So I was recently diagnosed with reactive hypoglycemia by my endocrinologist. I was also diagnosed as type 2 diabetic in 2014 and my episodes of hypoglycemia started roughly around the same time. I was initially put on only metformin for my diabetes which doesnt cause hypos, so I questioned my doctor as to why I was having hypos and she didnt know. So I've been managing them on my own for 5 years or so thinking it was part of being a type 2 diabetic. I recently found out this was not the case. Over this time I've worked at managing my blood sugars and have brought my hba1c down to 5.2 mmol. My fasting glucose is usually 4.8 mmol and I rarely get any reading above 8 even after a big meal. I test regularly every day. Fasting, before a meal, 1 hr after and 2 hrs after. Theres usually not any spike. It may be around 6-7 mmol at the one hour mark and back to between 4 and 5.5 mmol at the 2 hr mark. Over the next 3 or more hours it will keep dropping til I'm hypo. I get symptoms at the 3.7mmol mark and it sometimes hits 2 to 2.5. I eat really low GI, avoid sugar etc and I'm confused because I thought RH usually happened after a big carb intake and a sugar spike within 4 hours of eating? Mine seems to happen randomly up to 6 hrs after eating a low carb meal with no spike in blood sugar. I recently had a 3 hr OGTT done which showed a fasting glucose of 4.6mmol and insulin of 45 mU/L. The 1 hour test showed 9.5 glucose and 220 mU/l insulin. 2 hr was 6.1 glucose, 382 insulin and 3 hr was 2.9 glucose, 93 insulin. As far as I can tell, the glucose readings are fairly good for a diabetic and I was hypo at the 3hr mark. I'm not sure how to interpret the insulin readings and my Gp didnt know either. My diagnosis of RH came from this test but my endocrinologist didnt bother to tell me the diagnosis herself, she just sent it in a letter to the GP. She (my endo) wants me to start on injectable Exenatide, but I read that it increases insulin and may cause hypos? Does anyone know why I've been prescribed that? Or what's going on? I'm sorry for the essay and excessive info, but I'm confused and pretty frustrated.
Confused about RH diagnosis and treatment
- Thread starter Leshara86
- Start Date
- Messages
- 21,889
- Type of diabetes
- Type 2
- Treatment type
- Diet only
Hi and welcome 
This is speculation, but I am wondering whether you are having to produce large amounts of insulin in order to keep your blood glucose in the 4-7 range.
This insulin is likely what is causing the hypo.
You may find in informative to look up the relationship between insulin and glucagon. Obviously it is much more complex than I can explain here (and I don't fully grasp the complexities myself), but glucagon is the antagonist that is produced to stop insulin from working. So our bodies should balance glucose levels by using insulin and glucagon to firstly tuck excess glucose away into the cells, and then halt the action of the insulin when it is no longer needed.
RH is a complex issue and each RHer seems to experience it differently. In my own case I know that I have insulin resistance, and suspect that my glucagon production is somehow dysfunctional. But I am not in a position to speculate if any of that is relevant to you.
Perhaps you could also do some googling on the insulin levels shown by your test results. They are not in the same units as my own fasting insulin test result, so again I cannot speculate. But if you manage to find the 'normal range' of your units, both fasting, and after food, and during a glucose tolerance test, you will be able to make an educated guess, and hopefully have an educated discussion with your endocrinologist, about whether you have insulin resistance, or not.
Hope that helps.
This is speculation, but I am wondering whether you are having to produce large amounts of insulin in order to keep your blood glucose in the 4-7 range.
This insulin is likely what is causing the hypo.
You may find in informative to look up the relationship between insulin and glucagon. Obviously it is much more complex than I can explain here (and I don't fully grasp the complexities myself), but glucagon is the antagonist that is produced to stop insulin from working. So our bodies should balance glucose levels by using insulin and glucagon to firstly tuck excess glucose away into the cells, and then halt the action of the insulin when it is no longer needed.
RH is a complex issue and each RHer seems to experience it differently. In my own case I know that I have insulin resistance, and suspect that my glucagon production is somehow dysfunctional. But I am not in a position to speculate if any of that is relevant to you.
Perhaps you could also do some googling on the insulin levels shown by your test results. They are not in the same units as my own fasting insulin test result, so again I cannot speculate. But if you manage to find the 'normal range' of your units, both fasting, and after food, and during a glucose tolerance test, you will be able to make an educated guess, and hopefully have an educated discussion with your endocrinologist, about whether you have insulin resistance, or not.
Hope that helps.
Lamont D
Oracle
- Messages
- 15,939
- Type of diabetes
- Reactive hypoglycemia
- Treatment type
- I do not have diabetes
Hi, everything I've read in your post, is typically a patient with reactive hypoglycaemia, on a low GI diet, but still keeps going hypo, because of the excess insulin levels because of the reactive part of the overshoot of insulin to counter the quick glucose derived from the carbs you are still eating because low GI is still carbs, I am essentially the same, with most cases of RH, you will be carb intolerant. And only very low carb meals will not cause the hypos.
Your fasting levels are non diabetic, your Hba1c levels will be probably non diabetic, you may not be T2 with as I was misdiagnosed with T2, before my endocrinologist told me, I couldn't be diabetic. Do ask your endocrinologist or GP, if it's possible you are not.
I'm not too sure why you have been asked to try exenatide, the only reason is it increases your insulin response and slows down glucose production.
In my experience, there is no magic pill or drug that has been successfully tested to stop the process of going hypo after carbs.
I myself have been tested for the use of Sitagliptin, a similar drug as exenatide, but I still go hypo eating carbs despite this drug.
RH is essentially a food related condition, so your dietary intake can stop or drastically reduce the episodes of Hypoglycaemia, if you control the amount of carbs eaten with each meal.
I have found that most doctors, cannot grasp the significance of carbs on a reactive hypoglycaemic patient, we cannot cope with even so called healthy, complex carbs.
I have often referred the condition as carb intolerant. Similar to a food allergy because of the likelihood of feeling really awful and being ill from the food we have been told to eat as part of a healthy diet. But it's not for me and many others. I have learned to avoid these foods. And it has worked!
Amazingly, without potatoes, rice, wheat, oats and other grains, and of course, sugar or a few more others that I'm intolerant to, such as dairy, some vegetables, vegetable oils. So you can see, I need to be really careful. So, I have been eating like this for over five years since diagnosis and I haven't had a hypo in all this time, because I found that not eating those foods , I'm fit and healthy.
I would advise trying a dietary change rather than the drug treatment, see how that goes, but I have no doubt you will have opposition from your medical team.
RH is controllable by diet and if you get it right, your health and well-being will improve as well.
Best wishes
