“Low” hb1ac … help?

[Happybanana]

Hi all

I’m new to the forum but not newly diagnosed. Initially type 2 but now awaiting both lada and mody testing. My diabetes has been really hard to control - my doctors have struggled to understand it, up and down like a yo-yo so currently waiting the referral to an Endo. I’m in Scotland so I’m gonna be a few months at least.

I’m mid thirties female and overweight according to BMI but not obese. Could defo lose a few pounds - getting there! I’m pretty low carb. But I’m also active - gym 5 times a week, walking and yoga.

I’ve just had my hb1ac come back at 28 My last hba1c before that came back at 62, and the one before 51 and then 48. I get them done every 3 months.
My diabetic nurse went a bit nuts. Saying that it’s far too low, too big a drop and threatening to take me off my meds.

The only main difference between this one and the last is that I started victoza at 0.6, (no other meds) however it says online that victoza shouldn’t cause lows on its own?

Despite the fact I am getting lows (I had a libre self funded until recently but had to stop due to the cost) and I was regularly dipping below 3.3, especially at night (I was unaware if them other than getting an alarm) my nurse still says I shouldn’t be checking my blood sugars. This doesn’t feel right. I’m now left just waiting 3 months for my next one and my nurses advice is .. eat more potatoes?

Would love to hear what you think. I’m a bit baffled and would love some advice or insights.

 

[jonathan183]

Check lows with a finger prick test as CGMs are inaccurate at low and high blood glucose concentrations. GCMs can also cause false low readings if compressed ... it looks like the medication can cause low blood glucose

 

[Happybanana]

Check lows with a finger prick test as CGMs are inaccurate at low and high blood glucose concentrations. GCMs can also cause false low readings if compressed ... it looks like the medication can cause low blood glucose

Thank you! I did check with the finger prick and the lows are accurate. It wasn’t compression lows as I intentionally wore it on the arm I don’t sleep on.

But hb1ac doesn’t lie… I think? Correct me if I’m wrong.

I just don’t get how this has happened.
Victoza is a kind of meh/mediocre medication for diabetes at best and a 0.6 dose is super low - what they give to 10 year olds.

How can it cause my hb1ac to dip “that” low in such a short period of time?
If I was on insulin or something like glipticide then yeah, absolutely. But victoza?!

 

[jonathan183]

If you have genuine hypos its a problem and they should be treated ... the cause needs to be established and addressed. If it's going to be months before you see the specialist maybe you can discuss what options you have available in the meantime ...

 

[Oldvatr]

The incretin mimetics work by effectively jamming a crowbar into the beta cells in the pancreas, and switching them on for much longer than they would naturally. Now there is an automatic mechanism in the beta cells that cause the insulin to switch off when glucose is below about 5 mmol/l so should not cause a hypo. but in some people this mechanism is faulty. You may be one of the unlucky ones that have a lower threshold. It is to do with calcium and potassium levels in the blood, so maybe your potassium is out of whack? Not sure if it going high or low is the culprit, but is a possibility.

The problem is that once the med is injected, then the effect lasts well past the half life for the med which for the early incretins is around 11 hours. compare this to the normal beta cell response to food which is much shorter (typ. one or two hours) So any hypo will tend to last longer than expected.

 

[Happybanana]

If you have genuine hypos its a problem and they should be treated ... the cause needs to be established and addressed. If it's going to be months before you see the specialist maybe you can discuss what options you have available in the meantime ...

But realistically what would that be?

My diabetic nurse just told me (until the last appointment) me that type 2s don’t get hypos… until this recent hb1ac and now she’s angry at me for getting hypos. I’m not on insulin and don’t understand why.

I have no idea why I’m getting them or even when.

Her solution is just more potato but don’t test and it feels dumb.
‍

 

[Happybanana]

The incretin mimetics work by effectively jamming a crowbar into the beta cells in the pancreas, and switching them on for much longer than they would naturally. Now there is an automatic mechanism in the beta cells that cause the insulin to switch off when glucose is below about 5 mmol/l so should not cause a hypo. but in some people this mechanism is faulty. You may be one of the unlucky ones that have a lower threshold. It is to do with calcium and potassium levels in the blood, so maybe your potassium is out of whack? Not sure if it going high or low is the culprit, but is a possibility.

The problem is that once the med is injected, then the effect lasts well past the half life for the med which for the early incretins is around 11 hours. compare this to the normal beta cell response to food which is much shorter (typ. one or two hours) So any hypo will tend to last longer than expected.

Last time they checked my potassium was very low. They checked it twice, but the second time it came back barely in normal range, so they let it go.

I’m on victoza if it helps.
Maybe I should ask for another potassium test?

 

[Oldvatr]

It seems that hypoglycemia can be related to Victoza use. It is not common, but has been recorded. It seems to need another medication such as Metformin for that to happen.

Victoza: Side effects, dosage, alternatives, and more

Victoza (liraglutide) is a brand-name prescription drug that's used to improve blood sugar levels in people with type 2 diabetes. Learn about side effects, warnings, dosage, and more.

www.medicalnewstoday.com

If low potassium then try eating bananas or using a low salt (eg LoSalt) substitue that is potassium based instead of sodium. Don't go mad on that though, it is possible to go the other extreme.

edit to add: It is not shown that Victoxa has been tested with ketogenic diet or ultra low carb diets so if your body is fat adapted, then that may affect the beta cell switches.

 

[MissMuffett]

Do you take electrolytes everyday? Potassium, magnesium ….sorry I forget the other ones. If you’re low carb eating you need these. As Oldvatr has brilliantly explained what might be happening in your case, it might be worth taking electrolytes and see what happens. I think it’s irresponsible of your diabetic nurse to tell you to eat potatoes and don’t test as taking a BG test before eating the potatoes and again 2 hours later could give you lots of information as your insulin response.