Type 2 Sudden drop in blood sugar. What is going on?

[Roger5544]

My blood sugar levels have undergone quite a dramatic drop in recent months and I was wondering if anyone can help explain this. First some background history - apologies if this is drawn out.

I was diagnosed with T2 diabetes in July 2014. This was a complete shock as I was not overweight, have never been overweight, exercise regularly and to my knowledge there is no history of diabetes in my family. My diet was reasonably balanced but I was eating quite a lot of fruit. I was prescribed metformin and subsequently took more notice of food labels and cut back on sweet foods.

Prior to T2 diagnosis I had an itchy rash on my scalp and later on elbows, hips, knees and buttocks (the significance of this will become apparent later). My GP treated this as eczema, thereon prescribing various creams and occasionally antihistamine tablets. This rash would occasionally settle but never go completely and kept flaring up.

History of HbA1c readings, weight, diagnoses, medication, etc:-

July 2014: T2 diagnosis, HbA1c 55, 12st 5lbs (6ft tall)

Aug 2014: HbA1c 51, 11st 11lbs.

Sept 2014: switched from metformin to gliclazide.

Jan 2015: HbA1c 49, 12st 3lbs

June 2015: HbA1c 47

Jan 2016: HbA1c 43, 12st 4lbs

Feb 2016: Stopped gliclazide medication on recommendation of diabetic nurse as just above T2 threshold.

Apr 2016: HbA1c 45

Jan 2017: HbA1c 44, 11st 4lbs. - a loss of 1 stone from the previous year. I had not been dieting and just thought the loss was due to increased activity since my retirement in April 2016, exercising every day with various activities (swimming, gym, cycling, spin classes, walking)

July 2017: HbA1c 44

Aug 2017: Due to no progress with itchy rash and doubts if it was eczema I requested a consultation with a dermatologist. Skin biopsy taken for analysis.

Oct 2017: Biopsy result indicated Dermatitis Herpetiformis (not eczema) which is a manifestation of Coeliacs Disease and is due to gluten intolerance. Consultant prescribed Dapsone. Within 2 weeks the skin settled down and rash virtually disappeared. However I need to continue taking Dapsone and require regular blood tests to monitor side effects. I have subsequently become anaemic.

Nov 2017: HbA1c 30 - a significant reduction since July!

Jan 2018: Further blood test organised by my GP indicates consistency with Coelliacs Disease. Started gluten free diet.

Jan 2018: HbA1c 27, 11st 5lbs. Weight stable over 12 months but further drop in BG! Diabetic nurse advised that my T2 diabetes is in remission.

Whilst I am pleased with the drop in BG levels over the last 6 months I am at a loss to explain the reason(s). At first the diabetic nurse said it was due to my weight loss, but she retracted this when I pointed out that the HbA1c levels were consistent (43, 45, 44) from Jan 2016 to Jul 2017 when I had lost the weight. I am wondering now if my weight loss was not due to increased exercise but due to Coelliacs which I may have had for over 3 years.

I have also queried if the Dapsone medication could have lowered my blood sugar but my consultant has dismissed that.

I would be grateful if anyone can offer some explanation for this significant drop in HbA1c and what are the consequences if it continues to fall?

 

[Rachox]

People more expert than me will explain this more, but I think the fact that you’re anaemic may make your HbA1c readings inaccurate.

 

[Bluetit1802]

Hi,

You mentioned anaemia and that jumped out at me. Do you know what type of anaemia you have, and what treatment? It is well known, and well documented, that with certain types of anaemia the HbA1c will be lower than expected. Your nurse should have been aware of this. The HbA1c relies on our red blood cells being normal, and living the standard 120 days. In certain types of anaemia this is not the case.

http://www.ngsp.org/factors.asp
http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20130320091936685340&linkID=75946&cook=yes

I'm not saying that is the reason for your sudden unexpected (and huge) drop in HbA1c, but it could be. It depends on what treatments and what type of anaemia, and other factors.

You didn't have any blood transfusions did you?

 

[Roger5544]

I've full blood count tests (3 in last 3 months, mainly to monitor effect of medication) which indicated red blood cell count below the normal range, pointing to anaemia. Both the consultant dermatologist and GP advised it was not low enough to need treatment. I was unaware that this could affect HbA1c but would have expected GP/diabetic nurse to pick up on this. I need to contact my GP to discuss this further.
I've not had any blood transfusions.
Thanks for your help.

 

[Petecavo]

Dear Roger ,
Just over a year ago you posted the following:-

My blood sugar levels have undergone quite a dramatic drop in recent months and I was wondering if anyone can help explain this. First some background history - apologies if this is drawn out.

I was diagnosed with T2 diabetes in July 2014. This was a complete shock as I was not overweight, have never been overweight, exercise regularly and to my knowledge there is no history of diabetes in my family. My diet was reasonably balanced but I was eating quite a lot of fruit. I was prescribed metformin and subsequently took more notice of food labels and cut back on sweet foods.

Prior to T2 diagnosis I had an itchy rash on my scalp and later on elbows, hips, knees and buttocks (the significance of this will become apparent later). My GP treated this as eczema, thereon prescribing various creams and occasionally antihistamine tablets. This rash would occasionally settle but never go completely and kept flaring up.

History of HbA1c readings, weight, diagnoses, medication, etc:-

July 2014: T2 diagnosis, HbA1c 55, 12st 5lbs (6ft tall)

Aug 2014: HbA1c 51, 11st 11lbs.

Sept 2014: switched from metformin to gliclazide.

Jan 2015: HbA1c 49, 12st 3lbs

June 2015: HbA1c 47

Jan 2016: HbA1c 43, 12st 4lbs

Feb 2016: Stopped gliclazide medication on recommendation of diabetic nurse as just above T2 threshold.

Apr 2016: HbA1c 45

Jan 2017: HbA1c 44, 11st 4lbs. - a loss of 1 stone from the previous year. I had not been dieting and just thought the loss was due to increased activity since my retirement in April 2016, exercising every day with various activities (swimming, gym, cycling, spin classes, walking)

July 2017: HbA1c 44

Aug 2017: Due to no progress with itchy rash and doubts if it was eczema I requested a consultation with a dermatologist. Skin biopsy taken for analysis.

Oct 2017: Biopsy result indicated Dermatitis Herpetiformis (not eczema) which is a manifestation of Coeliacs Disease and is due to gluten intolerance. Consultant prescribed Dapsone. Within 2 weeks the skin settled down and rash virtually disappeared. However I need to continue taking Dapsone and require regular blood tests to monitor side effects. I have subsequently become anaemic.

Nov 2017: HbA1c 30 - a significant reduction since July!

Jan 2018: Further blood test organised by my GP indicates consistency with Coelliacs Disease. Started gluten free diet.

Jan 2018: HbA1c 27, 11st 5lbs. Weight stable over 12 months but further drop in BG! Diabetic nurse advised that my T2 diabetes is in remission.

Whilst I am pleased with the drop in BG levels over the last 6 months I am at a loss to explain the reason(s). At first the diabetic nurse said it was due to my weight loss, but she retracted this when I pointed out that the HbA1c levels were consistent (43, 45, 44) from Jan 2016 to Jul 2017 when I had lost the weight. I am wondering now if my weight loss was not due to increased exercise but due to Coelliacs which I may have had for over 3 years.

I have also queried if the Dapsone medication could have lowered my blood sugar but my consultant has dismissed that.

I would be grateful if anyone can offer some explanation for this significant drop in HbA1c and what are the consequences if it continues to fall?

Hi Roger
I read your post with interest as my similarities with your case are many.
I noted that your Consultant dismissed Dapsone as a contributing cause, however I have read that in some cases Dapsone CAN cause HBa1c drop.

As a new member of the forum I cannot post links yet however searching:-
Unexpectedly low HbA1c levels in two diabetes patients following dapsone use
would take you to a ncbi page that may explain more.
I do not take Dapsone however I do use Soolantra a topical cream that is used for almost the same symptoms and I too have experienced an unexpected drop in HBa1c.
I was wondering if there was any update to your situation if you would be happy to share it with me so that I may gain some insight into mine.
I would be also to answer any queries you have in reverse also
Kind Regards
Peter

 

[Roger5544]

Dear Roger ,
Just over a year ago you posted the following:-



Hi Roger
I read your post with interest as my similarities with your case are many.
I noted that your Consultant dismissed Dapsone as a contributing cause, however I have read that in some cases Dapsone CAN cause HBa1c drop.

As a new member of the forum I cannot post links yet however searching:-
Unexpectedly low HbA1c levels in two diabetes patients following dapsone use
would take you to a ncbi page that may explain more.
I do not take Dapsone however I do use Soolantra a topical cream that is used for almost the same symptoms and I too have experienced an unexpected drop in HBa1c.
I was wondering if there was any update to your situation if you would be happy to share it with me so that I may gain some insight into mine.
I would be also to answer any queries you have in reverse also
Kind Regards
Peter

Hi Peter,


Here is an update on the situation from my original posting 12 months ago.

I was not convinced with the dermatologist's advice that Dapsone was not affecting the HbA1c test and consequently did some research on the internet. I discovered several medical papers stating that Dapsone (and other medications) can lead to false HbA1c measurements. I discussed this with my GP who advised that it was not a concern and if the levels rise then further investigation would be required. I enquired about an alternative test (fructosamine) but apparently it is not as reliable.

Since my post, it has been confirmed that I have Coeliac Disease and I continued to lose weight throughout the year with a low of 10st 3lbs. The gastroenterologist advised that the weight loss was probably due to a lack of nutrition from food because of the Coeliac Disease but arranged for CT and MRI scans to investigate 'if there was anything else going on'. Fortunately the results were clear. I have subsequently managed to gain some weight to 11 st.

I still have to take Dapsone for the Dermatitis Herpetiformis. I have tried reducing the dose with the hope of being able to wean myself off it, but each time the rash has reappeared. I continue to see the dermatologist every 2 to 3 months and have blood tests to see how the Dapsone is affecting my blood count, etc. Unfortunately there is no cure for Dermatitis Herpetiformis or Coeliac Disease and they just have to be managed.

My HbA1c levels have continued to drop since my original posting 12 months ago. My last reading was 24 in January but has been as low as 21.

Hope this is useful.

 

[Petecavo]

Hi Roger, My sugars have remained at an unexplained low.
1st my doc's dismissed, but now are possibly going to consider Coeliac Disease, as a result of me suggesting it as a possible cause following reading your post - thank you. (this is also suspected from other symptoms that match and that I am anaemic).
I too am also going to try to reduce the topical treatment I take for my rash (soolantra) actrive ingredient Ivermectin. Will update in future with any results. Good luck