New - RH, OGTT-results & metformin

[iBelle]

Hi,

Thought I'd come right here as I'm not diabetic but recently had an OGTT done because of health issues and and increase in symptoms.
Long story short: been battling debilitating fatigue and pain for the passed 10 yrs (useless chronic fatigue diagnosis). I had a bad crash again 2 months ago and was referred for a glucose test. I have episodes of extreme fatigue, weakness and at times hunger. I wake up at night feeling weak needing to eat.
I'm confused about the results.

72mg/dl (fasting level) = 3.99
85mg/dl (1/2hrs) = 4.71
78mg/dl (1hrs) = 4.32
53mg/dl (2hrs) = 2.94
40mg/dl (3hrs) = 2.22

The endo told me I seem to have RH which could explain some of the fatigue but not all? She put me on Metformin and referred me to a dietician.
I don't understand the Metformin as my levels are low (85mg/dl after drinking glucose?) and never been high I think. Can someone explain to me why my levels hardly rise? Is Metformin necessary and how is it supposed to help me?

Thanks for reading
iBelle

 

[Brunneria]

Hi and welcome!

On the understanding that none of us here are professionals, and we are just speculating on the internet (sorry, but I have to add that disclaimer ) I am going to suggest that your body is very good at producing insulin (which prevents your blood glucose from rising), but not so good at turning it off once it has served its purpose.

This would explain why your blood glucose barely rose, yet went lower and lower until at 2 and 3 hours you were well into hypo territory.

Do you have your own home test meter? I suggest it would be a good idea to get one!

What advice have they given you? Particularly what diet advice? Or are they waiting until you see the dietitian?
Did they suggest a course of action (a hypo treatment) when your blood glucose drops so low?

Lots of us with RH who post here find that diet is key to controlling our blood glucose.

Re the Metformin - I suggest you have a good read up on it. Google yields a lot of info, from drug information leaflets to various studies. It has been shown to have a number of effects from reducing the amount of glucose released from the liver, to protecting the heart - and more recently to have some protective effect against cancer, but I don't have that study to hand. Metformin does lower blood glucose a bit, but it acts differently from most of the other diabetic drugs. It is also useful to reduce insulin resistance, so if they think your RH is due to insulin resistance that may be why they have prescribed it.

But really, for the best understanding of their rationale in prescribing Metformin to you, you would need to ask your endocrinologist.

 

[CherryAA]

Hi,
Are these numbers fasting glucose? It may well be that you are overreacting to the insulin you are producing to control your diet. what follows is said y an " accountant " not a doctor - so please make sure you get it checked out by your doctor!

If you are then this might cause your glucose levels to go too low, but your insulin to be too high If I were you I would ask initially for a fasting insulin test ( should be 2-6 iUI/ml ) ifs its higher than that then that might explain your symptoms, so they could repeat the OGTT test but this time with insulin.

The reason for the metformin is that it helps your body to be less insulin resistant which in theory should help you to produce less insulin then crash less afterwards.

You can probably fix most of this yourself by getting rid of processed foods sweets, sugar and vegetable oils from your diet.

 

[iBelle]

I know you guys aren't doctors and I will definitely check when I see her next! But that is still 1 1/2 months away.
The 3.99 was my fasting glucose. The rest is after drinking glucose. She didn't really say/explain anything, except for me going hypo after 2 hours. Didn't say I was insulin resistant. Also, I'm 125 lbs/57kg and shouldn't lose weight.
I thought insulin resistance meant that your glucose levels would first be high to very high before going hypo. So that's why I'm confused about the Metformin as I barely had a rise. I did try to read up on it a bit. The 'lowering glucose levels' didn't make sense at all to me and made me freak out a bit. My gp did tell me it doesn't actually cause hypo's and should regulate insulin as well? That would make more sense. The first week ond Metformin was horrible though. Felt even more fatigued, nauseous and less alert.
I'm still waiting for some blood results where they did fasting insulin. They should have done insulin levels with the OGTT but didn't .
I'm seeing the dietitian next week so no recommendations yet. Although I have experimented myself with going more low carb to see how it affected my fatigue. It didn't really do much to be honest. They didn't ask me to check my levels so I don't have a meter. I'm thinking about getting one though.
I realise I didn't ask the endo a lot of questions. I was quite stressed out as these past 10 yrs have been a struggle. Many tests were done in the past and came back 'normal'. And a lot of the time I wasn't taken seriously. Meanwhile I was going from being a athlete to not being able to walk for 10 minutes without feeling exhausted. This is my first glucose test though and a bunch of my symptoms could be hypo related. I don't understand why no one ever checked this before. But I'm scared to get my hopes up. Could this really be causing my extreme fatigue?

 

[Brunneria]

Basically, insulin resistance is where you body's cells need more insulin than normal to do the same job. A bit like being rather deaf to insulin. I hope that makes sense. So it is possible to be insulin restant (IR) and still have normal blood glucose levels. They only start to rise if the IR gets bad enough that the available insulin can't do the job.

However, it is worth remembering that RH is a very individual thing. It may involve IR, but it would be unwise to assume that it automatically does until you get those insulin test results back. RH can have a variety of causes. Mine seems to be strongly linked to gluten intolerance. I only found this out by self testing, using a food diary and my blood glucose meter. Other RHers find that exercise, stress, bariatric surgery, other health conditions - even pain levels, affect their blod glucose and their RH.

I agree without you about how frustrating it is to present the symptoms to health care professionals and have them missed, over and over again. I am pretty sure that my medical records have some very odd comments in them, from my old (decades ago) doc. He thought i was a neurotic hypochondriac, yet every single symptom 'magically disappeared' when i switched to low enough carb.

 

[kokhongw]

72mg/dl (fasting level) = 3.99
85mg/dl (1/2hrs) = 4.71
78mg/dl (1hrs) = 4.32
53mg/dl (2hrs) = 2.94
40mg/dl (3hrs) = 2.22

The glucose tells us half the story. We may get a clearer picture if we know how much insulin was released/present when the glucose readings were taken.

The next step is to explore what causes the elevated insulin response...any issues with the pancreas or simply amplified dietary response to high carbs and proteins...

 

[psychod787]

I actually went to see my endo today. She told me if my bs does not drop under 50mg d/l-2.7 mol, I am not hypo. So when my bs goes from being 100 to 61 in 2 sets of slight exercise, or from 106 to 65 1 hour after eating a high protein, moderate carb breakfast, that is not really hypoglycemic. Lol what a joke. So I understand your frustration with doctors!

 

[iBelle]

I called me gp today to hear about the other blood work. Everything (anything hormonal) was fine. So my fasting insulin level was ok. When I asked what caused the hypo's then, he couldn't really answer my question. Something in my energy metabolism isn't right I guess but I quote "there's still a lot we don't know about that". No kidding .
So I guess I'll see that dietitian next week and hear what the endo has to say in November. Not really hopeful Metformin and diet (I tried low card before) will help my fatigue but well... we'll see.

 

[Lamont D]

I called me gp today to hear about the other blood work. Everything (anything hormonal) was fine. So my fasting insulin level was ok. When I asked what caused the hypo's then, he couldn't really answer my question. Something in my energy metabolism isn't right I guess but I quote "there's still a lot we don't know about that". No kidding .
So I guess I'll see that dietitian next week and hear what the endo has to say in November. Not really hopeful Metformin and diet (I tried low card before) will help my fatigue but well... we'll see.

Hi, and welcome to our forum.
Your post reminds me so much of my past twenty years.
Not one of the many so called health practitioners had a clue, including an endocrinologist!
It wasn't I had a hypo in front of my present endocrinologist did he decided to do the tests that led to diagnosis.

Through my own personal experience and others that have posted here, that I have gained the knowledge on how to treat RH! Even my endocrinologist believes thou must have a certain amount of carbs.

You don't!
I have a lot of intolerance to many foods, which triggers my pancreas to produce the excess insulin that leads to the hypos.
It is all about that first insulin response from your food.
If you don't need that response, then you don't tend to get the hypo.

So by eating very low carb, you take away the recurring hypos.

How do you treat the hypos?

By your description of doing low carb, I believe you didn't do it long enough and the symptoms would have eased after about two to three weeks.

Metformin is tricky. I was told to stop taking it.
The side effects alone are bad enough for your system, with rh, your body is under enough without the metformin.

With RH your gut brain trigger is in imbalance. How different is how that reacts to glucose in any form. How you quickly digest food is why you start going hypo after two hours, there is a condition akin to RH, with the same symptoms called gastric dumping. Any form of hypoglycaemia will benefit from very low carbing.
Having your blood glucose levels in and around normal blood glucose levels for the majority of the day is so good for your health.
It will assist in getting your symptoms to go away.
And your health will improve.

Let us know how you get on with the dietician.
Wonder if he/she will recommend the eat well plate?

Best wishes.

 

[CherryAA]

I know you guys aren't doctors and I will definitely check when I see her next! But that is still 1 1/2 months away.
The 3.99 was my fasting glucose. The rest is after drinking glucose. She didn't really say/explain anything, except for me going hypo after 2 hours. Didn't say I was insulin resistant. Also, I'm 125 lbs/57kg and shouldn't lose weight.
I thought insulin resistance meant that your glucose levels would first be high to very high before going hypo. So that's why I'm confused about the Metformin as I barely had a rise. I did try to read up on it a bit. The 'lowering glucose levels' didn't make sense at all to me and made me freak out a bit. My gp did tell me it doesn't actually cause hypo's and should regulate insulin as well? That would make more sense. The first week ond Metformin was horrible though. Felt even more fatigued, nauseous and less alert.
I'm still waiting for some blood results where they did fasting insulin. They should have done insulin levels with the OGTT but didn't .
I'm seeing the dietitian next week so no recommendations yet. Although I have experimented myself with going more low carb to see how it affected my fatigue. It didn't really do much to be honest. They didn't ask me to check my levels so I don't have a meter. I'm thinking about getting one though.
I realise I didn't ask the endo a lot of questions. I was quite stressed out as these past 10 yrs have been a struggle. Many tests were done in the past and came back 'normal'. And a lot of the time I wasn't taken seriously. Meanwhile I was going from being a athlete to not being able to walk for 10 minutes without feeling exhausted. This is my first glucose test though and a bunch of my symptoms could be hypo related. I don't understand why no one ever checked this before. But I'm scared to get my hopes up. Could this really be causing my extreme fatigue?

Before I started to sort out my blood sugars, I got to the stage where I needed to sit down after ten minutes at the sink,. Now I happily cycle 20 km and dont even think about. I take no medications, so the only difference is getting my diet fixed . It might well be yours too Follow a real foods diet , get rid of the processed foods, sugar and refined stuff and you will probably be amazed at the difference in how you feel .if you don't want to lose weight, then probably eating your real foods over a number of snacks a day may help (I am currently trying to lose weight by only eating real foods once per day and its falling off me ! )

 

[ickihun]

I called me gp today to hear about the other blood work. Everything (anything hormonal) was fine. So my fasting insulin level was ok. When I asked what caused the hypo's then, he couldn't really answer my question. Something in my energy metabolism isn't right I guess but I quote "there's still a lot we don't know about that". No kidding .
So I guess I'll see that dietitian next week and hear what the endo has to say in November. Not really hopeful Metformin and diet (I tried low card before) will help my fatigue but well... we'll see.

Metformin is one of those meds which takes months to get its full benefit from. Like statins.
Im not RH but i only dont add weight if im on metformin. Otherwise i balloon to 22st plus. Become so insulin resistant i burst out of my skin, everywhere. Need 300units of insulin plus my own.

No longer now with long term use of metformin and low carb eating.

 

[CherryAA]

Metformin is one of those meds which takes months to get its full benefit from. Like statins.
Im not RH but i only dont add weight if im on metformin. Otherwise i balloon to 22st plus. Become so insulin resistant i burst out of my skin, everywhere. Need 300units of insulin plus my own.
No longer with metformin and low carb eating.

Have you taken a look at my one meal a day low insulin thread? you might find it helps you ? Ive been stalled for months and now the weight is flying off, simply by only eating lCHF once per day. I might work for you too? Its not hard to do after a couple of days so might be worth a go?

 

[ickihun]

Have you taken a look at my one meal a day low insulin thread? you might find it helps you ? Ive been stalled for months and now the weight is flying off, simply by only eating lCHF once per day. I might work for you too? Its not hard to do after a couple of days so might be worth a go?

Happy to stick with what I'm doing until no more weight loss. But I never say never. Thanks for thinking of me thou. Its very kind.

I went right wrong in the past tweeking what was working to then losing my way. I'm so easily distracted.
I've found what works for me.
That is keeping my bgs low enough to lose weight, even with more novarapid.
Strange but extra insulin isnt adding any weight on me as long as it keeps my bgs 4, 5 or low 6s. I'm amazed but it's the truth!
Maybe I dont have enough of my own insulin for my big body, at mo.
In heavy weight loss that could change. I'm hopeful.
So happy to stick to slow losing than risk adding again due to needing more basal for fasting periods. Id have to starve for 8wks to change my dynamics. Not prepared to do that without strict medical supervision after lchf problems with my other health problems hun.
I have a plan and happy with it.
Very content with where my diabetes is going.

 

[SimonCrox]

Hi; these GTT results do not show diabetes; if metformin was started as a result of these numbers, it is totally inappropriate. If you had evidence of diabetes and metformin was commenced all before the GTT, you still probably do not need the metformin.
What you have is a low normal fasting glucose that then goes hypo after the glucose load.
So, thinking low glucose, fatigue etc, one would wonder about underactive thryoid gland (but this has probably been excluded), Addison's disease with underactive adrenal glands. This can sometimes happen in older people with lots of other illnesses. Some drugs cause it such as quinine, alcohol, tramadol, beta blockers, and possibly ACE inhibitors
Thinking low gluocse after food, this can happen after surgery to the stomach eg for peptic ulcer disease ( but this is rare nowadays) or something called reactive hypoglycaemia happens and the cause is not totally clear.
So, I wuold ask the metformin prescriber what part of your GTT shows diabetes, I would get a glucose meter and test during your funny turns to confirm hypoglycaemia, get a mediation review, and get blood tests done to exclude Addison's disease and hypothyroidism.
Best wishes

 

[CherryAA]

Happy to stick with what I'm doing until no more weight loss. But I never say never. Thanks for thinking of me thou. Its very kind.

I went right wrong in the past tweeking what was working to then losing my way. I'm so easily distracted.
I've found what works for me.
That is keeping my bgs low enough to lose weight, even with more novarapid.
Strange but extra insulin isnt adding any weight on me as long as it keeps my bgs 4, 5 or low 6s. I'm amazed but it's the truth!
Maybe I dont have enough of my own insulin for my big body, at mo.
In heavy weight loss that could change. I'm hopeful.
So happy to stick to slow losing than risk adding again due to needing more basal for fasting periods. Id have to starve for 8wks to change my dynamics. Not prepared to do that without strict medical supervision after lchf problems with my other health problems hun.
I have a plan and happy with it.
Very content with where my diabetes is going.

Yes I agree completely ,DON'T change whats working for now. It's ONLY if you hit stall you might like to take a look. I've been prone to "tweaking" myself and ruined things, Its just an idea to keep in the back of your mind if it comes to that, I hope it' not necessary

 

[SimonCrox]

As you said and as your GTT says, you do not have diabetes if the GTT was done before metformin

 

[Lamont D]

Hi; these GTT results do not show diabetes; if metformin was started as a result of these numbers, it is totally inappropriate. If you had evidence of diabetes and metformin was commenced all before the GTT, you still probably do not need the metformin.
What you have is a low normal fasting glucose that then goes hypo after the glucose load.
So, thinking low glucose, fatigue etc, one would wonder about underactive thryoid gland (but this has probably been excluded), Addison's disease with underactive adrenal glands. This can sometimes happen in older people with lots of other illnesses. Some drugs cause it such as quinine, alcohol, tramadol, beta blockers, and possibly ACE inhibitors
Thinking low gluocse after food, this can happen after surgery to the stomach eg for peptic ulcer disease ( but this is rare nowadays) or something called reactive hypoglycaemia happens and the cause is not totally clear.
So, I wuold ask the metformin prescriber what part of your GTT shows diabetes, I would get a glucose meter and test during your funny turns to confirm hypoglycaemia, get a mediation review, and get blood tests done to exclude Addison's disease and hypothyroidism.
Best wishes

As with diabetes, reactive hypoglycaemic the cause cannot always be discerned but the chemical reaction between when you have carbs is the balance between glucose, glucagon, glycogen and how your alpha and beta cells trigger the amount of insulin in first insulin response, then because of the poor first response, the second insulin response is too much and that is why we go hypo.
If you prevent the insulin response and have normal blood glucose levels, the insulin response is not triggered by the gut brain trigger. No hypers, no hypos!
Control of your blood glucose levels are really important for good health.

I have Reactive Hypoglycaemia, I have normal fasting levels, I do not have diabetes, my body can't tolerate most carbs!
So I avoid them and it works!

Best wishes

 

[SimonCrox]

As with diabetes, reactive hypoglycaemic the cause cannot always be discerned but the chemical reaction between when you have carbs is the balance between glucose, glucagon, glycogen and how your alpha and beta cells trigger the amount of insulin in first insulin response, then because of the poor first response, the second insulin response is too much and that is why we go hypo.
If you prevent the insulin response and have normal blood glucose levels, the insulin response is not triggered by the gut brain trigger. No hypers, no hypos!
Control of your blood glucose levels are really important for good health.

I have Reactive Hypoglycaemia, I have normal fasting levels, I do not have diabetes, my body can't tolerate most carbs!
So I avoid them and it works!

Best wishes

That is a very interesting and logical approach (I would never be patronising) and really useful. Thanks for info. Best wishes

 

[pollensa]

Hi and welcome!

On the understanding that none of us here are professionals, and we are just speculating on the internet (sorry, but I have to add that disclaimer ) I am going to suggest that your body is very good at producing insulin (which prevents your blood glucose from rising), but not so good at turning it off once it has served its purpose.

This would explain why your blood glucose barely rose, yet went lower and lower until at 2 and 3 hours you were well into hypo territory.

Do you have your own home test meter? I suggest it would be a good idea to get one!

What advice have they given you? Particularly what diet advice? Or are they waiting until you see the dietitian?
Did they suggest a course of action (a hypo treatment) when your blood glucose drops so low?

Lots of us with RH who post here find that diet is key to controlling our blood glucose.

Re the Metformin - I suggest you have a good read up on it. Google yields a lot of info, from drug information leaflets to various studies. It has been shown to have a number of effects from reducing the amount of glucose released from the liver, to protecting the heart - and more recently to have some protective effect against cancer, but I don't have that study to hand. Metformin does lower blood glucose a bit, but it acts differently from most of the other diabetic drugs. It is also useful to reduce insulin resistance, so if they think your RH is due to insulin resistance that may be why they have prescribed it.

But really, for the best understanding of their rationale in prescribing Metformin to you, you would need to ask your endocrinologist.

Hello

Re Metformin,

I would seek second advice on this as to whether it is necessary.....who wants to take Metformin, sensible people no one if possible. My Doc gave it to me when my sugar finger test was normal, by that I mean random test 4 hours after eating breakfast was a tad high 180mg/dl although I had 7 tropical fruits in blender for breakie...mango, banana pawpaw, strawberries, peach, melon , so a cocktail of sugars, hence Tad high, but it was well below the cut off 200mg/dl i.e. normal Random is either normal or diabetic no mid way, so why on earth would a Doctor immediately put someone on Metformin. I asked him...do I have cholera or Diabetes, he said what do you mean, I said when Metformin first came it it was for Cholera......his face was a picture to see, he did not know this... thats frightening.

Obviously after 30 years being my Doctor, I felt the need to sack him.....lost confidence one could say.

Mallorca

 

[iBelle]

Thanks for the replies. The GTT was done before the Metformin. No, I don't have diabetes. And my fasting insulin was normal. Thyroid's fine. I didn't have surgery nor do I take any other medications. Over the past 10 years my fatigue gradually got worse.
They should have done insulin with the GTT but they didn't. Endo said, based on my glucose levels during the GTT, she does think my insulin was probably high, giving me the hypo after 2 hrs. But that sounds like an assumption. Metformin was supposed to make my body use insulin better? She didn't say anything about me being insulin resistant though. So yeah, I really don't know if Metformin is the way to go. I'm up to 850 mg with breakfast and 425 mg with dinner.
I don't feel okay. I bought a glucometer. Most of my levels were fine. Caught a 2.7, 2.9, 3.2 over the past week. But strangely not at a time I thought I would. It's like I feel worse after my glucose is already up again.
Seeing the dietitian on Thursday. Really hope this will help as I'm extremely fatigued and I can't do this anymore.
Today was not good. Even though I started out with oats/milk for breakfast at 7.30 am and yoghurt at 10 am, I was hungry and feeling weak and tired all morning. Checked my levels but they were normal. Only had a small lunch, a ham sandwich and an apple. Was feeling sleepy and I can't concentrate. By the time I got home from work I just crashed on the couch, not hungry at all, feeling too tired and nauseous to eat. And that happens on a lot of days. I realize I'm not doing a great job with diet at the moment. I'm just too tired.