Help interpreting results

[Cliff Town]

Just to preface this, I’ve had a number of blood tests done via a consultant, who I’m due to follow up with next week. However, I was hoping to get some general thoughts on those better educated on such matters than I in the interim.

Very quick history, I’ve been feeling generally unwell for a few years now. In short, I experience many of the symptoms highlighted on the page on hyperinsulinemia on this site, while regularly experiencing symptoms of hypoglycaemia. Important to note that I’ve never been diagnosed with diabetes.

In addition to the blood tests, my doctor also asked me to track my blood glucose alongside food, mood and exercise. Some insights from this also below, taken using a Freestyle Libera. First the blood test results.

Contrary to my inkling that I might be making too much insulin, I’m actually slightly under the range. I find it difficult to work out whether this is actually a bad or a good thing. Can you have too little insulin?

Despite my first supposition being wrong, it seems that I have been experiencing instances of hypoglycaemia. These have been sporadic, but most commonly occur after eating and through the night. Screenshots below.

The spike that precedes the drop in the second image was a late meal as I was driving home from an event in the early hours. I would never normally eat at that time, so I don’t know if that would play a role.

I’m just slightly confused by the results in totality. I’m so far away from an expert on this subject matter, but low insulin coupled with spells of low blood glucose seems an odd combination going off what I’ve read.

Any thoughts greatly appreciated.

 

[KennyA]

hi Cliff Town and welcome to the forums

You've asked some interesting questions, and I'm going to tag @Lamont D who has lots of experience and knowledge around this sort of thing. Just one thing, though - we don't allow attempts at diagnosis on the forum. None of us are capable of that. What you can get though are personal accounts (which can be very helpful) and links to some good sources.

As a bog standard T2, it's not that unusual for me to get hypo-territory lows through the night, usually followed by a very quick rise as my liver wakes up to what's going on. No insight on the rest of your situation, though.

best of luck

 

[Cliff Town]

Thanks Kenny. Any insights, within the parameters of the board’s rules, would be greatly appreciated!

 

[Cliff Town]

I just wanted to ask a follow-up question, following a little “experiment” I did today. My freestyle libre pinged me to say that my blood glucose was 3.4mmol/l, and I naturally felt quite ill. However, I’ve noticed previously that unless I’ve eaten recently, my baseline is still generally 4.8mmol/l and I still experience symptoms of hypoglycemia then.

To test something, I ate some glucose tablets to raise my glucose, and only when I peaked at around 12mmol/l, outside the normal range, did I feel any real cessation of symptoms.

Is it possible, through disease or otherwise, that blood glucose levels are normal, but that a proportion of that glucose isn’t actually getting through at the cellular level?

Apologies in advance if that’s a stupid question. I just don’t understand why I feel the way do when my glucose levels are in the lower normal range.

 

[Lamont D]

Just to preface this, I’ve had a number of blood tests done via a consultant, who I’m due to follow up with next week. However, I was hoping to get some general thoughts on those better educated on such matters than I in the interim.

Very quick history, I’ve been feeling generally unwell for a few years now. In short, I experience many of the symptoms highlighted on the page on hyperinsulinemia on this site, while regularly experiencing symptoms of hypoglycaemia. Important to note that I’ve never been diagnosed with diabetes.

In addition to the blood tests, my doctor also asked me to track my blood glucose alongside food, mood and exercise. Some insights from this also below, taken using a Freestyle Libera. First the blood test results.

Contrary to my inkling that I might be making too much insulin, I’m actually slightly under the range. I find it difficult to work out whether this is actually a bad or a good thing. Can you have too little insulin?

Despite my first supposition being wrong, it seems that I have been experiencing instances of hypoglycaemia. These have been sporadic, but most commonly occur after eating and through the night. Screenshots below.

The spike that precedes the drop in the second image was a late meal as I was driving home from an event in the early hours. I would never normally eat at that time, so I don’t know if that would play a role.

I’m just slightly confused by the results in totality. I’m so far away from an expert on this subject matter, but low insulin coupled with spells of low blood glucose seems an odd combination going off what I’ve read.

Any thoughts greatly appreciated.

Hi, @Cliff Town and welcome to our forum.
Your hba1c is normal.
So that means you are non diabetic.
But you are having high spikes after food or drink, then as your graphs are showing, your insulin response to the food is poor, and you get a spike of hyperglycaemia. Do you get symptoms at the spike?
So after the spike, your graphs shows that the drop or in terms of a sugar crash and you go into hypoglycaemia?
And you conclude that this is caused by insulin doing this?
Do you notice that the spike is just one peak?
Ok, as you are using a cgm, it is evident from that, something is happening.
I am not not an expert but from the graphs, I would ask your doctors to check for a form of hypoglycaemia.

I have a condition that is very similar, and have had the tests to confirm diagnosis.
You need to ask your doctor for a referral to an endocrinologist who has had experience with hypoglycaemic conditions that are non diabetic.
I would also like you to have a read of the threads in the Reactive Hypoglycaemia forum. It will rings a few bells!

My condition does produce too much insulin, and has hyperglycaemia when the intolerance to certain foods raise BG levels high, then production of excess insulin in reaction to the spike. The condition cannot stop the crash into hypoglycaemia, the response from the liver cannot cope with the excess insulin.

I won't bore you with too much science, but dietary treatment is at the heart of control.

Ask away? Keep using your cgm. When you do get an appointment, it will help with your doctor understanding the symptoms.

Best wishes

 

[Cliff Town]

Thanks for taking the time to reply, Lamont. I really appreciate that.

Please feel free not to answer, but may I ask what condition you have been diagnosed with and how it makes / made you feel generally (i.e. outside of any spikes / drops in blood sugar)? I feel pretty ill generally (lethargic, unable to concentrate etc.) most of the time, with things getting slightly worse when my blood sugar drops and only slightly better when it peaks (of course, I’ve only learned these patterns in the last few days).

Despite the lethargy I experience, I do my best to exercise 4-5 times a week and eat cleanly. In fact, this all began when I went from being considerably overweight to around 10% body fat a few years ago through diet and exercise. Assuming the two things are connected, it frustrates me that in trying to do something positive for my health has actually made me ill in other ways.

Would you concur that the patterns in blood sugar I shared above are not “normal”?

Thanks again!

 

[Lamont D]

Thanks for taking the time to reply, Lamont. I really appreciate that.

Please feel free not to answer, but may I ask what condition you have been diagnosed with and how it makes / made you feel generally (i.e. outside of any spikes / drops in blood sugar)? I feel pretty ill generally (lethargic, unable to concentrate etc.) most of the time, with things getting slightly worse when my blood sugar drops and only slightly better when it peaks (of course, I’ve only learned these patterns in the last few days).

Despite the lethargy I experience, I do my best to exercise 4-5 times a week and eat cleanly. In fact, this all began when I went from being considerably overweight to around 10% body fat a few years ago through diet and exercise. Assuming the two things are connected, it frustrates me that in trying to do something positive for my health has actually made me ill in other ways.

Would you concur that the patterns in blood sugar I shared above are not “normal”?

Thanks again!

I have been around here for over a decade now, because what I have is a rare condition that the majority of doctors and even some endos don't have a clue about. So I try to help those like yourself that have an issue and need help.
My condition is loosely termed as Reactive Hypoglycaemia, but as with other similar conditions there is a few different types. My condition is non diabetic.
Because I was misdiagnosed with T2 and was told to eat the eat well plate, they didn't rea!use that some of those certain foods were actually the root cause of the symptoms.
I was having hypo symptoms every day and I was having so many different symptoms the list is quite long, but it was awful and I termed it my 'hypo hell'.
The difference in the knowledge that it is food, mostly carbs and sugars that trigger the reaction, that is where the control is.
There is no magic pill or cure, just dietary balance. I am essentially carb intolerant.
You say you eat cleanly, I think that is weight lifting terminology.
But I ate healthy food. It was very slowly killing me!

It is not losing the weight. If it is, like me, it's what your body reacts to.
Exercise for me is quite difficult, because as you are probably aware, when your energy levels drop, you need a liver dump of energy (glucogenisis) that and glucose helps you with strenuous exercise
If I do too much, a liver dump or glucose will trigger the reaction, and of course my age and restrictions cos of arthritis, so my exercising is gentler such as walking and stretching.
And becos I'm in control and my BG levels are in normal levels range, in or just above normal levels, my energy levels are great. And there is no symptoms.

There is something going on, that is why you need to get diagnosed, hence the referral, because an endocrinologist can do the necessary tests.

Keep asking and have a read of the RH forum.

Best wishes.

 

[EllieM]

I'm going to make a comment about the libre graphs. I wouldn't necessarily assume that it is accurate, particularly at low levels. I don't suppose you were able to check its low readings against a glucometer?

Good luck with your appointment with the consultant.

 

[Cliff Town]

Thanks again, both.

Regards the libre graphs, I’ve noticed that I can predict when I’m going to get a notification on my phone (that my glucose is below 3.9) by the way I feel. I know if I start getting shaky or this kind of tired, turgid feeling in my midriff and my concentration starts to lapse, then it will be coming through any moment. The one occasion I was wrong it was at 4.0 when I checked, so I’ve got a certain degree of faith in it.

Even when it’s, say, 4.5 to 6.0 however I don’t feel amazing, which I know is more or less the kind of perfect range. That’s the bit I’m struggling to understand, but I’m hoping my endocrinologist will (and will have a solution to boot!).

The libre has been fascinating really. Whatever it is that’s not quite right with me has really affected my life over the past 3 or 4 years and this piece of technology has at least helped me understand the patterns and relationship to how I’m feeling, even if I’m still struggling to understand precisely what’s going on.

 

[Lamont D]

Thanks again, both.

Regards the libre graphs, I’ve noticed that I can predict when I’m going to get a notification on my phone (that my glucose is below 3.9) by the way I feel. I know if I start getting shaky or this kind of tired, turgid feeling in my midriff and my concentration starts to lapse, then it will be coming through any moment. The one occasion I was wrong it was at 4.0 when I checked, so I’ve got a certain degree of faith in it.

Even when it’s, say, 4.5 to 6.0 however I don’t feel amazing, which I know is more or less the kind of perfect range. That’s the bit I’m struggling to understand, but I’m hoping my endocrinologist will (and will have a solution to boot!).

The libre has been fascinating really. Whatever it is that’s not quite right with me has really affected my life over the past 3 or 4 years and this piece of technology has at least helped me understand the patterns and relationship to how I’m feeling, even if I’m still struggling to understand precisely what’s going on.

I do hope you have started reading the RH sub forum.

If it is RH or of a type similar condition to it. It is controlled by dietary means.
I have read posts where different doctors, posters have tried diabetic meds for their symptoms, but it doesn't seem to matter, you will still go hypo!
If you get advised to eat every two to three hours, to prevent the hypoglycaemia, it won't and you will be in rollercoaster mode, just as in your top graph shows. And it won't stop the hypos, hypers, reaction of symptoms.

So, don't be expecting too much from the doctors cos of the lack of research and the total rubbish in medical books that the doctors repeat.

Once diagnosed and you have to learn the mechanics of the condition and how your body reacts to certain foods. You may be intolerant to these foods and usually, like me with lactose intolerance. I was told in no uncertain terms to avoid dairy, which I do!
So if like me you are carb intolerant, why do the doctors and the guidance insist on eating them!
Not logical and wrong!

Best wishes

 

[Cliff Town]

I’ll give that sub-forum a read. I’m sure I’ll find the answer in there, but is such an intolerance something you can develop pretty suddenly as an adult (this goes back to my early 30s)?

 

[ajbod]

Type 2 and RH start years earlier than when they actually show themselves with symptoms. When we are younger our bodies cope better with the swings in sugar level, this ability gradually erodes, due to over work, to the point where we notice the problems more. That's when we have to moderate our dietary input to lessen the problems.

 

[Lamont D]

I’ll give that sub-forum a read. I’m sure I’ll find the answer in there, but is such an intolerance something you can develop pretty suddenly as an adult (this goes back to my early 30s)?

Mine was developed over time. When?
No idea, but symptoms and odd readings were first recognised at the turn of the century, but it wasn't diagnosed until 2013. Before that in 2009 I was misdiagnosed as T2, because I was eating the recommended carbs!
My endo wasn't sure and had no evidence of how.
But after a lot of research by me. I developed some bad bacteria in my gut, called helicobactor pylori. Again how long, no idea, but I had issues with my stomach, gut for a long time going back to my thirties.
I noticed on a paper, that it was included in the list of possible causes, and someone has included it on Wikipedia. I put it on my list in the sub forum.

I will try and give you an example of how the intolerance worsens through time.

Once you get a small imbalance in the first phase insulin response, having the high quick spikes and rapid drops in blood glucose levels, will alter the response and the amount of insulin produced, in the secondary phase and if not addressed, it can only get worse, the effect of all the imbalance in hormonal responses grows the amount of insulin in your blood which is wasted, increasing insulin resistance and the levels of hyperinsulinimia and that tends to exacerbate more insulin, hyperglycaemia can be evident by the high than normal spikes. until it starts dropping into hypo levels. This is called The overshoot of insulin. Because the function of correcting the high insulin is called glucogenisis or a liver dump, is not enough.

Because of the imbalance, you spike, you overproduce insulin, you hypo. When you eat foods that cause the spike.

I tried, however going too scientific, might scare me and you. But a lot of the cells involved have evolved to be this intolerant you become.
And I will add how much your brain contributes to the whole thing. Because, if your brain response to create more insulin then cause and effect would be different.

Hope that helps.

Keep asking, keep reading.
Best wishes

 

[Cliff Town]

Quick update. Saw my consultant today; he seems to think Addison’s disease is probable. His reasoning is low 9am cortisol, coupled with symptoms and hypoglycaemia.

I have to admit, I’m not convinced personally. A key symptom of Addison’s is weight loss; I struggled seriously with losing / maintaining weight following my initial weight loss. Likewise no dark patches, no upset stomach, nausea etc.

Some symptoms do ring true. Fatigue, absolutely. I weight train, but I do have sensations of weakness at times. Low mood / depression - 100%. My life is good, so it’s hard to explain that one. Irritability? Ask my wife.

Ultimately, I’ll be surprised if this becomes a confirmed diagnosis, though when I challenged my doctor he pointed out that “not everyone presents like a textbook”, which I suppose is a fair point. Fortunately, it seems that the ACTH test that he has ordered seems pretty effective at definitively ruling it in or out.

Thoughts or experiences welcome.

 

[Lamont D]

Quick update. Saw my consultant today; he seems to think Addison’s disease is probable. His reasoning is low 9am cortisol, coupled with symptoms and hypoglycaemia.

I have to admit, I’m not convinced personally. A key symptom of Addison’s is weight loss; I struggled seriously with losing / maintaining weight following my initial weight loss. Likewise no dark patches, no upset stomach, nausea etc.

Some symptoms do ring true. Fatigue, absolutely. I weight train, but I do have sensations of weakness at times. Low mood / depression - 100%. My life is good, so it’s hard to explain that one. Irritability? Ask my wife.

Ultimately, I’ll be surprised if this becomes a confirmed diagnosis, though when I challenged my doctor he pointed out that “not everyone presents like a textbook”, which I suppose is a fair point. Fortunately, it seems that the ACTH test that he has ordered seems pretty effective at definitively ruling it in or out.

Thoughts or experiences welcome.

Having come across low cortisol only a couple of times., I am aware that it does effect your first phase hormonal response to glucose and of course insulin levels.
having the tests is another rung on the ladder.
I can only say that most tests, are not actually used for diagnosis, but they mostly eliminate other conditions.
It is usually a series of tests to get no other reason why it cannot be anything else but what the tests show. The low cortisol does make a difference and the other test will give more clues, as will the next blood panel, the symptoms when the low cortisol is corected.
You will get there, it isn't easy it does take time and looking after yourself, being sensible.
Hope that helps a little.
Let us know how you get on.