Does RH lead to T2?

GrantGam said:

Apologies to butt in, just a wee query... RH; does that go hand in hand with T2 or not?

I can be contacted via PM if this is in anyway a thread derailment

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From my anecdotal experience...it precedes T2D diagnosis and also when we have recovered to normal glucose levels, as its presence in response to high carbs meal indicate that we have not restored/normalized insulin response.

Yes, sometimes ppl (like me) can have T2 and RH simultaneously.

But, like any condition, there is a whole spectrum of severity and a host of other factors in play...

I understand that the progression from RH to T2 often happens because, over time, our bodies just lose the capacity to over produce insulin and then deal with the following hypo. Beta cells burn out. Large amounts of insulin and insulin resistance, and so on.

There are also some misdiagnoses.

@Lamont D was misdiagnosed T2 for years before he got a referral and a correct diagnosis of RH instead. I sometimes wonder how many of us there are, and I guess it is a lot more that we think

GrantGam said:

So the two can go together, but my reasoning for asking (and I should have been clearer) can RH appear in someone who is not T2D? And most importantly, not develop T2D?

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Yes. I believe @Lamont D has been told he was never T2, always RH - although presumably the T2 diagnosis must have been based on diabetic blood glucose levels. Hopefully he will be back to explain his experience.

Sorry if I've got any details wrong, Lamont! Please correct me if I have!

GrantGam said:

Thanks very much.

Again, not with the intention of detailing the thread... But does someone with RH have T2D?

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From the current glucose centric perspective, no.

But from Dr Joseph Kraft insulin centric perspective, the unusual insulin response should be recognized as the first phase of T2D.

GrantGam said:

I read that as everything that's not blue is diabetic?

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Yes. That was his observation and conclusion after performing over 10000 OGTT with insulin assay. There is a fifth response which is Type1, low/no insulin that is not in the diagram.

https://intensivedietarymanagement.com/understanding-joseph-kraft-diabetes-in-situ-t2d-24/

Dr Jason Fung, Prof Grant, Ivor Cummin basically subscribe to this model for T2D/obesity treatment.

GrantGam said:

Thanks for the link

So it would seem that (from the info you've provided) RH and T2D are both forms of diabetes and wholly T2D?

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Yes that would be my interpretation. But currently that is not the views of the mainstream medical community.

Perhaps because there's few drugs if any that effectively the lowers/normalize insulin levels more than fasting or low carbs high fats...

Given that I have RH symptoms since my early teens...it took over 30 years to make that connection after stumbling on it in this forum...most people simply dismissed RH symptoms as being too hungry, just eat some sweet stuff and leave it as that.

Ok, here goes!
Yes, you can have RH and T2!
Yes, you have all the symptoms of t2!
Yes RH can lead to T2
Yes, the levels of hyperglycaemia and hyperinsulinaemia does lead to T2!
Yes, if the symptoms of RH is predominately huperglycaemic, then diagnosis of T2 is given.

There is a difference between the condition of RH. And having the symptoms of RH!
Non diabetic RH is a seperate and totally different diagnosis and does not lead to T2, unless it is ignored.
As I posted earlier, there are many types of RH, which may or not be diagnosed as diabetic.

It is a condition of the pancreas, but you have always normal fasting levels.
The reason why I was diagnosed T2, was because, my glucose levels were higher than diabetic levels because I was constantly eating as a normal person would and my hbaic was in diabetic range. The carbs were feeding the high insulin and high glucose, I developed insulin resistance, the viscous circle continued upto really high levels of hyperglycaemia.
It wasn't until the tests for the reasons of hypoglycaemia, were done, eOGTT, 72 hour fasting and c-peptide and GAD were done, which eliminated other pancreatic conditions, that the diagnosis of 'Late Reactivve hypoglycaemia' was given.
It is non diabetic.

So, no RH does not lead to T2!

The reason why so many RH ers do develop T2 is because of the dietary advice! The eat carbs with every meal thing!
I don't believe that despite all the very low levels of actual research, non diabetic reactive hypoglycaemia, has been given as much thought to it as would other pancreatic conditions. Because most specialist endocrinologists have only seen RH ers with either T2 or a different form of hypoglycaemia.

I do stress that RH is a condition.
But you can have all the symptoms of RH, with other underlying hormonal conditions.
It is Unusual for somebody like me (a man) not to have other hormonal problems as well as RH!

Now @Brunneria has probably had RH for a long time and developed T2, because of the viscious circle of high insulin etc. I believe the only way she can control it is by being in permanent ketosis.

Being in normal blood glucose levels range is the best way to be healthy with RH.

I look forward to the response.

GrantGam said:

Thanks for the link

So it would seem that (from the info you've provided) RH and T2D are both forms of diabetes and wholly T2D?

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No totally wrong assumption

kokhongw said:

From the current glucose centric perspective, no.

But from Dr Joseph Kraft insulin centric perspective, the unusual insulin response should be recognized as the first phase of T2D.

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My curve is different than that!
You do not show in detail the first and secondary insulin response.
You only show the glucose curve.
In diabetics and non diabetics the first insulin response is normal or lacking in enough. The first insulin response is shown as a dip then another peak to spike.
My first insulin response is not there and doesn't show on graph.
Hence the high hyper quickly. (Dumping syndrome)
The second insulin response is abnormal for us RH ers! It is called an overshoot because it keeps producing insulin, where normal and T2 has a low secondary insulin response. Hence the hypo!
It is the second insulin response that diagnosis depends on!

Lamont D said:

My curve is different than that!
You do not show in detail the first and secondary insulin response.
You only show the glucose curve.
In diabetics and non diabetics the first insulin response is normal or lacking in enough. The first insulin response is shown as a dip then another peak to spike.
My first insulin response is not there and doesn't show on graph.
Hence the high hyper quickly. (Dumping syndrome)
The second insulin response is abnormal for us RH ers! It is called an overshoot because it keeps producing insulin, where normal and T2 has a low secondary insulin response. Hence the hypo!
It is the second insulin response that diagnosis depends on!

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http://meridianvalleylab.com/wp-content/uploads/2012/08/GITT-Article-Re-type1.pdf
The graph is a summary of the insulin response, it did not mapped the glucose response.
Pattern 1 - Blue - Normal insulin response, peak within 1 hr.
Pattern 2 - Yellow - Elevated insulin level, peak around 1 hr. (Normal peak, delayed return)
Pattern 3 - Orange - Elevated insulin level, peak around 2-3 hr (Delayed peak)

In rare cases (seven), peak insulin response occurred later than three hours after the glucose load was given and were included in this group.

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Pattern 4 - Red - Elevated insulin level, peak after 2hr and remain elevated. (High Fasting)

My interpretation of the charts...
The reactive hypo would typically be present in pattern 2 and 3, because of the delayed high insulin levels and higher insulin sensitivity still present. These are people in the pre-diabetes or newly diagnose stage.

There needs to be higher than normal level of insulin present yet sufficient insulin sensitivity to trigger the reactive hypo.

kokhongw said:

http://meridianvalleylab.com/wp-content/uploads/2012/08/GITT-Article-Re-type1.pdf
The graph is a summary of the insulin response, it did not mapped the glucose response.
Pattern 1 - Blue - Normal insulin response, peak within 1 hr.
Pattern 2 - Yellow - Elevated insulin level, peak around 1 hr. (Normal peak, delayed return)
Pattern 3 - Orange - Elevated insulin level, peak around 2-3 hr (Delayed peak)

Pattern 4 - Red - Elevated insulin level, peak after 2hr and remain elevated. (High Fasting)

My interpretation of the charts...
The reactive hypo would typically be present in pattern 2 and 3, because of the delayed high insulin levels and higher insulin sensitivity still present. These are people in the pre-diabetes or newly diagnose stage.

There needs to be higher than normal level of insulin present yet sufficient insulin sensitivity to trigger the reactive hypo.

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I would totally agree with your summary however, once the insulin resistance and hyperglycaemia and hyperinsulinaemia have decreased, the actual glucose/insulin response can be different.
I have not seen, someone like me, in the public domain, where a RH er in ketosis is shown during a eOGTT.
The tolerance test done with another lady after diagnosis done by my endocrinologist, was different to the tolerance test done before diagnosis when we both had high levels of insulin.
Because of the lower insulin resistance, the first and secondary insulin response was more evident and pronounced in the curve of both insulin and glucose.

Hence, the sitagliptin prescribed by my endocrinologist to both of us.
My fourth or was it fifth eOGTT, showed much lower insulin response and therefore reduced the hyper, to which reduces the second insulin response. No hyper, no hypos!

That's the reason why a ketogenic diet works!

I would love to have my insulin response mapped out - using a variety of different carbs and quantities. Sadly, I haven't heard of anywhere in the UK that does such testing.

All I have are a few Libre screenshots.
This one hopefully shows how different a RH glucose curve is from the 'normal' curve of either a non-Diabetic or a T2.



I believe that the 'double hump' is a pretty classic sign of RH, and the sharp drop and sharp recovery are also good indicators.
The trigger for this hypo of mine was eating about 30g carbs (pringles) on an empty stomach (after a day out where I ate more carbs than usual and had jangly blood glucose all day). So it really doesn't take much.

@GrantGam
If your friend has RH, then they may live for years (possibly indefinitely) without developing T2, especially if they learn how to avoid the spike-and-drop-cycle.
I started RH symptoms aged 4 and didn't develop T2 blood glucose levels til my mid 40s.
I think I might have held it off longer, if I hadn't spent a chunk of my 20s living a student lifestyle of pizza, chips, yoyo diets and chocolate. But hey, ya live and learn

Now that I have dropped my BG levels and been normal for a few months I often feel my energy levels drop in the mid to late afternoon, something which always used to happen when I was younger - I hated Wednesday afternoon games - we'd had games in the morning during earlier years, and I'd been fine, but changing to the afternoon made it like struggling through treacle. In my twenties I found it difficult to be as alert as I ought to have been for the last two hours of the working day.
Now I am in my mid 60s and there are days when I get the same feeling, and my BG can drop quite low. I need to eat some carbs with my first meal in order to counter it, but too many is as bad as none.