Type 2 Low Fasting Insulin

[NotBeyonce]

Hi Guys,

I have not posted here in a while. I've been really busy not being married to Jay-Z, not being a mom of 3, and not voicing a character in the Lion King. I think the last time I posted, I was a Type 2 on insulin maintaining decent glycemic control. After getting really serious with my diet and exercise, I was able to get off insulin and all oral medications. My A1C has been stellar ranging from 4.9 to 5.1 for the past year or so. However, starting this spring (around lockdown for Corona), I started having highs and lows. My highs were double digits (up to 11) which is hard to deal with after basically never seeing anything above a 7 in forever. I also get tons of lows, generally as low as 2.0. My endocrinologist initially didn't seem concerned as my fasting (3.6 to 4.1.) and my A1C (4.9 to 5.1) have been stellar. However, after looking at my glucose logs, they saw multiple highs on a pretty clean diet and lows that are not influenced by sulfonylureas or insulin as I've off all meds. My doctor ordered labs. My fasting glucose came back normal. My fasting insulin came back low. This seems confusing and contradictory. I feel like as a type 2 should have high fasting insulin, with normal or high fasting glucose. If I'm having reactive hypos, I feel like I should have normal or high fasting insulin levels, with low fasting blood sugar. I feel like if I have low fasting insulin, I should have high fasting glucose (if I were some how LADA, or or in the early stages of adult onset type 1). My blood sugar highs, though high to me, are not at an alert level. My lows, I can not correlate them to anything dietary (eating a high carbohydrate meal and having a reactive hypo, going several hours without eating etc). My thirst has only slightly increased. I occasionally feel EXTREME hunger (but when I test my blood it will show a 5.4 or something), so I got my thyroid hormones tested too, but they were normal. I don't feel like how I did prior to diagnosis of type 2 (but my fasting and A1C were in the 20s so I had multiple diabetes symptoms), so I don't know what is up. I have my virtual appointment with my endocrinologist on Friday to get more insight. Until then, I'm relying on Dr. Google who has advised me to start planning for my funeral. I think Jennifer Hudson will give a soulful rendition of Amazing Grace. In all seriousness, anyone have a low fasting insulin?

 

[Member496333]

Low fasting insulin is generally a good marker of metabolic health but in your case I think you would benefit from a C-peptide or postprandial insulin test in order to determine whether or not your pancreas can actually secrete a decent amount when required.

 

[KK123]

Hi there, I agree with Jim. Maybe they need to take another look at your original diagnosis (as they seem to be doing). You are young, slim, etc and whilst this does not automatically define type, it's a factor. You came off insulin but again that does not always mean you are a type 2 who has gone low carb and was therefore able to stop insulin. A type 1/lada can come off insulin for a while at the start (sometimes) because of the honeymoon period. How did they come to diagnosis initially?, do you know whether you had a C Peptide/Antibody test? x

 

[Aurelien_1009]

Following. I had the same problem. My FBG is normal (4.8), my Fasting Insulin is 25.98 (17.8-172 pmol/l) and the C-peptide is 0.66 (0.37 - 1.47 pmol).
I can't find an answer.

 

[ert]

Hi Guys,

my fasting (3.6 to 4.1.) and my A1C (4.9 to 5.1)

If these are your results, you wouldn't expect a high insulin result, just normal low insulin resulting from fasting, as you're currently in remission.
As you mentioned, abnormally low insulin needs to be combined with an abnormally high fasting glucose to be one of the indicators of LADA, together with GAD antibodies and an abnormally low c-peptide below the normal range. Normal people, without diabetes and fasting, will have a low insulin result but also a low blood sugar result.

However, you were put on insulin, then came off it, so something clearly isn't right, despite these current results. It also isn't normal to have blood glucose readings of 2 mmol/l, if it's not down to the accuracy of your meter or contamination, as you normally have a glucagon response to get sugar from your liver. I hope you find some answers through your consultants soon.

 

[ziggy_w]

Hi @NotBeyonce,

I agree, what you are experiencing is a bit confusing.

These are some of my thoughts (and I largely agree with @ert on this):

As other have said, low fasting insulin can be due to the inability to produce sufficient insulin. However, combined with the fact that your fasting blood sugars are very low (much lower than for most of us low carbers), I not really sure there is reason for concern. It is possible that your body just doesn't need to produce more insulin to keep fasting levels normal -- so in my mind your low fasting insulin levels tend to be more based on a lack of demand for more insulin (rather an inability to produce more insulin) -- possibly as a result of a low carb diet and almost optimal insulin sensitivity. (Anyway that would be my guess -- of course this is not meant to be a diagnosis).

Also, the fact that your metabolism is able to bring down higher blood sugar levels to hypo levels (without medication if I read your post correctly) seems to point towards an adequate insulin production (though you might also want to consider whether you might even possibly overproduce insulin in response to food or in response to higher blood sugar levels).

I also tend to agree with you that it sounds a lot more like reactive hypoglycemia than what you would normally see in traditional T2s (though I have to admit I'm not really knowledgeable on this, but maybe @Brunneria and @Lamont D can chime in as our resident experts on this). How many grams of carbs are you having on average per meal? Is it possible that your carb intake is still high enough to cause these blood sugar swings?

 

[Lamont D]

Hi Guys,

I have not posted here in a while. I've been really busy not being married to Jay-Z, not being a mom of 3, and not voicing a character in the Lion King. I think the last time I posted, I was a Type 2 on insulin maintaining decent glycemic control. After getting really serious with my diet and exercise, I was able to get off insulin and all oral medications. My A1C has been stellar ranging from 4.9 to 5.1 for the past year or so. However, starting this spring (around lockdown for Corona), I started having highs and lows. My highs were double digits (up to 11) which is hard to deal with after basically never seeing anything above a 7 in forever. I also get tons of lows, generally as low as 2.0. My endocrinologist initially didn't seem concerned as my fasting (3.6 to 4.1.) and my A1C (4.9 to 5.1) have been stellar. However, after looking at my glucose logs, they saw multiple highs on a pretty clean diet and lows that are not influenced by sulfonylureas or insulin as I've off all meds. My doctor ordered labs. My fasting glucose came back normal. My fasting insulin came back low. This seems confusing and contradictory. I feel like as a type 2 should have high fasting insulin, with normal or high fasting glucose. If I'm having reactive hypos, I feel like I should have normal or high fasting insulin levels, with low fasting blood sugar. I feel like if I have low fasting insulin, I should have high fasting glucose (if I were some how LADA, or or in the early stages of adult onset type 1). My blood sugar highs, though high to me, are not at an alert level. My lows, I can not correlate them to anything dietary (eating a high carbohydrate meal and having a reactive hypo, going several hours without eating etc). My thirst has only slightly increased. I occasionally feel EXTREME hunger (but when I test my blood it will show a 5.4 or something), so I got my thyroid hormones tested too, but they were normal. I don't feel like how I did prior to diagnosis of type 2 (but my fasting and A1C were in the 20s so I had multiple diabetes symptoms), so I don't know what is up. I have my virtual appointment with my endocrinologist on Friday to get more insight. Until then, I'm relying on Dr. Google who has advised me to start planning for my funeral. I think Jennifer Hudson will give a soulful rendition of Amazing Grace. In all seriousness, anyone have a low fasting insulin?

Hi and welcome back,
I will give you the benefit of my experience.
I too was misdiagnosed with T2, because my blood sugar levels were high when tested by my doctors. It was always high because I had porridge for my breakfast and usually after a while I was being tested at my spike (ish). Also because my insulin resistance and health was bad. My levels after a while were abnormal in the extreme.
When I was diagnosed with RH, I had to adapt to a very low carb diet, because as a few of T2s are carb intolerant. As soon as I stopped eating carbs, my diabetic levels came down dramatically. So much so that since then my hba1c levels of and my fasting levels were in normal range. I was referred because I had a hypoglycaemic episode in front of my GP. After a few tests I was diagnosed with RH.
As has been said, quite low fasting insulin levels should be taken as a healthy metabolism, but with RH, you always get a weak insulin response. It isn't until you trigger what is known as an overshoot of insulin that your blood sugar levels are driven down into hypoglycaemia. RH is a non diabetic condition that is similar to T2 symptoms. The reasons for the low insulin response is not known but you could also have hyperinsulinaemia along with insulin resistance and it wouldn't be of any use, because the background insulin, circulating insulin won't get rid of the glucose. And your results would show low insulin levels. That is why it can be confusing.
RH is a food derived condition. The reaction to certain foods is as I have described.
Treating a hypoglycaemic episode as you would a diabetic you would have something high carb or sugar to get your blood sugar levels back above normal. This would create a rollercoaster ride of high and low levels until you stop eating.

I would ask your specialist for an extended OGTT. Up to five hours, which should include c-peptide and GAD. This will be a first step. If you go hypo during the test then it is a possibility that you have some type of hypoglycaemia.

Don't forget to take your readings that you have taken to your appointment.
Whatever is going on, it is not right, have a read of our forum, it might help you understand a little bit more.

Ask any questions, keep safe

 

[NotBeyonce]

I do not think I was initially misdiagnosed with diabetes. I had all the classic markers and A1C and fasting glucose at around 20. I do, however, feel like I'm a Type 2 in remission. Or a Type 2 managing with diet and exercise. I feel like I'm definitely more in the RH category than the LADA category. Also, I wish my body would adapt to running efficiently. It's like, hello, pancreas, we don't have to combat a blood glucose of 20 mmol/L! We ate vegetables and chicken; we're at a 6! My endo has talked about scheduling a OGTT. I haven't had one since my original diagnosis. I don't know if I can get one now due to covid measures and the hospital/endocrinologist limiting non emergency visits/tests. I really wish when I got my fasting insulin test last week that they just did all the all the other tests, but I guess they needed to see if others were warranted. I have my provided all my logs (food and glucose) to my endocrinologist, endocrinology dietitian, and endocrinology nurse. They have not been be able to correlate my lows and occasional highs to anything dietary.

I'll keep you guys updated in case any other (former) Type 2s are dealing with (potentially) RH.

 

[Lamont D]

I would imagine that tests will still be going on and because people still need blood transfusions etc. The suite and staff will still be operational.
Do remember it's a extended oral glucose tolerance test you need, not a two hour test but four hours and more if necessary. I don't go hypo till around three and a half hours after the glucose, I have had about six eOGTTs and it was the same timing every time.
I have also wished I wasn't so weird, but I am, having a quite rare condition and having the knowledge that there is no cure, no pill that will resolve it.
Only dietary management. Of course it's changed my life, no treats, making sure that what you are eating has no hidden sugars, but you are already aware about your diabetes diagnosis and the dietary advice. You are nearly there.

Even if it isn't RH you should get the tests. If you are getting hypos, there is a reason for it.

Keep safe

Great avatar by the way!