Eating ideas for RH other than low carb

tooner9

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i was prescribed it to slow down the speed food passes through my stomach its just a trail my doc suggested
 

tim2000s

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I suspect the theory of using Bydureon (Byetta would also do the same thing) is that it slows digestion and blocks glucagon release, which with higher protein meals would help to alleviate glucose shocks. The bit I'd be concerned about is that it also encourages insulin secretion, which as an RH you don't need any more of.
 
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Lamont D

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The thing that fascinates me is why we use our glucose, glucagon resources from food so quickly, so that the insulin stimulus carries on.
Increasing insulin isn't the problem, it's the way our body converts our food into glucose initially that is the key.
If our bodies get our energy from stored fat, rather than carbs or sugars, our system works so much better and you feel better and the symptoms go away, which means that the spike is avoided, which in turn offsets the hypo.

I would imagine most RH ers, have a form of dumping syndrome.

Good thread this!
 

tim2000s

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Increasing insulin isn't the problem, it's the way our body converts our food into glucose initially that is the key.
I wonder if it is just that? I wonder if there is also something to do with the RH body thinking that it has released glucagon and then releasing insulin to cover that, much like you see with whey protein and insulin in T1s.
 
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arniemouse

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Ok thanks just googled it interesting will it stop pancreas producing too much insulin? Or is that why its a trial?
 

Lamont D

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I wonder if it is just that? I wonder if there is also something to do with the RH body thinking that it has released glucagon and then releasing insulin to cover that, much like you see with whey protein and insulin in T1s.




From off the top of my head there is two reasons for the excess insulin or overshoot.

A RH patient may have a deficiency in glucagon secretion.
Or
A delay in early insulin release from pancreatic beta cells.

And it's slightly different for RH ers who have T2 as well.
 

Brunneria

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I have often wondered if my issue is multiple failures, effectively stacking together
- insulin resistance (PCOS, medication, obesity and prolactinoma)
- failed 1st insulin response (this predates the T2 by decades)
- delayed? insufficient? glucagon

No way of sorting out the mess really. Just dietary control.

Although I would bite the hand off anyone who offered me metformin - but then that would be because of the hope of reduced insulin resistance, which is the bane of my life. If you don't have obesity, PCOS, the prolactinoma and the accompanying med cabergoline, then I can't see metformin helping RH.
 

tim2000s

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Ok thanks just googled it interesting will it stop pancreas producing too much insulin? Or is that why its a trial?
Looks like the reason that @nosher8355 was put on Sitagliptin (a DPP-4 inhibitor) is the same as the reason you have been put on Bydureon (a GLP-1 inhibitor). Aside from all the other aspects of the drug, it seems to enhance insulin release at time of eating. It has been put forward (as @Brunneria said) that it is the immediate insulin response to meals that is missing/faulty in RH, and both these drugs enhance that insulin release.
 

Lamont D

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Looks like the reason that @nosher8355 was put on Sitagliptin (a DPP-4 inhibitor) is the same as the reason you have been put on Bydureon (a GLP-1 inhibitor). Aside from all the other aspects of the drug, it seems to enhance insulin release at time of eating. It has been put forward (as @Brunneria said) that it is the immediate insulin response to meals that is missing/faulty in RH, and both these drugs enhance that insulin release.

It also should keep blood glucose levels down. Especially if someone is at a fasting prediabetic or diabetic Hba1c level, which could trigger the fast spike even more!
 

tim2000s

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I guess you guys have seen this paper? https://oda.hio.no/jspui/bitstream/10642/220/2/Sorensen_MonicaRED.pdf

It discusses some of the issues with GLP-1 receptors (which is where the Sitagliptin and Bydureon come in) but also suggests that in the study, success was had with the introduction of Fructo-Oligosaccharide supplements into the diet of RH patients.

It may be something that RHs could try if they are having issues. There's a fair amount of controversy about FOS supplements, so you may want to make your own mind up with that one, but the following are naturally high in those:
  • Jerusalem artichoke
  • Chicory root
  • Leeks
  • Onions
  • Garlic
 

Lamont D

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The study was done on patients with reactive hypoglycaemia symptoms of hypoglycaemia but not the patients with late reactive hypoglycaemia or many with both RH and T2.
IRH is not a classification of a medical condition now.
It is a different response to a high carb diet more prevalent in the last twenty years.
The test to see if the fibre used, would help those with that response helps. Well without going through and thorough reading, I believe an increase in fibre, if someone needs to would benefit quite a bit. It would slow do digestion!
Leeks and Onions I eat a lot of, Jerusalem artichokes, no!
Garlic is disguised in foods I also eat!
I can have bananas, well half of a small one.

Unfortunately, most RH ers, have a fructose intolerance, so bananas would be out.
There is a type of RH that comes from a genetic fruit intolerance!
Not met one, but it's there.

Thanks, Tim, I will read that again, there's good science in there.
 

Lamont D

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Another one for you @nosher8355 - https://link.springer.com/article/10.1186/1750-1172-7-26 - looking at metabolic diseases that cause hypoglycaemia. One of the things it notes (and I can't find anything via google that gives the opposite view) is that RH is rarely linked to Hereditary Fructose Intolerance, rather than it being particularly commonly linked.
And I quote;

Post prandial hypoglycaemia, (RH) can be an indicator of either endogenous hyperinsulinism linked to non insulinoma pancreatogenic hypoglycaemia syndrome, or very rarely, inherited fructose intolerance.

The paper was written in 2012, and post prandial is not in use now. Nor is idiopathic in reference to RH.

The reason it can longer be termed as idiopathic, is they now know the underlying cause of hypoglycaemia in all but a few very rare blood glucose disorders.
 

Kaz261

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Kat, the idea is not to have hypos at all if possible, and the T2 shouldn't give her the hypos, unless she is on insulin, which is very unlikely!
I would give the metformin a wide berth honestly, if it was me.
The old lady, does she know her trigger?

I know my meds have helped, but I haven't had a hypo in over two years now, except for the glucose test in hospital.

If any meds you would probably benefit from, I would suggest the sitagliptin.
Unfortunately my consultant is reluctant to prescribe Sitagliptin for me because of potential further weight loss. I'm slowly gaining some weight now after losing loads and nearly becoming underweight.
 

Lamont D

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Unfortunately my consultant is reluctant to prescribe Sitagliptin for me because of potential further weight loss. I'm slowly gaining some weight now after losing loads and nearly becoming underweight.
Hi Kaz,
Off the top of my head, I can't remember reading that it exacerbates weight loss.
I will look again, doing a lot of reading this afternoon, sometimes my brain hurts!:p:rolleyes:
 

Lamont D

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It does not cause weight gain!

That's what is only there!


So the tablet does not alter or make you put on weight, so if you want to put weight on, then it has be down to what protein and fats you eat. Of course calories should come into it somewhere but I've never bothered with counting them.

Does that also mean that if you eat enough calories etc. Sitagliptin should not be a problem, my head hurts now!
 

arniemouse

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48
Type of diabetes
Type 2
I need a lie down after reading just the posts never mind the articles as well!!
It is fascinating though what goes wrong. I am banned from all diabetic meds because too many hypo's. If I throw in my other problem which is adrenal failure (like addisons disease) does that help or hinder the glycogen discussion. My problem is that sometimes I cannot rescue myself when going hypo as no cortisol to mobilise liver to release glycogen ( I take a replacement) so once it goes down it just keeps on going hence the sever hypos. I have injectable glucose at home and my husband had to learn how to inject me!
Tim does the average type 1 get a lot of hypos? Do many of you 'over there' (other thread!) try the low carb options? Perhaps we need to share a bit more with the other types?
 

tim2000s

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If I throw in my other problem which is adrenal failure (like addisons disease) does that help or hinder the glycogen discussion. My problem is that sometimes I cannot rescue myself when going hypo as no cortisol to mobilise liver to release glycogen ( I take a replacement) so once it goes down it just keeps on going hence the sever hypos.
One of the the points that regularly comes up is sensitivity to epinephrine (adrenalin) causing the symptoms to be worse, which would make sense in your case if you lack it naturally. Add to that a lack of epinephrine and as you say, you don't have a good feedback response mechanism to counter regular insulin, let alone excess insulin.

Tim does the average type 1 get a lot of hypos? Do many of you 'over there' (other thread!) try the low carb options? Perhaps we need to share a bit more with the other types?
The answer to this is always "It depends". One or two readings between 3.5 and 4 per day seems normal. Does that qualify as hypo? Typically for me, anything below 3.5 is what I consider hypo, and that's about twice a month, usually exercise or carb count failure related. I'm not sure what the average is.

There are plenty of us that find low carb makes management easier as it reduces the ups and downs that accompany higher carbs and therefore more insulin.
 

Lamont D

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Is the injection glucose or glucagon? as there is a difference!

What paramedics use in coma situations in glucagon!

I have to carry my card in my wallet to stop them using glucagon as it would rocket my spike too quickly and cause excessive insulin overproduction.

I know nothing about Addisons. So can't say what effect it would have but I will look.
Defo headache now!

But, bottom line, finding out what spikes you, then not having that will stop the spikes.

I asked about all these type of things whilst having my hypo hell, and what would happen if I went too low etc. Talked to endo, paramedics, doctors, nurses, dieticians, uncle Tom Cobbley. Once I got control and came out of my hypo hell, that worry dissipated. It hasn't gone away, but knowing that I can live without hypos, if I behave is a really good incentive!
 

arniemouse

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48
Type of diabetes
Type 2
Yep just been to fridge its glucagon. Was told inject while phoning ambulance with third or fourth hand so hopefully will be in A+E before too much spike and then drop. I carry the glucose gel as well but am reluctant to use it as it will def cause a hypo.