New - RH, OGTT-results & metformin

[Lamont D]

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.

Just looking at what you have eaten in the morning, I'm not surprised the way you feel, I would be extremely ill and lethargic.
The amount of carbs in your first meal of oats and milk would have my bloods hyper then hypo. Oats are a grain and if not full fat milk, then the carb count rocket.
A sandwich, more grains, and you are probably not making it any better with an apple.

You cannot tolerate that amount of carbs.

Regardless of diagnosis. You must change your diet, to a very low carb diet.
It is the only way to get your health back and your energy.

Please take care and start addressing the food you eat.
The food you are eating are causing the way you feel.

Best wishes.

P.S., my money is on your dietician to recommend carbs with every meal!
(They haven't got a clue)

And I would drop the metformin as well! (In my opinion!)

 

[Brunneria]

I have to say that a breakfast of porridge and a lunch of sandwiches would floor me too.

Can i suggest you try an experiment?
Just have protein for breakfast one day. No bread or oats or similar. Have scrambled eggs without toast. Or ham and cheese, without the bread. Bacon and eggs. Yoghurt might be too high carb (it is for me) so i wouldnt suggest it for your experiment day. no sugar in drinks, or even much milk in your drinks. No fruit juice. Just protein.

I know that is unusual, and the instinct is to 'carb up' for breakfast, but just try it for one day. See if you feel different. It was a game changer for me when i tried it.

 

[SimonCrox]

Hope you are feeling better soon.
I totally concur with LamontD above that there seems no good reason to take the metformin (I woud never be patronising)
You are already getting lowish sugars that seem to include a strong element of reactive hypoglucaemia ie your own insulin is effective enough.
I beleive that in the UK, it would be unusual to measure an insulin level during a GTT.
I would measure a 9.00 am cortisol level (aiming for level greater than 400) just to make sure that your 3.99 mM fasting level was not due to underactive adrenal glands, but I accept that this is very rare.
Best wishes

 

[Lamont D]

Hope you are feeling better soon.
I totally concur with LamontD above that there seems no good reason to take the metformin (I woud never be patronising)
You are already getting lowish sugars that seem to include a strong element of reactive hypoglucaemia ie your own insulin is effective enough.
I beleive that in the UK, it would be unusual to measure an insulin level during a GTT.
I would measure a 9.00 am cortisol level (aiming for level greater than 400) just to make sure that your 3.99 mM fasting level was not due to underactive adrenal glands, but I accept that this is very rare.
Best wishes

Hi @SimonCrox
I concur with your post but in my experience, if RH is suspected as a diagnosis then insulin tests alongside a c-peptide would be and should be mandatory in a eOGTT.
The number of blood samples taken can be somewhere near twenty over the four to five hours test. All the samples are taken from your arteries through a catheter.

 

[iBelle]

I will definitely give the low carb diet a new try and do the experiment with no carbs at all.
I never or very rarely drink sugary drinks or juice so that's a plus. I drink about 2l of water each day. And tea or coffee. No sugar, just a splash of milk. I'll leave the milk and yoghurt for a while.
Had the day off and I'm tired but in better spirits. Also went low on the carbs today. I was far less hungry.
I did have a 3.27 when I tested this afternoon. But that was 3 hours after lunch and I had had a coffee about half an hour before. Cafeine probably isn't a great idea.
Will keep you all posted on what the dietitian recommends and what happens with the Metformin.
I really appreciate your help. Thank you all!

 

[Brunneria]

Dietitians vary a great deal in their advice. Some say that carbs are vital and indispensable to brain function, others are fine with people reducing their carbs (or other foods) if those foods are causing problems.

I really hope you get a good one!

 

[Lamont D]

I will definitely give the low carb diet a new try and do the experiment with no carbs at all.
I never or very rarely drink sugary drinks or juice so that's a plus. I drink about 2l of water each day. And tea or coffee. No sugar, just a splash of milk. I'll leave the milk and yoghurt for a while.
Had the day off and I'm tired but in better spirits. Also went low on the carbs today. I was far less hungry.
I did have a 3.27 when I tested this afternoon. But that was 3 hours after lunch and I had had a coffee about half an hour before. Cafeine probably isn't a great idea.
Will keep you all posted on what the dietitian recommends and what happens with the Metformin.
I really appreciate your help. Thank you all!

Sounds like a good start.
Keep us informed.

 

[SimonCrox]

Hi @SimonCrox
I concur with your post but in my experience, if RH is suspected as a diagnosis then insulin tests alongside a c-peptide would be and should be mandatory in a eOGTT.
The number of blood samples taken can be somewhere near twenty over the four to five hours test. All the samples are taken from your arteries through a catheter.

Sorry; yes - you are correct - I was a bit slow there. As you say, if suspecting hypoglycaemia, insulin levels and c-peptide ( +/- sulphonylurea level in medical settings) are crucial at the time someone is hypo. And one can always send the samples to the lab and only process them for the specialist tests if the glucose levels come back as low. The cost of insulin assays and the ease to perform them have just got better over the last 30-40 years. Thanks for comment.
Best wishes

 

[psychod787]

I am on day 3 of a lower carb diet. Not as low carb as some, about 30% with fiber being 50grams a day, and am feeling much better. I hope it continues. Almost anything is better than ridin what i have lovingly started calling the norepinephrine pony and the insulin swing Broncos! I know how you feel hun. Pardon my American euphemisms. My bs have been a little higher, but compared to having them low, I will take it. Just praying for you!

 

[psychod787]

Dietitians vary a great deal in their advice. Some say that carbs are vital and indispensable to brain function, others are fine with people reducing their carbs (or other foods) if those foods are causing problems.

I really hope you get a good one!

As the dietitian I am working with told me, "dietary guidelines vary person to person and most of what is out there is pseudoscience. All people are different." I mean how many dietitians actually tell you to eat more fat and less carbs! Lol

 

[Lamont D]

As the dietitian I am working with told me, "dietary guidelines vary person to person and most of what is out there is pseudoscience. All people are different." I mean how many dietitians actually tell you to eat more fat and less carbs! Lol

I got one that told me to do as such, but only because my endocrinologist told her.
But I found what I was looking for on this forum and of course trial and error with my glucometer.

I am on day 3 of a lower carb diet. Not as low carb as some, about 30% with fiber being 50grams a day, and am feeling much better. I hope it continues. Almost anything is better than ridin what i have lovingly started calling the norepinephrine pony and the insulin swing Broncos! I know how you feel hun. Pardon my American euphemisms. My bs have been a little higher, but compared to having them low, I will take it. Just praying for you!

Getting along rather well, are you?
Keep it up, you may find this level ok, but I have a hunch you might need to go a little lower. Or get rid of some of the carbs you eat from your diet altogether.

Best wishes.

 

[psychod787]

I got one that told me to do as such, but only because my endocrinologist told her.
But I found what I was looking for on this forum and of course trial and error with my glucometer.


Getting along rather well, are you?
Keep it up, you may find this level ok, but I have a hunch you might need to go a little lower. Or get rid of some of the carbs you eat from your diet altogether.

Best wishes.

I am still fighting! I am feeling better, for now as you say. I may have to drop to the 20-25% range over time. For now, I am letting my body adjust. I just recently went through a 2 year starvation mode. Keto might be an option one day, but for now, I am just happy to feel better. Good to see you still hanging in there as well.
Cheers!

 

[iBelle]

Had a bit of a hypo around 10pm, 58mg/dl (3.22). Didn't feel bad. Had a biscuit. Was back to 71mg/dl (3.94) going to bed
Woke up sweaty and nervous around 1 am but my levels were 74mg/dl (4.11). What's low and needs to be treated? And what's the best way the do it?
Pretty fatigued waking up and coming home from work but felt somewhat better throughout the day. And I wasn't hungry.
I tried testing today:

8.30 am: 71mg/dl (3.94) fasting glucose
Breakfast: 2 egg omelet with ham, onion, cherry tomatoes, herbs + 1 piece of buttered toast
9.00 am: 88 mg/dl (4.88)
9.30 am: 120mg/dl (6.66)
10.00 am: 73 mg/dl (4.05) (is that too much of a drop in half an hour, even though it's not hypo?)

11.45 am: 72mg/dl (4.00)
Lunch: salad with dressing, chicken, carrots, tomato, green beans
2 pm: 70mg/dl (3.88)
Snack: handful of mixed nuts
4pm: 65mg/dl (3.61)
Snack: small piece of gingerbread

7pm: 77mg/dl (4.27)
Dinner: Vegetable soup, quinoa salad with goats cheese
8pm: 126mg/dl (7.00)
8.30pm:120mg/dl (6.66)

Any advice? I know there's still carbs in there.
What's a good breakfast? I can't eat eggs everyday.

 

[Lamont D]

I am still fighting! I am feeling better, for now as you say. I may have to drop to the 20-25% range over time. For now, I am letting my body adjust. I just recently went through a 2 year starvation mode. Keto might be an option one day, but for now, I am just happy to feel better. Good to see you still hanging in there as well.
Cheers!

Yes, nice and slow, just feeling better is a bonus.
I'm not going back to that hypo hell!
The difference in my health is so amazing, you wonder why it is so difficult to understand why the bad advice is given, well it was for me for over ten years.

Keep on trucking!

 

[Lamont D]

Had a bit of a hypo around 10pm, 58mg/dl (3.22). Didn't feel bad. Had a biscuit. Was back to 71mg/dl (3.94) going to bed
Woke up sweaty and nervous around 1 am but my levels were 74mg/dl (4.11). What's low and needs to be treated? And what's the best way the do it?
Pretty fatigued waking up and coming home from work but felt somewhat better throughout the day. And I wasn't hungry.
I tried testing today:

8.30 am: 71mg/dl (3.94) fasting glucose
Breakfast: 2 egg omelet with ham, onion, cherry tomatoes, herbs + 1 piece of buttered toast
9.00 am: 88 mg/dl (4.88)
9.30 am: 120mg/dl (6.66)
10.00 am: 73 mg/dl (4.05) (is that too much of a drop in half an hour, even though it's not hypo?)

11.45 am: 72mg/dl (4.00)
Lunch: salad with dressing, chicken, carrots, tomato, green beans
2 pm: 70mg/dl (3.88)
Snack: handful of mixed nuts
4pm: 65mg/dl (3.61)
Snack: small piece of gingerbread

7pm: 77mg/dl (4.27)
Dinner: Vegetable soup, quinoa salad with goats cheese
8pm: 126mg/dl (7.00)
8.30pm:120mg/dl (6.66)

Any advice? I know there's still carbs in there.
What's a good breakfast? I can't eat eggs everyday.

A hypo is usually felt under 4mmols. And we all feel it at different levels but going below 3.5 you should treat it, a biscuit and a black tea or coffee will slowly raise your blood levels. You notice that you didn't go too high after just the one biscuit?
Yes you are still eating low carb though. But your readings, I would be really happy with those and you should start feeling a little bit better as your blood levels remain around those numbers.
If you can keep it at these levels, you won't feel hungry and you decide when to eat and eggs are the perfect breakfast. There is a lot of different low carb meals involving eggs. Just experiment and keep testing and writing it all down in your food diary.

Keep it up, you are doing brilliant.

Best wishes

 

[iBelle]

Guess what? She suggested carbs with every meal and 3 to 4 snacks per day.
I asked about what exactly is happening with the hypos but she couldn't really explain. And that all those carbs make me feel tired and worse and if I shouldn't eat more protein. I was super annoyed and I think I scared her . As I went from kind of aggressive to being on the verge of crying. I think I kind of scared myself too . But yeah, I know, she's a dietitian and no doctor. She suggested I speak to the endo who was too busy to see me this afternoon. I ask her to ask the endo to email me about the reason for Metformin and what is causing my reactive hypos. So I hope she does...

 

[Lamont D]

Guess what? She suggested carbs with every meal and 3 to 4 snacks per day.
I asked about what exactly is happening with the hypos but she couldn't really explain. And that all those carbs make me feel tired and worse and if I shouldn't eat more protein. I was super annoyed and I think I scared her . As I went from kind of aggressive to being on the verge of crying. I think I kind of scared myself too . But yeah, I know, she's a dietitian and no doctor. She suggested I speak to the endo who was too busy to see me this afternoon. I ask her to ask the endo to email me about the reason for Metformin and what is causing my reactive hypos. So I hope she does...

This is exactly the same thing I went through till my endocrinologist got involved.
And of course this website.

They are unaware of the nature of the food and how it reacts to carbs!

We are different to other metabolic conditions and they don't understand!

Talk to your endocrinologist and explain why certain foods spike you so high and then send you low and try and think about an analogy that those foods are making you ill, and wouldn't it be better to avoid them if your health and symptoms improve without them!

I always use a nut allergy. Why would eat nuts if you had an allergic reaction to them?

They call our condition reactive!

So why eat carbs?

It's logical!

Sorry, but of a rant there.

Best wishes

 

[Brunneria]

sorry @iBelle

Please don't let this demoralise you, or put you off doing your own investigations (armed with your meter).

It is an all too familiar story on this forum - but please remember, it is YOU who has to live with this condition, and YOU who needs to find the best way for YOU to manage it. All dieticians will do is make suggestions.

Keep posting, keep asking, keep experimenting, and we will be here to help.

 

[andersl]

The endocrinologist told me I have idiopathic postprandial syndrome. .. ie my blood sugar stays within normal range. However it is usually in the low 4s before eating and I have had 3.9 recorded a few hours after a hypo. If I exercise extensively ... like a 3 hour walk. .. I then go into a deep sleep for 3 hours. My bg is around 4.1 before I become 'comatose '(?). Although I've had a 3 hour gt test I'm not convinced that my levels don't fall below 4 more often. I've been prescribed metformin which I understand lowers bg. I haven't started taking it yet as I've read it lowers bg and with usual readings in the low 4s it concerns me that it might take it below 4. Any advice /thoughts?

 

[Lamont D]

I'm intrigued as to the symptoms of idiopathic postprandrial syndrome.

Hi @Anderson, welcome to our forum.
I started a thread a couple of years ago about this condition as I came across it when exploring an American university paper.
If you look back a couple of pages of threads in the reactive hypoglycaemia forum, you will find it there. It is on page seven on our forum.

The endocrinologist told me I have idiopathic postprandial syndrome. .. ie my blood sugar stays within normal range. However it is usually in the low 4s before eating and I have had 3.9 recorded a few hours after a hypo. If I exercise extensively ... like a 3 hour walk. .. I then go into a deep sleep for 3 hours. My bg is around 4.1 before I become 'comatose '(?). Although I've had a 3 hour gt test I'm not convinced that my levels don't fall below 4 more often. I've been prescribed metformin which I understand lowers bg. I haven't started taking it yet as I've read it lowers bg and with usual readings in the low 4s it concerns me that it might take it below 4. Any advice /thoughts?

Please feel free to explain how your medical team came to this diagnosis.

Why only a three hours OGTT? I have had quite a few four to five hours eOGTTs.

If you want, I can ask a mod @Brunneria to start your own thread on IPPS?

Metformin is a slow acting drug and should not lower your blood glucose levels as much as you fear, only testing will prove this. The side effects from the drug may cause some discomfort in your system, are you on the SR type of metformin?
Have they give you a glucometer to test yourself?
Do you keep a food diary?
What sort of dietary advice have they given you?

Sorry for all the questions, I'm trying to learn as much as I can about these types of metabolic conditions.
I have a condition called Late Reactive Hypoglycaemia.
It took me over twelve years to get a definitive diagnosis.
How long have you been trying to get to the bottom of what has happened to you?

Please reply, as I said, I'm fascinated.

I don't believe we have had an official diagnosis of Idiopathic post prandial syndrome on the forum.

We will try and help if we can.

Best wishes