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glucose and insulin test - Reactive hypoglycemia ?

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guillaumelondon

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Hi,

New here. Nice to find a forum about reactive hypoglycemia !

So in summary : For me eating = getting tired for hours, even sleepy. So I went to see GP.

I was asked to take one of these glucose/insulin test (Where I need to drink some sugary drink and then they take my blood every 30 minutes for 2 hours).

GP says that I have reactive hypoglycemia and that by changing diet, I should be lots better. Of course its true that If I only eat salads, and very light - well, I dont tire, I am just nervous (as I am not really eating !) or taking metabet SR (metformin i think).

As I believe a few of you passed the same test, maybe you can check the information given here and let me know if the doctor is right ?

Given the fact that I am 68Kg.

BG (in mmol/l) :

fasting : 4.3
0.5 hr : 8.0
1 hr : 6.6
1.5 hr : 5.4
2 hr : 4.9

Insulin (in mIU/L) :

fasting : 4.4
0.5 hr : 101
1 hr : 84.6
1.5 hr : 52.6
2 hr : 32.3

Let me know if this rings a bell, and if this indeed support the diagnosis of reactive hypoglycemia ?

Thanks
 
I'm not familiar with the insulin test results - because we don't get to see them often - they are so rarely done!

However, the usual test for RH is a 5 hours glucose tolerance test. Same as you had done, but for 5 hours, not 2.
For that test, RH is diagnosed if the blood glucose level dips to hypo levels sometime during those 5 hours. At which point the patient is shown to have had a hypo, the test is discontinued and the hypo is treated.

In your test, it was for just 2 hours, every reading was above 4 (hypos are below 4) and you ended up higher at the end than you were at the beginning.

That doesn't look like RH to me. But I am not a doctor, or an endocrinologist. I do know that my RH readings (before I got it under control) would be something like, start at 5mmol/l, rise to 15mmol/l at 1 hour, drop down to 2 or 3mmol/l over the next 2-5 hours, get ravenously hungry at the low point and fall face first into the nearest carbs, and start the whole process off again.

HOWEVER, without continuing the test for the full 5 hours, none of us know what your results would have been at 3, 4 and 5 hours. You might easily have gone below 4 in that timespan, or you might have leveled out again in the low 4s, but it wasn't recorded so we don't know.

Regarding the insulin test results, I simply cannot comment because I have nothing to compare them with. You would have to find 'normal' insulin test results and compare yourself to them, AND compare yourself to known RHers, in order to assess whether your RH diagnosis is representative.
 
I agree with the above. Your glucose levels over that 2 hours are perfectly normal. They are neither diabetic nor showing any RH. I also can't comment on your insulin levels as these insulin tests are very hard to come by on the NHS. If you can't get any advice about what these insulin levels mean, I suggest you speak to your doctor. I believe the correct tests for RH in the UK are done in hospital after a referral to an endocrynologist.

RH is a condition of high insulin output that brings your glucose levels right down to hypo levels, often very low
 
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Did your GP drawer blood for the insulin tests every 30 minutes? And was it an NHS doctor? If so its the second ever time I have heard of an NHS insulin test.. so much so that my surgery denied that it was even a possibility on the NHS.
 
Hello. I am new! I did a 5 hour test two weeks ago for Reactive Hypoglycaemia and a file of blood was taken/tested every half hour. My count dropped to 3.2 quite quickly so the test was stopped to avoid me feeling worse than I did and I was fed biscuits and coffee immediately followed by a meal. It took about 45 minutes to feel get back to “normal”. I am waiting for the full analysis from my Endocrinologist as each blood sample that was taken was sent to the hospital lab for more in depth tests. I suspect I will be diagnosed as having RH. I have been on Metformin SR for 12 years for glucose intolerance prescribed by a gynaecologist during a period of Chronic Fatigue.

I have to admit to feeling a bit scared by all this and will definitely be looking for others input re food intake etc. I am a 58 year old female living in Surrey, UK.
 

Hi and welcome @KarenTh
Sounds like you are getting the tests you need.
I hope you also get the appropriate treatment and diet advice too

I must say, I am increasingly impressed with the number of people who arrive on the forum having been tested and diagnosed with RH. Shows that reactive hypoglycaemia is actually being more widely recognised, and better understood that ever before.

Even 4 years ago, it was as rare as hens teeth to get a diagnosis.

Shows that progress is being made, and well done to everyone who has pushed and pushed and pushed to be heard, so that health care professionals are now starting to take us seriously. Well done!
 
I am pleased to say it was my GP who spotted it first. I didn’t have a clue what was going on but knew I felt awful every time I tried to do anything requiring a bit of energy. Even changing the bed linen?! Plus I kept having to lie down?! Can’t wait to find out how to manage it soon.
 

That was exactly the same as my first eOGTT, the treatment the same (ish) to treat the hypo as you would if you have diabetes. Instead of being there for five hours, I was there for ten because my blood glucose readings were all over the place.
Well done to your GP, very rare indeed, for a doctor to know about RH.
The intensive testing during the eOGTT and blood being sent to labs is the correct stage of getting a diagnosis, in which there will be more tests, because it is a process of eliminating other endocrine/ pancreatic, liver conditions.
You could end up like I did, having a 72 hour fasting test.
Because I have had problems for well over a decade and since being diagnosed, my life, health has taken a turn for the better. Because you will be aware, that dietary intake is so important, and no magic pill to cure you.
So you will have to find out which foods are doing this to you and at what balance of the protein, fats and the small amount of carbs you can tolerate.

Please ask away about the experience we have had in getting to grips, when you get your diagnosis.

Oh yeah, ask your endocrinologist about taking metformin and how some meds might make you worse, my endocrinologist, said that metformin will not make any difference to how I treat the RH.
It's what you have been advised to eat!
For someone like me, who has RH, and we are so different in the way food effects us, the so called healthy normal foods, are not normal and not particularly healthy for us.

You have to understand that with RH, many of these healthy carbs, are definitely not healthy for me. The tiredness, lethargy, wanting to lie down, the worry and the long list of symptoms is a typical reaction from what you are eating.

I avoid those foods and my energy levels are really great.
 

Hi, I don't believe if those results are RH.
Again, as others have said, insulin testing is rare and only done when an endocrinologist is trying to diagnose a reason for the hyperinsulinaemia he suspects.
But do let us know, what it is.
The reason I say this is your initial insulin response is very good. Whereas, if you have RH, that would not be the case.
Your glucose levels are consistent with a good initial insulin response and normal glucose levels from the glucose test.
 
Thank you - I will certainly come back to you once I get the full test results. I forgot to mention that my endocrinologist also asked me to collect urine for 24 hours after not eating and drinking key foods and he says the results of that will also be very important to determining how I manage this.
 
Hello again. 24 urine test clear so back to the Endocrinologist for advice and dietician next week. Having cut out all bread, pasta, rice, alcohol and caffeine for a week now I am feeling so much more myself with only 2 "crashes". I read a very useful book by KE Lytle called "Reactive Hypoglycaemia". It can be read in one sitting and whilst it's about her personal journey with this condition, it's full of good information for newbie like myself.

I need to buy a blood sugar monitor. Does anyone have any recommendations?
 

Have a look at the Tee2 or the Codefree from Homehealth
They are both comparable prices.
But shop around. There are a lot of meters at v different prices around.
The thing to remember is that you need a new test strip for every test. So the cheaper they are, the lower your long term costs are.
 
Thank you very much!
 

If you have realised that what you are going through is a food issue and once you have a glucometer, please keep trying to understand why the crashes happen.
Use the glucometer well and it will be your best friend to get a better healthier lifestyle.

I have written a blog on the blog forum on this website about my journey to getting my life back and my health.
Hope you enjoy it.
 
guillaumelondon said:
Thanks. I understand. I will get back to the GP and ask for a full 5 hours test.
Click to expand...

There is no point in taking a full 5 hour test. You’re not RH, why.

Your insulin levels has decreased at the 2 hour mark, while your blood sugar is higher then it were fasting.

Also feeling tired after eating is not what a hypo feels like at all, just saying.

If your GP says you’re RH he/she has no clue at all. You do not have symptoms of having a hypo, you have no readings below 4 mmol, and your test indicates that your blood sugar and insulin levels are perfectly normal. Sorry, but your GP are not right, have to disagree badly here.
 

Hi. I had a 3hr extended GTT.
Fasting: 5.3
0.5 hr after glucose was 6.8
1hr: 12.1
1.5 hr : 6.6
Then I was feeling a bit dodgy about 10 mins later so she did a fingerprick test which was 3.8
10 mins later was 2.7 and feeling bad and shaking like mad so test was discontinued

Hope this helps x
 

Wow!
That is dumping syndrome!
Reactive Hypoglycaemia in this form is not like mine, even though my first hour is similar, I am still above normal blood sugar levels until three hours after the glucose is drank.

What did your supervision nurse/doctor do when you went that low, that quickly?

Best wishes
 

I was like that Lamont, I got my hypos soon after two hours from first bite.

In fact my pancreas doesn't seem to work much on low blood glucose, then there seems to be an avalanche insulin effect on higher levels of blood glucose.

My hba1c last week was 45 after being in ketosis for four months, so it seems to confirm graded insulin output is my issue.

With all these measures my hba1c has only dropped 5 from a maximum of 50.

It just shows how relevant hba1c is to R.H. Not Very!.

Even though the quality of life on low carb is vastly improved, the average, In maths terms, The area under the graph, is similar!


I doubt whether I can get my my hba1c down further without meds or long term fasting when I don't need to lose weight.
I frequently do not eat any lunch because breakfast takes me through to my evening meal feeling satisfied.
regards
Derek
 
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Hi Derek,
Hope you are well.
It's all to do with that first insulin response.
My insulin response is just as you describe, only turns on, after carbs. No carbs, no excess insulin. The avalanche insulin response is a great description of what my endo called an overshoot. It is actually termed as an overshoot!
I don't believe that hba1c is a determining factor because it only confirms non diabetic state. If you don't have T2, with RH, then normal levels are the norm, and being in normal levels consistently, or in ketosis, or fasting, your blood levels and hba1c is only gonna be in normal levels.
Unless, you are still trying to lower your circulating insulin levels, your insulin resistance and because of these factors your blood levels could be higher than normal. Then your Hba1c levels will be higher, as mine were.
Also, depending on your tolerance or insulin response to other foods such as fruit, dairy and even chicken. Plus too much protein can be just as bad, if you don't get that balance right.
From my experience, of which we can only go on, as there are no real experts, that I have come across, even during discussion with my endocrinologist, he has been surprised, how his thinking and knowledge has been changed over these last five years.
My intermittent fasting, is indiscriminate. Because I'm sometimes don't know what time I will be eating. Or travelling, if I'm off work, I usually leave it till 3pm (ish) and have a couple or three small meals that day.

I've not been in a position to put weight on yet, still trying to get under 12 stone for quite a while, it seems it doesn't matter how much I eat or work, walk and so on, it just won't go under! But I'm not too unhappy with that.
I can have a cooked breakfast and like you, won't eat again for about seven or eight hours.
It's weird!

Best wishes mate.
 
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