Can't get out of this hypo.

[Quietmindstitcher_]

Hi all. I have been lurking for a while and I need some help today please. I have hypoglycaemia. Both reactive after food and overnight after 5-6 hours without food. I had a gastric bypass five years ago and this is thought to be the cause of it. I have a fantastic endocrinologist who is working hard with me to resolve this. I am taking adizem (a calcium channel blocker) and yesterday I started sitagliptin. I took the sitagliptin at tea time. Great night - first night without a hypo in three. Months! BUT - today has been a really tough day. I went hypo after breakfast and have basically stayed there all day. I have even tried fruit juice and oatcakes; glucose tablets (two) and milk as well as my normal high protein low fat solutions.

So, what can I do to bring my levels up? I wear a CGM and have confirmed the readings with my accu-chek - I am bouncing from 2.1 up to the dizzy heights of 4.0 and then drop down to 3.4 and steadily decline all the way back to the high 2,s. Could the sitagliptin have caused this? I was so pleased to be hypo free overnight! Any ideas?

 

[Lamont D]

Hi, welcome to our forum!

Yes, your Hypoglycaemia is probably the bypass, I have heard of this happening.

Have you been into the fours at all since your morning reading?.
It is unusual to be that low especially after all the carbs you have eaten.

Sitagliptin is a blood glucose lowering drug but it is an inhibitor and helps me not spiking. It very well could be the meds.
You do need to phone your endocrinologist, if he is like mine, he will tell you to stop.

Has anyone explained why RH actually occurs?
Are you still having a lot of carbs in your diet, you do know that most carbs trigger the hyper because of the sugar rush followed by the excess insulin, which creates the hypo? Having the com should give you an idea where you should be!
I have to stay in the area between 4-6 mmols, and that makes me feel great.
I don't hyper, so I don't hypo!

Let us know what your diet plan is please!

 

[Brunneria]

Hi and welcome!

I am afraid this is waaaay outside my area of experience, both the gastric bypass and the sitagliptin, so please take this as a comment stemming from common sense, rather than knowledge, if you see what i mean.

Having looked up sitagliptin, i found this
http://www.rxlist.com/januvia-drug/clinical-pharmacology.htm
Which suggests that Sitagliptin has a half life of a little over 12 hours. With a peak effect at 3-4 hours. So it will lose half effectiveness at 12 hrs, then another 1/2 after another 12 hrs, so after 24 hrs it will still be 1/4 effective, allowing for a slow build over several days, if you take a tablet daily. At least, that is how i understand it. (I am on a med called Cabergoline, which has a half life of several days, so i have a similar 'buildup' and only take a tab twice a week).

So, long story short - i wouldn't take another tab tonight - unless you have discussed it with someone a lot more knowledgeable than me!

You may find they suggest a smaller dose, and maybe alternate days - but that is pure speculation.

Regarding the hypo, if you are used to high protein, low fat, you have probably been managing your hypos using that? Can you increase the portions? Or the frequency?

My instinctive reaction would be to use protein (medium), fat (slow) AND carbs (fast) - like pate on a cracker, or ham and cheese, or even (dare i say it) dark chocolate.

But you know your body best, so those suggestions may not work for you.

Hope that helps. You must be feeling pretty rough.

I would also be setting the alarm to wake up and check bg a few times during the night.

 

[tooner9]

i had a gastric bypass nearly four years ago im either reactive hyoglycemia or hyperinsulinaemic hypoglycaemia im just waiting on my OGTT results its been a nightmare two years ive had


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[Lamont D]

i had a gastric bypass nearly four years ago im either reactive hyoglycemia or hyperinsulinaemic hypoglycaemia im just waiting on my OGTT results its been a nightmare two years ive had


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Hi @tooner9 , how are you coping?

 

[tooner9]

so so just waiting for test results to clarify whats wrong with me


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[Lamont D]

It will get better after diagnosis, then you can move forward.

Best wishes!

 

[Quietmindstitcher_]

EThanks guys. Much appreciated. I had two more glucose tablets and some more orange juice and am on my way back up. I have hit 7! So I have now eaten some bologna use sauce (no pasta) and some, caluiflower to keep it up.Much better. I am trying to keep below 9 from food spikes as that seems to be the level that I cause increased insulin release. Tooner9 - I am interested they did an OGTT on you - my endo - who specialises in diabetes and obesity and bariatric surgery said they no longer do them on bypass patients as the are not accurate? He did say though that they have almost reached consensus on what post bariatric levels should be, so maybe you are treated in one of the centres providing data? My endo calls what I have hyperinsulinaemic hypoglycaemia rather than reactive - I think because I also hypo overnight - he explained that the RH had been happening for quite a long time according to my symptoms and that eventually leads to overnight hypos too. I hope you get some help soon. when I wore the CGM my endo lent me, I was hypo 35-85% of the time. That has dropped down to 20-30% of the time with the adizem but he believes he can get me hypo free. I am usually hypo free during the day as I manage my food - complex carbs (some not all), protein and fat, well. Also the CGM alerts me to fast rising levels so I can catch the drop on the way back. It also alerts me when I am going low. This is tough guys isn't it? I feel so out of control. I have been off work for the last three Mitch's - am desperate to go back and they won't have me until I am hypo free!

 

[Quietmindstitcher_]

Months, not Mitch's! What even IS a Mitch!


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[Quietmindstitcher_]

Nosher - you asked about food. I am not too adventurous at the moment - and to be honest, that is also getting me down as well as the roller coaster bloods - you are right Brunneria - today has been a rough day! So, I start the day with peanut butter on half a slice of rye and seed bread. That works for me, but I would like to find a no carb breakfast. During the day I eat cold meats, cheeses, home made natural yogurt - sometimes I add palatinose to it and other times just plain. I can tolerate half a small Apple without a spike - but can't manage even one fresh apricot! My son made me a strawberry, mango, banana and coconut milk smoothie and it did nothing to my blood sugar level (I did only have a small glass full)yay). Porridge and jacket potatoes are food of the devil for me. I have had to consign crumpets to the past (sob). Potatoes in any shape or form are out. I can tolerate rye crackers. That is about all have tried tone honest. I ant get out of a hypo without simple carbs, but I have learnt that 3 jelly a
Babies, or two glucose tabs is enough or else I leap up. Any suggestions?


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[Quietmindstitcher_]

Oh and Brunneria - thank you so much for looking up sitagliptin for me. I can't believe I didn't think of doing that myself. I blame hypo-head!


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[Lamont D]

Nosher - you asked about food. I am not too adventurous at the moment - and to be honest, that is also getting me down as well as the roller coaster bloods - you are right Brunneria - today has been a rough day! So, I start the day with peanut butter on half a slice of rye and seed bread. That works for me, but I would like to find a no carb breakfast. During the day I eat cold meats, cheeses, home made natural yogurt - sometimes I add palatinose to it and other times just plain. I can tolerate half a small Apple without a spike - but can't manage even one fresh apricot! My son made me a strawberry, mango, banana and coconut milk smoothie and it did nothing to my blood sugar level (I did only have a small glass full)yay). Porridge and jacket potatoes are food of the devil for me. I have had to consign crumpets to the past (sob). Potatoes in any shape or form are out. I can tolerate rye crackers. That is about all have tried tone honest. I ant get out of a hypo without simple carbs, but I have learnt that 3 jelly a
Babies, or two glucose tabs is enough or else I leap up. Any suggestions?


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What I use to do was have a cuppa, black no sugar, and a rich tea biscuit!
That would bring it up slowly and later from a suggestion by Brun, to eat a small salad or low carb meal after about 15 minutes later.
That way it does exacerbate the fluctuating blood glucose levels if you use glucose or sweets and such.

 

[Quietmindstitcher_]

How slowly is slowly nosher?


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[Lamont D]

Once you recognise the symptoms and you are probably not at that stage without the cgm. You have your whatever it is too make your blood levels rise slowly and then check every fifteen minutes. You are nudging it up so you don't go above normal levels. So if at fifteen minutes you are ok, eat a snack, if not eat another whatever you need to nudge your bloods up, then check again. Then eat!

How are you feeling now?

 

[Quietmindstitcher_]

Much much better thanks. Steady at 5.0 now. What a stinky day!


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[Quietmindstitcher_]

And you are right - I can't tell if I am hypo/hyper or in the good zone. I feel awful when the levels are changing rapidly and I feel awful if I am hypo for a long time, but otherwise I just have to guess - that is why I have the CGM. My endo assures me that once I go 48 hours is so without a hypo I will get my awareness back.


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[Lamont D]

Glad of that!

I used to call that period my hypo hell!

Off to bed, got work in the morning!

Hoping for a good night's rest.
If you want some heavy reading about RH our forum has a lot of information and also the other posters.
I also have a blog about me and my thoughts, it tells my story!

Keep us updated.

Our unique club keeps growing.

If I haven't said it before, welcome to our forum!

 

[Brunneria]

How are you feeling this morning?

 

[Quietmindstitcher_]

Hi Brunneria - it has been a long dopey day! I am like that after a bad day. How are you?


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[Brunneria]

Good thanks.
Hopefully the Sitagliptin is out of your system now?
Have you been in contact with your consultant about continuing to take it?