Insulin resistance

[Catkysydney]

Hi ,
I have reactive hypoglycemia and type 2 diabetes.
I watched Dr Berg’s YouTube regarding reactive hypoglycemia .
He said those who have reactive hypoglycemia have insulin resistance, but my fasting insulin level is 4. Normal range is 2.6-24.9 mcIU/ml , I don’t have insulin resistance.
Is there anyone can help me regarding insulin resistance, please ? Also do I have type 1.5 ? I have never been overweight , now nearly underweight…
I am confused ….
Thank you very much for your help in advance.

 

[Jasmin2000]

Hi ,
I have reactive hypoglycemia and type 2 diabetes.
I watched Dr Berg’s YouTube regarding reactive hypoglycemia .
He said those who have reactive hypoglycemia have insulin resistance, but my fasting insulin level is 4. Normal range is 2.6-24.9 mcIU/ml , I don’t have insulin resistance.
Is there anyone can help me regarding insulin resistance, please ? Also do I have type 1.5 ? I have never been overweight , now nearly underweight…
I am confused ….
Thank you very much for your help in advance.

Hi @Catkysydney - wow that's a conundrum!

Insulin resistance means that the your cells don't respond to insulin and not that less insulin is secreted - in fact insulin levels rise above normal. This is on Dr Berg's graph where is says "Over Secretion Insulin." I'm not sure what that means wrt fasting insulin levels compared to post-prandial levels.

Unless there's a genetic component, reactive hypoglycemia can be addressed by dietary changes. It may sound counter-intuitive when you're suffering from low BG but a balance of fewer carbs and more protein and fat will teach your cells to become insulin responsive again.

 

[Lamont D]

Hi ,
I have reactive hypoglycemia and type 2 diabetes.
I watched Dr Berg’s YouTube regarding reactive hypoglycemia .
He said those who have reactive hypoglycemia have insulin resistance, but my fasting insulin level is 4. Normal range is 2.6-24.9 mcIU/ml , I don’t have insulin resistance.
Is there anyone can help me regarding insulin resistance, please ? Also do I have type 1.5 ? I have never been overweight , now nearly underweight…
I am confused ….
Thank you very much for your help in advance.

Insulin resistance is unfortunately with us for life, I would imagine. But it can improve.
Through dietary means.
The thing with RH is not your fasting level, but the response to the glucose. The initial first phase insulin response is weak, even if your insulin resistance is poor.
And then the reaction to the low insulin response. Which is the overshoot of insulin. Which sends you hypoglycaemic.
If you have been diagnosed with RH, it is a non diabetic condition. So it is highly unlikely to be an autoimmune condition such as T1, 1.5, Lada.

Keep asking.

 

[Catkysydney]

Thank you very much for your reply , Jasmin and Lamont !

So I don’t need to worry about less insulin level .

I have been managing my blood glucose level, I have not had hypo for more than years . But my fasting blood glucose and 2 hours after are becoming higher so my doctor prescribed me Ozempic, which is helping me .

But still sometimes my fasting blood glucose is a bit high. How could I lower this to normal range, please ?

 

[Jasmin2000]

Thank you very much for your reply , Jasmin and Lamont !

So I don’t need to worry about less insulin level .

I have been managing my blood glucose level, I have not had hypo for more than years . But my fasting blood glucose and 2 hours after are becoming higher so my doctor prescribed me Ozempic, which is helping me .

But still sometimes my fasting blood glucose is a bit high. How could I lower this to normal range, please ?

There's no magic bullet to rebalancing your diet (and lifestyle) and it may take some weeks of trial and error. As I said above - more protein and fats in the diet should help and lower GI carbs.

My own solution for high fasting BG is not for everyone. - I burn 200-400 kcal on my exercise bike or go for a walk (1-2 miles) to bring it down. But be careful as BG continues to fall for about an hour and can create a hypo.

In your situation I would start with at the low end and see what happens, and gauge if from there.

 

[Lamont D]

Thank you very much for your reply , Jasmin and Lamont !

So I don’t need to worry about less insulin level .

I have been managing my blood glucose level, I have not had hypo for more than years . But my fasting blood glucose and 2 hours after are becoming higher so my doctor prescribed me Ozempic, which is helping me .

But still sometimes my fasting blood glucose is a bit high. How could I lower this to normal range, please ?

I don't know how ozempic could help.
If I was to suggest something that my endo and other American end is have expressed some success with is sitagliptin.
Because of the lower BG response initially, that I have experienced. And others I have read about and viewed on YouTube. Sitagliptin follows the science, giving an additional percentage of insulin, when a weak first phase insulin response and insulin resistance has a direct effect on your BG over after carbs. Indeed I had an average of 3mmols lower response to the eOGTT tests and food experimenting, which in turn lowered the spike and the drop towards hypo, the symptoms and rapidity were curtailed.

The best way I have control of my BG levels is by dietary knowledge. It is the carbs and sugars that are the issue. Your body has an intolerance to carbs, and in my experience, avoidance of most carbs is the logical approach to getting better health.. T2 follows this path. You could achieve remission withaa very low carb diet.
This website recommend this dietary control.
Do discuss this with your GP. It will help you to get control.

My best wishes

 

[Catkysydney]

There's no magic bullet to rebalancing your diet (and lifestyle) and it may take some weeks of trial and error. As I said above - more protein and fats in the diet should help and lower GI carbs.

My own solution for high fasting BG is not for everyone. - I burn 200-400 kcal on my exercise bike or go for a walk (1-2 miles) to bring it down. But be careful as BG continues to fall for about an hour and can create a hypo.

In your situation I would start with at the low end and see what happens, and gauge if from there.

Thank you very much, Jasmin !
Yes , I have to be careful about exercise, I will not do too much .
I used to eat something beforehand . But I feel it is not necessary now.
I am doing low carb diets. So my blood sugar 2 hour after meals is usually OK. But sometimes my fasting level is a bit high.. I am wondering why..

 

[Catkysydney]

I don't know how ozempic could help.
If I was to suggest something that my endo and other American end is have expressed some success with is sitagliptin.
Because of the lower BG response initially, that I have experienced. And others I have read about and viewed on YouTube. Sitagliptin follows the science, giving an additional percentage of insulin, when a weak first phase insulin response and insulin resistance has a direct effect on your BG over after carbs. Indeed I had an average of 3mmols lower response to the eOGTT tests and food experimenting, which in turn lowered the spike and the drop towards hypo, the symptoms and rapidity were curtailed.

The best way I have control of my BG levels is by dietary knowledge. It is the carbs and sugars that are the issue. Your body has an intolerance to carbs, and in my experience, avoidance of most carbs is the logical approach to getting better health.. T2 follows this path. You could achieve remission withaa very low carb diet.
This website recommend this dietary control.
Do discuss this with your GP. It will help you to get control.

My best wishes

Thank you very much, Lamont !

I have been taking Sitagliptin as well . But I still eat carbs, so my blood sugar is sometimes a bit high 7.7ish. So my doctor prescribed me Ozempic . This is great . It suppresses my appetite in a great deal.
I don’t need to eat sugar now . So it has become easier to control what I eat .
I am trying to do low carb and high protein diet.
I think I should reduce more carbs in my diet.
Thank you very much for your advice !! Very helpful!

 

[Lamont D]

Thank you very much, Lamont !

I have been taking Sitagliptin as well . But I still eat carbs, so my blood sugar is sometimes a bit high 7.7ish. So my doctor prescribed me Ozempic . This is great . It suppresses my appetite in a great deal.
I don’t need to eat sugar now . So it has become easier to control what I eat .
I am trying to do low carb and high protein diet.
I think I should reduce more carbs in my diet.
Thank you very much for your advice !! Very helpful!

Reduce your carbs slowly. Say leave out some carbs and add more protein and good fats.

Sitagliptin helps but it doesn't let you have too many carbs.
I found that my body couldn't tolerate too much at all.

Since doing the research and the experimenting, I found that reducing the spikes helps with control, staying below prediabetic levels (7mmols), helps so much. Also gets your hba1c and improves your insulin resistance.
And the symptoms of course.

The only exercise I can do is walking.
But as always, it is individual to you.
I did find that going for a walk fifteen minutes after eating, for fifteen minutes aided BG levels.

I do think you are getting it.
And well done as it's not easy.
Keep letting us know how you are doing.
And if you find something that you want to share please do.

Us weirdos have to keep together!

 

[Catkysydney]

Sitagliptin helps but it doesn't let you have too many carbs.
I found that my body couldn't tolerate too much at all.

Since doing the research and the experimenting, I found that reducing the spikes helps with control, staying below prediabetic levels (7mmols), helps so much. Also gets your hba1c and improves your insulin resistance.
And the symptoms of course.

The only exercise I can do is walking.
But as always, it is individual to you.
I did find that going for a walk fifteen minutes after eating, for fifteen minutes aided BG levels.

I do think you are getting it.
And well done as it's not easy.
Keep letting us know how you are doing.
And if you find something that you want to share please do.

Us weirdos have to keep together!

Thank you very much , Lamont !!

Oh … I did not know that ..no wonder my blood sugar level became a bit higher ( around 7-8 ).
“Under 7 “ means 2 hours after meal ? If so , mine is in that range. Ozempic is helping me to control carbs.. no more cravings .

Do you do Keto diet ? I have tried, but ended up low carbs. So I eat a small amount of carbs.

My friend made remission through a strict Keto diet, he has type 2 Diabetes.

What do you think about Keto ??

Thank you very much for your advice !! Very valuable to me …. You are so knowledgeable !

 

[Lamont D]

Thank you very much , Lamont !!

Oh … I did not know that ..no wonder my blood sugar level became a bit higher ( around 7-8 ).
“Under 7 “ means 2 hours after meal ? If so , mine is in that range. Ozempic is helping me to control carbs.. no more cravings .

Do you do Keto diet ? I have tried, but ended up low carbs. So I eat a small amount of carbs.

My friend made remission through a strict Keto diet, he has type 2 Diabetes.

What do you think about Keto ??

Thank you very much for your advice !! Very valuable to me …. You are so knowledgeable !

I thank you for the compliment but when I was first diagnosed, and even before that, the learning curve to find out the science and how the various treatments espoused by the medical profession, did not improve my health. I found someone on here who had T2 and RH.
Of course my endo helped.

Under 7 means all the time and you can still have a few carbs, obviously if you are able.

Yes I do keto, as my intolerance is so bad. But I do occasionally have a couple of bites of something sweet.
I also use intermittent fasting. Don't eat until mid afternoon and don't eat after around 7 which is four hours before bed. So I know I'm not going to sleep on a hypo.
Fasting really helps, cos of the whole daily issue of sticking to a restrictive diet.
It helps with food choices, over thinking about food, it reduces your intake, cuts down on shopping and saves money as well!
But fasting, if you keep to under 7mmols gives your body a chance to recuperate and there are health benefits.
Keto or as I've said under 7mmols can lead to remission and also stop the RH hypos.
I have had so much success with it.

Keep asking, you are doing well. Just a few tweaks to food choices can make such a difference.
My best wishes.

 

[Catkysydney]

I thank you for the compliment but when I was first diagnosed, and even before that, the learning curve to find out the science and how the various treatments espoused by the medical profession, did not improve my health. I found someone on here who had T2 and RH.
Of course my endo helped.

Under 7 means all the time and you can still have a few carbs, obviously if you are able.

Yes I do keto, as my intolerance is so bad. But I do occasionally have a couple of bites of something sweet.
I also use intermittent fasting. Don't eat until mid afternoon and don't eat after around 7 which is four hours before bed. So I know I'm not going to sleep on a hypo.
Fasting really helps, cos of the whole daily issue of sticking to a restrictive diet.
It helps with food choices, over thinking about food, it reduces your intake, cuts down on shopping and saves money as well!
But fasting, if you keep to under 7mmols gives your body a chance to recuperate and there are health benefits.
Keto or as I've said under 7mmols can lead to remission and also stop the RH hypos.
I have had so much success with it.

Keep asking, you are doing well. Just a few tweaks to food choices can make such a difference.
My best wishes.

Thank you very much , Lamont !

Under 7 all the time .. I am checking blood sugar 2 jours after meals , which I have twice a day .
Usually under 7, but sometimes over 7.

So I have to reduce carbs intake a little.

I found an edamame pasta, this is great ! No carbs.

Also I cook easy cake from almond flour or soy protein. This actually lower my blood sugar. Amazing.

I will be more careful what I eat to achieve under 7 !

Thank you very much for your advice !!! Very valuable to me….

 

[KennyA]

Thank you very much , Lamont !

Under 7 all the time .. I am checking blood sugar 2 jours after meals , which I have twice a day .
Usually under 7, but sometimes over 7.

So I have to reduce carbs intake a little.

I found an edamame pasta, this is great ! No carbs.

Also I cook easy cake from almond flour or soy protein. This actually lower my blood sugar. Amazing.

I will be more careful what I eat to achieve under 7 !

Thank you very much for your advice !!! Very valuable to me….

I do not have RH - I'm T2. The "under 7.8mmol/l" reading is what you should be looking for at the two hour mark after eating. In the first hour after eating any carb at all I'll see figures in the 9s - eg after a small latte, just from the lactose. That will have gone after 60 minutes.

This paper looks at blood sugar profiles from non-diabetic subjects recorded using a CGM. You'll see that there is substantial variation in blood glucose in these people. The conclusion (really not surprisingly) is

This study provided continuous glucose profiles in nondiabetic subjects and demonstrated that differences in meal composition are reflected in postprandial interstitial glucose concentrations. Regarding the increasing application of continuous glucose monitoring in diabetic patients, these data suggest that detailed information about the ingested meals is important for adequate interpretation of postprandial glucose profiles.

Continuous Glucose Profiles in Healthy Subjects under Everyday Life Conditions and after Different Meals - PMC

This study investigated continuous glucose profiles in nondiabetic subjects. Continuous interstitial glucose measurement was performed under everyday life conditions (2 days) and after ingestion of four meals with standardized carbohydrate content ...

www.ncbi.nlm.nih.gov

 

[Lamont D]

I do not have RH - I'm T2. The "under 7.8mmol/l" reading is what you should be looking for at the two hour mark after eating. In the first hour after eating any carb at all I'll see figures in the 9s - eg after a small latte, just from the lactose. That will have gone after 60 minutes.

This paper looks at blood sugar profiles from non-diabetic subjects recorded using a CGM. You'll see that there is substantial variation in blood glucose in these people. The conclusion (really not surprisingly) is

This study provided continuous glucose profiles in nondiabetic subjects and demonstrated that differences in meal composition are reflected in postprandial interstitial glucose concentrations. Regarding the increasing application of continuous glucose monitoring in diabetic patients, these data suggest that detailed information about the ingested meals is important for adequate interpretation of postprandial glucose profiles.

Continuous Glucose Profiles in Healthy Subjects under Everyday Life Conditions and after Different Meals - PMC

This study investigated continuous glucose profiles in nondiabetic subjects. Continuous interstitial glucose measurement was performed under everyday life conditions (2 days) and after ingestion of four meals with standardized carbohydrate content ...

www.ncbi.nlm.nih.gov

I would agree with the T2 readings and I have used the pre and post meal testing at two hours to see what the results are.
However, with RH, which I probably never made clear, is the spike over around 7-8mmols creates the trigger for the overshoot of iinsulin. Which causes the hypo.
If you stop the spike you stop the hypo.

 

[Catkysydney]

I do not have RH - I'm T2. The "under 7.8mmol/l" reading is what you should be looking for at the two hour mark after eating. In the first hour after eating any carb at all I'll see figures in the 9s - eg after a small latte, just from the lactose. That will have gone after 60 minutes.

This paper looks at blood sugar profiles from non-diabetic subjects recorded using a CGM. You'll see that there is substantial variation in blood glucose in these people. The conclusion (really not surprisingly) is

This study provided continuous glucose profiles in nondiabetic subjects and demonstrated that differences in meal composition are reflected in postprandial interstitial glucose concentrations. Regarding the increasing application of continuous glucose monitoring in diabetic patients, these data suggest that detailed information about the ingested meals is important for adequate interpretation of postprandial glucose profiles.

Continuous Glucose Profiles in Healthy Subjects under Everyday Life Conditions and after Different Meals - PMC

This study investigated continuous glucose profiles in nondiabetic subjects. Continuous interstitial glucose measurement was performed under everyday life conditions (2 days) and after ingestion of four meals with standardized carbohydrate content ...

www.ncbi.nlm.nih.gov

Thank you very much for, Kenny !

Under 7.8 mmol/l ?

That would be easier to achieve.

Thank you very much for your advice !

 

[Catkysydney]

I would agree with the T2 readings and I have used the pre and post meal testing at two hours to see what the results are.
However, with RH, which I probably never made clear, is the spike over around 7-8mmols creates the trigger for the overshoot of iinsulin. Which causes the hypo.
If you stop the spike you stop the hypo.

Thank you very much , Lamont !

Right. “Around 7 - 8 mmol create the trigger for the overshoot of insulin “ is interesting.

“If you stop the spike you stop the hypo” is absolutely true.

So better “under 7”.

When I looked at UK and US site regarding RH, their number for hypo is below 4mmol/L and 70mg/dL. Almost the same number.

When I had 4 hours glucose tolerance test , my number was 3.2mmol/L. But I was diagnosed from pathology, I do NOT have RH because it is not lower than 3mmo/L !

I don’t know why Australia’s number for hypo is under 3mmol/L…

I had a severe headache , sweating, body shaking and could not think about anything other than eating sugar to raise my blood sugar at that time.
I was so scared that I may be fainted…

I think UK and US are correct …

 

[EllieM]

When I looked at UK and US site regarding RH, their number for hypo is below 4mmol/L and 70mg/dL. Almost the same number.

When I had 4 hours glucose tolerance test , my number was 3.2mmol/L. But I was diagnosed from pathology, I do NOT have RH because it is not lower than 3mmo/L !

I don’t know why Australia’s number for hypo is under 3mmol/L…

For an insulin dependent diabetic (such as myself, I am T1) , whose levels can go very very low due to excess insulin, a hypo is defined as less than 4 because if we go a lot lower it can be dangerous (irrationality, unconsciousness etc). So we get told that less than 4 is a hypo and take sugar accordingly.

But non diabetics can and do go down as low as 3.5 or so (they might feel a bit faint or hungry) and no one worries because their body's feedback loop of insulin and glucagon stops them from going dangerously low.

The paper below describes what happened when 39 non diabetics wore a cgm

Continuous Glucose Monitoring Profiles in Healthy Nondiabetic Participants: A Multicenter Prospective Study - PMC

Use of continuous glucose monitoring (CGM) is increasing for insulin-requiring patients with diabetes. Although data on glycemic profiles of healthy, nondiabetic individuals exist for older sensors, assessment of glycemic metrics with new-generation ...

www.ncbi.nlm.nih.gov

Apparently they spent an average of 15 minutes a day under 4mmol/L . (I've seen a non diabetic family member with a blood sugar of 3.5 before a meal).

But personally I would definitely regard 3.2mmol/L as seriously low (I wouldn't want to be driving or operating machinery with that level though I personally am still conscious into the high 2s. ) But I suspect (and I stress I don't have RH and am not a doctor) that the diagnostic test for RH is chosen to de deliberately much lower than the 4 for a conventional hypo just because normal non diabetics and non RHers can go down into the mid 3s without issue.

 

[Jasmin2000]

For an insulin dependent diabetic (such as myself, I am T1) , whose levels can go very very low due to excess insulin, a hypo is defined as less than 4 because if we go a lot lower it can be dangerous (irrationality, unconsciousness etc). So we get told that less than 4 is a hypo and take sugar accordingly.

But non diabetics can and do go down as low as 3.5 or so (they might feel a bit faint or hungry) and no one worries because their body's feedback loop of insulin and glucagon stops them from going dangerously low.

This diagram describes symptoms occurring as BG drops. I was always wondering when those counter-regulatory BG spikes occur and this says it's 3.8 mmolLL (68.4 mg/dL) and below, which is the start of the hypo region in the recommended BG range 3.9-10 mmol/L We're all a bit different of course but it's a good explanation of what's going on as you descend into hypoglycemia.

From https://pubmed.ncbi.nlm.nih.gov/29678605/ or https://drjockers.com/hypoglycemia-natural-solutions/

 

[Catkysydney]

For an insulin dependent diabetic (such as myself, I am T1) , whose levels can go very very low due to excess insulin, a hypo is defined as less than 4 because if we go a lot lower it can be dangerous (irrationality, unconsciousness etc). So we get told that less than 4 is a hypo and take sugar accordingly.

But non diabetics can and do go down as low as 3.5 or so (they might feel a bit faint or hungry) and no one worries because their body's feedback loop of insulin and glucagon stops them from going dangerously low.

The paper below describes what happened when 39 non diabetics wore a cgm

Continuous Glucose Monitoring Profiles in Healthy Nondiabetic Participants: A Multicenter Prospective Study - PMC

Use of continuous glucose monitoring (CGM) is increasing for insulin-requiring patients with diabetes. Although data on glycemic profiles of healthy, nondiabetic individuals exist for older sensors, assessment of glycemic metrics with new-generation ...

www.ncbi.nlm.nih.gov

Apparently they spent an average of 15 minutes a day under 4mmol/L . (I've seen a non diabetic family member with a blood sugar of 3.5 before a meal).

But personally I would definitely regard 3.2mmol/L as seriously low (I wouldn't want to be driving or operating machinery with that level though I personally am still conscious into the high 2s. ) But I suspect (and I stress I don't have RH and am not a doctor) that the diagnostic test for RH is chosen to de deliberately much lower than the 4 for a conventional hypo just because normal non diabetics and non RHers can go down into the mid 3s without issue.

Thank you very much for your information, Ellie !

Yes, 3.2 mmol/L was very low also this was after 4 hours, nowadays glucose tolerance test is done for 5 hours . If I did 5 hours, my blood sugar would be lower for sure . I was so sick .

CGM sounds great ! I have spoken to my doctor about it, but he told me that he would not recommend those who do not take insulin…
I have extremely sensitive skin to bandage, my skin reacts even surgical tapes and ECG electrodes…. So I may not be able to use it ..

Someone told me that he had hypo from teens and diagnosed T2D, but actually he has T1D. So I will ask my doctor for testing autoantibodies. I am not overweight ( now nearly underweight), even my doctor was wondering why I got T2D..

Let’s survive together !

 

[Catkysydney]

This diagram describes symptoms occurring as BG drops. I was always wondering when those counter-regulatory BG spikes occur and this says it's 3.8 mmolLL (68.4 mg/dL) and below, which is the start of the hypo region in the recommended BG range 3.9-10 mmol/L We're all a bit different of course but it's a good explanation of what's going on as you descend into hypoglycemia.

View attachment 66377
From https://pubmed.ncbi.nlm.nih.gov/29678605/ or https://drjockers.com/hypoglycemia-natural-solutions/

Thank you very much for the information, Jasmin !

I always have symptomatic hypoglycemia from teens, if I do not have breakfast for a long time , I have hypo. Doing exercise without food , then I have hypo. If I eat lots of carbs, I have hypo.
I was always carrying chocolates with me when I was a student . I knew it was low blood sugar without being told by a doctor , my body told me so.

Now I am doing low carb diet ( I tried Keto , but failed ), so I do not have hypo lately.

HbA1c was 5.5 last time, my doctor is happy with it .

Let’s survive together !