HB1AC and reactive hypoglycaemia

[Mrsimonc]

Hi everyone

I need advice as I am somewhat confused.

I was diagnosed with reactive hypoglycaemic. My yearly HB1AC came back as 50 (twice) and no my doctor want to put me on slow releasing metformin. I am always having hypos after eating irrespective of what I’m eating low or high carb.

I purchased a freestyle Libre CGM and have been using it for the last two weeks. My average glucose is 5.4 with an estimated HB1AC of 30.

my confusion is how can I have a high HB1AC with a low Average blood glucose. Won’t the metformin lower my blood glucose more. There are more questions and confusion but the main thing is how can I be a type 2 diabetic with a high HB1AC when I’m producing loads of insulin to have a hypo and have low blood glucose levels regularly?

help me understand please

thanks

 

[Lamont D]

Hi everyone

I need advice as I am somewhat confused.

I was diagnosed with reactive hypoglycaemic. My yearly HB1AC came back as 50 (twice) and no my doctor want to put me on slow releasing metformin. I am always having hypos after eating irrespective of what I’m eating low or high carb.
Hi @Mrsimonc and welcome to the forum.
I purchased a freestyle Libre CGM and have been using it for the last two weeks. My average glucose is 5.4 with an estimated HB1AC of 30.

my confusion is how can I have a high HB1AC with a low Average blood glucose. Won’t the metformin lower my blood glucose more. There are more questions and confusion but the main thing is how can I be a type 2 diabetic with a high HB1AC when I’m producing loads of insulin to have a hypo and have low blood glucose levels regularly?

help me understand please

thanks

I have Reactive Hypoglycaemia and I know what you are confused about.
First if you have been diagnosed, you are non diabetic and hba1c should be in normal range. Your fasting blood glucose levels should be around normal levels.
If your doctor has any clue about how metformin works, it is not necessary or essential in helping with reactive hypoglycaemia. Unless your organs have been damaged because of long term hyperglycaemia, (high glucose) or hyperinsulinimia (high insulin) or it is possible to have both because of insulin resistance, but hopefully not.
Type 2s do not have hypoglycaemia unless it is caused by blood glucose lowering drugs or have another condition such as insulinoma.
However it is known to be hypoglycaemic and have T2. That is because over time the constant highs because of the lack of good control will raise your hba1c levels into diabetic levels continually.
Reactive Hypoglycaemia is a condition which is all about food intolerance. If you eat too many carbs or sugars in your meals, the high blood glucose spike will trigger a response from your pancreas, which will then drive your blood glucose levels into hypoglycaemia.
We have our own sub forum, which has more information.
It is difficult and you do need to learn how to control and only dietary intervention will do this.
We are here to help with those other questions and probably more from this post.
Do please ask, there is a lot of knowledge to be learnt.

Best wishes

 

[ianf0ster]

Hi @Mrsimonc and welcome to the forum.
I have no personal experience of reactive hypoglycaemia, though there are several members in here who have it. Sorry, but their names escape me right now.
It is a tricky condition, but I too find it hard to see how Metformin (of any type) can help, because what Metformin does is to reduce the amount of glucose that your liver produces - unless your glucose isn't coming from eating carbohydrates (like most of us) but instead is being produced in large quantities by your liver.

Those Type 2's of us with difficult livers which overproduce glucose in the mornings (Dawn Phenomenon or Foot on the Floor syndrome), sometimes find that eating a zero carb breakfast such as boiled eggs, mushroom or cheese, bacon and eggs etc. causes the liver to get the message that we don't need extra energy to go hunt/gather our cave dweller breakfast and switch off glucose production until either next morning or until we need it.

 

[EllieM]

I purchased a freestyle Libre CGM and have been using it for the last two weeks. My average glucose is 5.4 with an estimated HB1AC of 30.

Hmm, have you checked the libre against a glucometer at all? It is possible that it has been under reading. (It works better for some people than others). There are also a number of medical conditions which distort hba1c values and can give you an inaccurate reading as regards the average state of your blood sugar. eg iron deficient anaemia. Though the paper below uses US units for hba1c and blood sugar, it has a useful table at the end listing things that can make the hba1c inaccurate.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3912281/

If you think the hba1c might be inaccurate, you could try asking for a fructosamine test instead?

 

[Mrsimonc]

Thanks everyone for their reply.

I have used a finger prick test and it’s never been out of range either.

I’ve only been above range for a non diabetic twice and that’s because I ate twix (Argh the caramel goodness lol).

I’m gonna ask for a full blood count and thyroid test. My CGM is telling me a different story to my HB1AC. I know my risk score for type 2 is high. I’m a fat black guy with hypertension. Add a high HB1AC and they will want shove tablets down my neck.

Anyhow thanks for the advice.

 

[Lamont D]

Thanks everyone for their reply.

I have used a finger prick test and it’s never been out of range either.

I’ve only been above range for a non diabetic twice and that’s because I ate twix (Argh the caramel goodness lol).

I’m gonna ask for a full blood count and thyroid test. My CGM is telling me a different story to my HB1AC. I know my risk score for type 2 is high. I’m a fat black guy with hypertension. Add a high HB1AC and they will want shove tablets down my neck.

Anyhow thanks for the advice.

Hi again and WoW!

Why?

Well, those graphs, are outstanding. I would call them exceptional.
The doctors would dismiss you as being normal.
Until you eat carbs!

 

[Mrsimonc]

It’s them graph’s that confuse me. With them graphs how come I have a high HB1AC.

Hi again and WoW!

Why?

Well, those graphs, are outstanding. I would call them exceptional.
The doctors would dismiss you as being normal.
Until you eat carbs!

 

[Lamont D]

According to them graphs your hba1c is 30.
that is normal.

At your next review, ask for a full blood panel, including hba1c, the usual other blood markers and an insulin levels test.
this would give your doctor an idea how much circulating insulin is in your blood.
Your doctor will probably disagree but try and insist.
Was your last blood panel test fasting or non fasting?

keep safe.

 

[Mrsimonc]

Non fasting but if memory serves all I had was black coffee that morning.

 

[Lamont D]

Non fasting but if memory serves all I had was black coffee that morning.

Ok, that is fine, because with RH fasting tests are important as the insulin overshoot would skew the tests.

 

[Jess Shan]

Hi everyone

I need advice as I am somewhat confused.

I was diagnosed with reactive hypoglycaemic. My yearly HB1AC came back as 50 (twice) and no my doctor want to put me on slow releasing metformin. I am always having hypos after eating irrespective of what I’m eating low or high carb.

I purchased a freestyle Libre CGM and have been using it for the last two weeks. My average glucose is 5.4 with an estimated HB1AC of 30.

my confusion is how can I have a high HB1AC with a low Average blood glucose. Won’t the metformin lower my blood glucose more. There are more questions and confusion but the main thing is how can I be a type 2 diabetic with a high HB1AC when I’m producing loads of insulin to have a hypo and have low blood glucose levels regularly?

help me understand please

thanks

Hi there

I am the exact same as you. I suffer with reactive hypoglycaemia and have now been diagnosed with type 2 diabetes.

A gentleman in this forum kindly suggested I try and see if my consultant would prescribe me sitagliptin. As there is a study that shows it can help symptoms of hypoglycaemia and the keto diet. So I am currently trying to his. Hope it helps you

 

[thhpe]

Hi There

Just sharing what I had learnt from Dr Richard Berstein (Type 1 diabetic, who become a diabetologist specialising in diabetes.) He wrote the book Complete Diabetes Solution for those diabetics who would like to treat themselves and learn all about diabetes.

One of his patient father persuaded Dr Berstein to conduct free monthly teleseminars on the last Wednesday of the month answering questions which are not answered in the book. These teleseminars are on Youtube videos (search for Dr Berstein teleseminars). The purpose of these teleseminars is to store the wisdom and nuggets of gold uncovered by Dr B in treating diabetics.

In one of his Teleseminar, he shared that reactive hypoglycemia is usually precursor to Type 2. This is because of the vicious cycle that occurs, in reactive hypoglycemia, the body overproduces insulin upon glucose challenge and when the beta cells over produces insulin it also over produces amylin which tend to misfold when produced in large quantity blocking future flow of insulin and diminish production of iinsulin.

The solution mentioned by Dr B is to eat only low carb and high protein food to avoid glucose challenge, also the protein consummed will very slowly convert to the minimum glucose needed for the body.

 

[Lamont D]

Dr Bernstein is correct that the correlation between uncontrolled reactive hypoglycaemia symptoms can be a precursor to T2.
This is because, having insulin resistance, high circulating insulin and high insulin levels overall is called hyperinsulinimia. Something that a majority of T2s, prediabetics and some hypoglycaemic conditions have.
However, there is a difference between controlled reactive hypoglycaemia and uncontrolled reactive hypoglycaemia.
When you are in control, you don't have insulin resistance, you don't have any excess insulin but because of the weak initial first phase of insulin and the spike derived from carbs, the insulin overshoot, which is not found in prediabetics or T2s, still happens.
There is a number of endocrine or metabolic conditions that mimic other diabetic or non diabetic symptoms.
One of the main differences between T2 and RH, is the impact of the insulin overshoot causing the hypoglycaemic episodes.
Low carb might not be enough go stop the hypos, whereas zero carb or ketogenic diet will be an almost certainty to prevent the trigger of an insulin overshoot.
But other than that, Dr Bernstein, is a very good advocate for advice on diabetes.

 

[thhpe]

I just like to elaborate on reactive hypoglycemia - being a precursor of Type 2

Type 2 is a polygenic disease. Many genes are involved. Some people do not have the genes and can load on carbohydrates with impunity. There is no money in understanding or finding how to try to change the genes/behaviour.

Reactive hypoglycemia starts of as a result of over production of insulin due to glucose challenge (or starch challenge), the extra insulin shunted most of the blood glucose into the muscle, fat and other tissue that can be used to store glucose under the action of insulin. The person will start to get giddy, shaky etc, symptoms of classic hypo. If he or she consumed refined carbs to bring up the blood glucose and results in another overproduction of insulin the cycle will repeat - That's why it is a vicious cycle. There is still much hypothesis on what causes the overproduction of insulin in certain people and not in others.

The continuous storage of glucose into body tissues will saturate the storage capacity of the body, the insulin resistance of the body tissues will start to rise. More insulin will be required to store the same amount of glucose.

At the same time, the hormone amylin which is co-secreted with insulin tends to misfold when produced in large quantity blocks and reduce the future flow of insulin and amylin. (The extend of misfolding of the amylin peptide is still an hypothesis although the co-secretion of amylin had been measured)

By Dr Berstein's standard of low carb is 6grams, 12 grams and 12 grams of mainly leafy vegetables. Many people on reading the book are so happy to see that a total of 30grams of carbs and assumed that the equivalent of 30grams of starchy carbs will also do!

Even leafy carbs will still convert to glucose but very slowly for injected insulin to counter for Type 1 resulting in a flat blood glucose profile. This 6, 12, 12 is the amount estimated for 150 lbs adult, for person who is half the weight the amount is reduced in proportion to weight - as the amount of blood in a person half the size is approximately half so the blood glucose level will remain the same.

There are still many things in the human body that cannot be explain by medical science at this time and age as understanding and proofing these hypothesis about amylin does not bring wealth to medical science. But practical application is simpler e.g this 53 year-old lady in 2020 looks 30+ on low carb or keto

Low Carb Denver 2020 Interviews - Dr. Brian Lenzkes and Kelly Peterson

 

[Lamont D]

There are many reasons and causes for T2, and if the condition of RH is found to be a precursor of T2, it means that the medical profession have either misdiagnosed or the established treatment is totally wrong.
That is what happened to me. The number of doctors and an endo never had a clue. I was close to having severe metabolic conditions due to the hyperinsulinimia, the trigger because of my intolerance to carbs.
RH is a totally food intolerance condition.
Even though the symptoms are similar in how your brain, hormones, gut and organs react to with T2.
The reactions of these properties are different in RH. RH is non diabetic, and the treatment is totally different because the trigger is the spike to creating too much insulin that your liver is unable to produce enough glucagon by glucogenisis to prevent hypoglycaemia. There is no safety net for RH, so standard recommendations of dietary intake advice is misleading and don't understand the importance of averting the trigger.
Prevention is better than after care.
no spike, no trigger, no trigger, no insulin overshoot, no hypo.
the gut brain trigger, the signals, the imbalance in hormones all types even before eating and reaction to digestion is outside even modern science. There is an often quote on this site. That everyone is different!
Your diabetes is different to another for so many reasons.
My RH is different to others with the same condition. As There are many types of hypoglycaemic conditions.
The doctors on these advice forums have to advise in general to target for their audience, they are not individual enough for many people.I
I am intelligent enough to recognise relevant information and over ten years of experience in avoiding hypos and the downward march to serious ill health. I am intrigued in new theories, in new research, in their outcomes. But I'm comfortable in my achievements and my good health which is my overall benchmark.