Why don't insulin-resistant people experience reactive hypoglycemia?

[Coolifornia]

Hi,

No medic that I have ever seen has shown the slightest interest in my insulin levels, so I have never had a diagnosis of insulin resistance.
In fact, the first measure ever taken was a self funded fasting insulin test around a month ago - which showed... DRUMROLL... the high insulin resistance that I know I have had since childhood.

How do I know this? Well it was kind of inevitable.
All of the following are likely to cause insulin resistance
- childhood onset of RH continuing into adulthood
- polycystic ovary syndrome onset during teens
- a pituitary gland tumour (produces excess prolactin) in my late teens
- medication for the prolactinoma that is known to raise insulin resistance
All of which led to obesity (which raises insulin resistance further)
With Type 2 diabetic level blood glucose arriving a few years ago, some 40 odd years after the dominos started to fall.

Its one of the reasons I am always banging on about T2s and RHers playing a long game.
In my opinion, it really isn’t enough to just control your current symptoms.
Play the long game.
We need to look after ourselves well enough now, so that we delay or reduce the deterioration (from age, stress or other health issues) so that we can continue to have our health for decades. So many of us start young, and have many decades ahead. Might as well enjoy them

Thanks Brunneria, I really appreciate and respect your work on this forum, informing others about how to take preventative measures to keep our RH in control throughout our lives. Prior to finding this forum, nobody had ever told me that RH can lead to diabetes!

 

[Lamont D]

Thanks Brunneria, I really appreciate and respect your work on this forum, informing others about how to take preventative measures to keep our RH in control throughout our lives. Prior to finding this forum, nobody had ever told me that RH can lead to diabetes!

And that is why a controlled dietary regime is important. Having normal fasting levels and hba1c levels can also make you healthier as well as non diabetic.
I found out that having consistent normal levels, helps repair the damage done previously by an uncontrolled rollercoaster ride that the symptoms of RH puts you through.

Best wishes

 

[Catkysydney]

Hi,

No medic that I have ever seen has shown the slightest interest in my insulin levels, so I have never had a diagnosis of insulin resistance.
In fact, the first measure ever taken was a self funded fasting insulin test around a month ago - which showed... DRUMROLL... the high insulin resistance that I know I have had since childhood.

How do I know this? Well it was kind of inevitable.
All of the following are likely to cause insulin resistance
- childhood onset of RH continuing into adulthood
- polycystic ovary syndrome onset during teens
- a pituitary gland tumour (produces excess prolactin) in my late teens
- medication for the prolactinoma that is known to raise insulin resistance
All of which led to obesity (which raises insulin resistance further)
With Type 2 diabetic level blood glucose arriving a few years ago, some 40 odd years after the dominos started to fall.

Its one of the reasons I am always banging on about T2s and RHers playing a long game.
In my opinion, it really isn’t enough to just control your current symptoms.
Play the long game.
We need to look after ourselves well enough now, so that we delay or reduce the deterioration (from age, stress or other health issues) so that we can continue to have our health for decades. So many of us start young, and have many decades ahead. Might as well enjoy them

Hi @Brunneria,

You said,

“All of the following are likely to cause insulin resistance
- childhood onset of RH continuing into adulthood
- polycystic ovary syndrome onset during teens
- a pituitary gland tumour (produces excess prolactin) in my late teens
- medication for the prolactinoma that is known to raise insulin resistance”

I had the first one ( childhood ... ) and I had an ovarian cyst...

These are likely to cause insulin resistance..

So I have insulin resistance. It leads hyperglycemia, right ? I have after eating. Then after 4 hours, I had hypoglycemia.

I am not obese ( 158cm 54kg ).

It is very complicated for me...

I sincerely appreciate your knowledge and experience !

I have been learning about blood glucose and insulin in this Forum. Thank you very much !!

With best Wishes

 

[Lamont D]

Hi @Brunneria,

You said,

“All of the following are likely to cause insulin resistance
- childhood onset of RH continuing into adulthood
- polycystic ovary syndrome onset during teens
- a pituitary gland tumour (produces excess prolactin) in my late teens
- medication for the prolactinoma that is known to raise insulin resistance”

I had the first one ( childhood ... ) and I had an ovarian cyst...

These are likely to cause insulin resistance..

So I have insulin resistance. It leads hyperglycemia, right ? I have after eating. Then after 4 hours, I had hypoglycemia.

I am not obese ( 158cm 54kg ).

It is very complicated for me...

I sincerely appreciate your knowledge and experience !

I have been learning about blood glucose and insulin in this Forum. Thank you very much !!

With best Wishes

If you have insulin resistance, your pancreas will over produce too much insulin, but it doesn't get rid of the glucose, so you have to produce too much to get rid of the glucose derived from even lower carb meals. You will get Hyperglycaemia because of the insulin resistance. The likelihood that because of hyperglycaemia and insulin resistance will lead to symptoms of a T2 nature. The likelihood of hyperinsulinaemia as a condition may happen because of the above.
Too much glucose, quickly, will swamp the insulin, your trigger for more insulin, an overshoot, will not be effective immediately, but hours later.
So when you eat a too high percentage of carbs and sugars in a meal, the gastric dumping causes too much glucose, the weak initial insulin response is not enough, that triggers a secondary insulin response, the overshoot, that drives the blood sugar levels down into hypoglycaemia.
The viscous cycle of insulin resistance, insulin overshoot, gastric dumping, is why all the symptoms are awful and the cause of hypoglycaemia!

That is why a very low carb diet works, it doesn't trigger the insulin overshoot.
No hyper, no hypo.

Hope that helps.

Best wishes

 

[HSSS]

I am one of these. Right from diagnosis I have had good fasting and pre-meal levels, weekly averages never out of the 5s, usually the lower 5's and sometimes 4's. I can't say the same for my post meal levels at the beginning of my journey. As is so often said on this forum. We are all different. If diagnosis were made entirely on a fasting level, I would never have been diagnosed.

I did an OGTT several years ago. At the time the reports describe impaired glucose tolerance as a result and also impaired fasting glucose. The former generally too high numbers after glucose and the latter which relates specifically to fasting numbers. One or other or both were possible and both classed then (in Australia) as prediabetic. It’s only through digging amongst old paperwork I found this. I was told “normal” after this test despite failing both measures.

 

[lindisfel]

It all depends! Short of doing all the blood work we can't be sure of cause and effect.

I think in my case it is a blunted first phase insulin response from my pancreas.
Until my blood glucose has been high enough for long enough, the pancreas does not produce enough insulin! Then an avalanche process take place and the flood gates of insulin poor out to produce an hypo!
I can verify I have never flaked out but hypos caused me to fall down on a number of occasions a few years ago, which in turn caused me to have an hernia, which was only repaired Wednesday last.
Hypos are no joke and should not be treated lightly.
regards
Derek

 

[Brunneria]

It all depends! Short of doing all the blood work we can't be sure of cause and effect.

I think in my case it is a blunted first phase insulin response from my pancreas.
Until my blood glucose has been high enough for long enough, the pancreas does not produce enough insulin! Then an avalanche process take place and the flood gates of insulin poor out to produce an hypo!
I can verify I have never flaked out but hypos caused me to fall down on a number of occasions a few years ago, which in turn caused me to have an hernia, which was only repaired Wednesday last.
Hypos are no joke and should not be treated lightly.
regards
Derek

Good to hear you’ve had the hernia op! Hope it went smoothly, and you are recovering well?

 

[kitedoc]

Here is a graph of prolonged OGTT results. Note the one in red.
BSL of 100 mg/dL = 4.67 mmol/ , 50 mg/dL = 2.8 mmol/l where according to the Home page
hypoglycaemia is less than 4 mmol/l or less than 3.6 mmol.\l
At this stage I have not found any mixed meal GTTs to illustrate the same thing.

 

[Lamont D]

Here is a graph of prolonged OGTT results. Note the one in red.
BSL of 100 mg/dL = 4.67 mmol/ , 50 mg/dL = 2.8 mmol/l where according to the Home page
hypoglycaemia is less than 4 mmol/l or less than 3.6 mmol.\l
At this stage I have not found any mixed meal GTTs to illustrate the same thing.

View attachment 32211

That is a very good graph of what happens with Hypoglycaemia.
In my graph during my third eOGTT, and I understand from what I have read, along with glucose dumping, I have a double spike, from my initial weak insulin response, then a little dip, then spike again, then usually around the 45 minutes/ one hour mark, the insulin overshoot takes effect, which from three to four hours later, causes the drop into hypo levels.
My readings from my third test.
8.30. 4.8. (Pre test)
9.00. 9.5
9.30 12.6
10.00. 13.4
10.30. 11.2
11.00. 11.5
11.30. 9.2
12.00. 4.4
12.30. 3.7
1.00. 3.0 (test stopped)

During my last eOGTT, the spike is lower, I still have the double spike, the timing of the overshoot is later, the drop is less severe, but I still go hypo. This was because my test to show the effect that sitagliptin 100mg has on my blood glucose levels.

My last eOGTT test results

8.30. 5.3mmols (pre test)
9.00. 7.2
9.30. 8.7
10.00 8.7
10.30 8.0
11.00 5.7
11.30 6.0
12.00 4.0
12.30 3.7
1 00. 3.4 (test stopped)
I wish I could have kept my first eOGTT results.
My second was similar as the third.
My fourth was more comprehensive. This was done because of the introduction of sitagliptin 50mg, but was not as effective as 100mg.
My readings on my fourth test were every fifteen minutes and clearly shows the double spike and the descent into hypo levels.

 

[Catkysydney]

Here is a graph of prolonged OGTT results. Note the one in red.
BSL of 100 mg/dL = 4.67 mmol/ , 50 mg/dL = 2.8 mmol/l where according to the Home page
hypoglycaemia is less than 4 mmol/l or less than 3.6 mmol.\l
At this stage I have not found any mixed meal GTTs to illustrate the same thing.

View attachment 32211

Hi,

I had 4 hours OGTT in September.

The result was like this.

Result mmol/l
Fasting. 5.1
1hr. 14.1
2hr. 13.1
2.5hr. 10.2
3hr. 5.3
3.5hr. 3.6 Headache
4hr. 3.2 Body Shaking


But the doctor of this pathology said that the blood glucose is not lower than 3.0, so this is not hypoglycemia.


I read various websites, they say it is hypoglycemia if the blood glucose is lower than 4.0 with symptoms.


I think it is hypoglycemia if the blood glucose level is lower than normal range ( 4.4 - 6.6 ).


Thank you very much for your information !

 

[Lamont D]

Hi,

I had 4 hours OGTT in September.

The result was like this.

Result mmol/l
Fasting. 5.1
1hr. 14.1
2hr. 13.1
2.5hr. 10.2
3hr. 5.3
3.5hr. 3.6 Headache
4hr. 3.2 Body Shaking


But the doctor of this pathology said that the blood glucose is not lower than 3.0, so this is not hypoglycemia.


I read various websites, they say it is hypoglycemia if the blood glucose is lower than 4.0 with symptoms.


I think it is hypoglycemia if the blood glucose level is lower than normal range ( 4.4 - 6.6 ).


Thank you very much for your information !

My endocrinologist said that he considered a hypo for Hypoglycaemia, would be under 3.5mmols!

I think, logically, because of the variance in getting accurate readings, with a glucometer, it would be nonsensical to say that a hypo is a certain level. If you have any symptoms and its lower than 4mmols, it's a hypo!
And, if I was getting episodes of symptoms under 4mmols, I would treat it as a hypo!

Best wishes

 

[Lamont D]

Hi,

I had 4 hours OGTT in September.

The result was like this.

Result mmol/l
Fasting. 5.1
1hr. 14.1
2hr. 13.1
2.5hr. 10.2
3hr. 5.3
3.5hr. 3.6 Headache
4hr. 3.2 Body Shaking


But the doctor of this pathology said that the blood glucose is not lower than 3.0, so this is not hypoglycemia.


I would definitely recommend that you see a different doctor because this is very similar to what my eOGTT readings were!
The high spike, the hypo, after four hours, it's a pity they didn't continue for another half hour! I believe that you would have gone lower still!

Best wishes

 

[Catkysydney]

My endocrinologist said that he considered a hypo for Hypoglycaemia, would be under 3.5mmols!

I think, logically, because of the variance in getting accurate readings, with a glucometer, it would be nonsensical to say that a hypo is a certain level. If you have any symptoms and its lower than 4mmols, it's a hypo!
And, if I was getting episodes of symptoms under 4mmols, I would treat it as a hypo!

Best wishes

Hi Lamont D,

Thank you very much !! Your knowledge is so valuable to me !! I feel clear !!
Thank you again !!

Best wishes

 

[Lamont D]

Hi Lamont D,

Thank you very much !! Your knowledge is so valuable to me !! I feel clear !!
Thank you again !!

Best wishes

Because I went through all the confusion and battling back to good health through good control, the experience and knowledge I have gained is all due to others, I'm just a conduit to try and help those like me, that are also struggling with their health!

My best wishes and please do ask questions I'm sure will arise during this time.

 

[Catkysydney]

Because I went through all the confusion and battling back to good health through good control, the experience and knowledge I have gained is all due to others, I'm just a conduit to try and help those like me, that are also struggling with their health!

My best wishes and please do ask questions I'm sure will arise during this time.

Hi Lamont D,

You are fantastic !! So helpful !! Especially I am in very much like your condition....

Blood glucose spike, hyperglycemia and hypoglycemia!

Also lactose and gluten intolerance.... very difficult.

You are on Sitagliptin, right ? Me, too.
Are you taking any other medicine ?

I had a lot of sever side effect from other diabetes medicines such as Metformin, gliclazide and empagliflozin...

Only Sitagliptin is working for me, but I still got high blood glucose when I ate pasta even a half size.. I may have to stop eating pasta.

Your story about insulin resistance and hypoglycemia is eye opener !!

Thank you very much for your great contribution in this Forum !!

Best Wishes.

 

[kitedoc]

Can I just clarify @Catkysydney ? Do you have coeliac disease?
It is just that gluten intolerance can be a confusing name/entity.

 

[kokhongw]

Hi,

I had 4 hours OGTT in September.

The result was like this.

Result mmol/l
Fasting. 5.1
1hr. 14.1
2hr. 13.1
2.5hr. 10.2
3hr. 5.3
3.5hr. 3.6 Headache
4hr. 3.2 Body Shaking


But the doctor of this pathology said that the blood glucose is not lower than 3.0, so this is not hypoglycemia.


I read various websites, they say it is hypoglycemia if the blood glucose is lower than 4.0 with symptoms.


I think it is hypoglycemia if the blood glucose level is lower than normal range ( 4.4 - 6.6 ).


Thank you very much for your information !

Often times the hypo symptoms occur due to the sharp drop in glucose level...

Freestyle Libre gives a good view of how sharp the rise and fall may be...even though glucose was above 4 mmol, the shakes and hunger was definitely there...

 

[Catkysydney]

Can I just clarify @Catkysydney ? Do you have coeliac disease?
It is just that gluten intolerance can be a confusing name/entity.

Hi kitedoc,

No, I don’t have coeliac. But I have gluten intolerance.. when I eat gluten, I will get diarrhea and other uncomfortable symptoms.

I had gastroscopy and colonoscopy many times to find out why I had diarrhea frequently.. then the doctor found lactose intolerance, bile reflux and also I don’t have an enzyme to digest fat/oil.

So I don’t have coeliac, but gluten intolerance.

Best wishes

 

[Catkysydney]

Often times the hypo symptoms occur due to the sharp drop in glucose level...

Freestyle Libre gives a good view of how sharp the rise and fall may be...even though glucose was above 4 mmol, the shakes and hunger was definitely there...

View attachment 32273

Hi kokhongw,

Thank you very much for your information !!

Freestyle Libre is an app ? This graph is very good !!

I use Dario app to record my blood glucose and it has a graph chart function, but yours looks better...

Best Wishes

 

[Lamont D]

Hi Lamont D,

You are fantastic !! So helpful !! Especially I am in very much like your condition....

Blood glucose spike, hyperglycemia and hypoglycemia!

Also lactose and gluten intolerance.... very difficult.

You are on Sitagliptin, right ? Me, too.
Are you taking any other medicine ?

I had a lot of sever side effect from other diabetes medicines such as Metformin, gliclazide and empagliflozin...

Only Sitagliptin is working for me, but I still got high blood glucose when I ate pasta even a half size.. I may have to stop eating pasta.

Your story about insulin resistance and hypoglycemia is eye opener !!

Thank you very much for your great contribution in this Forum !!

Best Wishes.

Yes, I'm on sitagliptin, 100mg per day!
The only other meds I'm on is Irbesartan for hypertension, aspirin for blood thinning, and a antihistamine for itching at night! My health is good and I don't want to change after so long on the meds.
I have to be careful with meds because of the amount of lactose in tablets, so my aspirin is enterric, the others are fine!
Metformin and other drugs never worked for me, statin's crippled me!
Because my GPS didn't understand my symptoms and of course the misdiagnosis, they assumed that it was my diagnosis of T2, that was the cause of all my symptoms!

I would stop eating anything like pasta, the so called healthy carbs, will still spike you, and what we are trying to achieve is no spikes because that triggers the hypos!

Keep asking,

Best wishes