blood, the individual has to eat some fast acting carbs to give the insulin something to work with..

In your case, your fasting levels are low..

Do you test after meals to see what the food you eat effect your BG? You would then be able to determin if there are any spikes that would cause concern..

I would book an appointment to discuss this with your doctor, as it may be that since you've lost weight this has lessend your insulin resisdence, and your medication can be reduced to reflect this...

P.S

Well done on your wieght loss, you must be chuffed

 

[marleemacd]

Hi Jopar,

Many thanks for your response. I did test religiously after meals to find what foods would work, I thought I'd kind of got there with the basics and intended testing less as I'm supplementing the prescribed strips on ebay. After the last HbA1c the consultant mentioned that next time they would probably take me off the metformin, maybe I should push for that sooner.

I am thrilled about the weight loss, I did need to lose it and this was just the shock that I needed. I do seem to have some excess skin though....but being able to shop in normal clothes shops is still a terrific novelty!

Cheers

Marlee

 

[jopar]

Yes I think a push to get your medication reviewed is a must idea..

They will likely go for a reduction of your dose fist, rather than a stopping straight away, as it might be that your weight gain could have stemed from your body not be able to handle glucose probably, if so this might mean that you still require some medication to keep this in check..

If they change your medication or stop it, insist that you have a good supply thats enables you to monitor you BG's correctly to what you call correct and not there version.. Explain that you don't want to undo what you've achieved... If you feel that you might struggle putting your case for strips across we can help you build your case, with NICE guide lines etc to stregthen your case for you... Just shout if you need any help.. As you don't want to undo all the good work that you've done to achieve your brillient results..

Sadly the skin excess can happen when losing weight, for some they aren't bothered by it as there achievement and the benefits they've gained outweighs everything....

 

[marleemacd]

Hi Jopar,

Thanks again! My problem is that I live in Scotland! When I mentioned the NICE guidelines to my DSN in June she told me to ignore those completely and read the relevant Scottish Guidelines SIGN 55. Trouble is, they don't contain target blood glucose levels, but I think they're up for consultation as they're now quite old. I had wondered why I hadn't been given any guidance on what I should be aiming for. The vague dietary instructions didn't appeal to my inner control freak either.

I feel so much better thinner that I don't mind too much about the excess skin, never wearing a bikini is a small price to pay. You're absolutely correct, I definitely appreciate the benefits.

Cheers

Marlee

 

[wallycorker]

Hi Marlee,

I'm a Type 2 on metformin who has also goes below 4 quite often - 3.4 is the lowest that I've ever recorded if I remember correctly. My body doesn't tell me when I'm low - in fact, I feel no different at 3.4 than I do at 10+. My GP is quite relaxed about it and says that I'm in no real danger of anything happening to me just so long as I'm only on metformin. He quite simply says if I think I'm low then all I should do is eat something. These days, I don't worry about it.

Best wishes - John

 

[cugila]

Hi Marlee.

Here is a link to a pdf document which is the draft of the SIGN guidelines. September 2009.
http://www.sign.ac.uk/pdf/Diabetes-cons ... -draft.pdf

As stated this is a DRAFT. Might be of use to you ??

 

[saz1]

I was told I wouldn't get hypos as a type 2 with such high blood sugars. but lo and behold, after cutting out potatoes,rice,pasta and bread, 3 1/2 stone weightloss, increased activity I started to have hypos every couple of weeks or so. Low readings of 3.3 and thereabouts meant that I had to go back to basics and review my meds, diet and possible reasons for these hypos with my GP.

It seems my insulin resistance is variable and is linked to hormonal activity to a degree so I'm more prone to hypos at certain times a month and have then increased my wholegrain carb intake for those days when I know I'm heading down towards a hypo. My work does not allow regular breaks or set meal times so I have to gauge my days on a daily basis. Now I always have some sweets or a cereal bar to scoff if I feel iffy. But my strategy is paying off, I'm not having hypos at the moment and bs levels are still steady. I suppose \I'm lucky since I feel an approaching hypo from a bs of 4.2 and under so am getting enough warning to be able to carry on my normal day withoiut sick time.

 

[marleemacd]

Hi there,

Thanks for your messages, I'm strangely relieved to discover it's not just me. It's interesting what you say about the variable insulin resistance Saz1 as there's seems to be a pattern to my lows. My cycle has become really short since diagnosis, but I wasn't actually seeing the two as linked, I'll speak to my GP.

Many thanks for the link to the SIGN consultation Cugila, it's interesting to see a brief mention of low carb and low glycaemic diets.

John, my lowest reading was a 2.6, and I only knew by checking two hours after a meal, otherwise I had no idea anything was going on. I've added in a wee afternoon snack now, especially as I cycle 5 miles home, admittedly that's on a canal towpath and at a leisurely pace.

Cheers

Marlee

 

[JohnEGreen]

I know a T2 on metfornin only who recorded a BG level of 1.4 about ten days ago as had never been so low before and as she had never been told how to treat a hypo she was unsure of what to do. That is drink some sweet sugary liquid to bring the level up quickly which is what we advised her to do.

It worked.

 

[bluejeans98]

I would be inclined to get your test strips from another source and see if that makes a difference. Buying of Ebay your not sure of the source. Or go to the chemist and get them to do a blood test on there machine, while you do a test on yours at the same time. See how the readings differ. If they are then same then you know the readings are correct. Well done on the weight loss and BG readings from the start of your journey to now. Having cut out what you have from your eating your liver must be well and truly fat free, Other would have liver dumps if sugars hit that low. Metformin only lowers BG by 1 to 1.5 points.