Mixed meal test

MarthaD

Active Member
Messages
38
Type of diabetes
Other
Treatment type
Tablets (oral)
I've been a type 2 for about 18 months now but have been experiencing hypos for years. Sometimes about 4 hours after a carby meal (not always), but always after activity (e.g. a 30 minute walk or mowing the lawn). After battling for months for a referral, I finally saw a very sympathetic endocrinologist who is sending me for a mixed meal test for suspected RH. I'm nervous it will be "normal" and they'll dismiss me with no resolution. I'm on metformin and my hba1c is worsening slightly (latest 60). They've upped my dose but I'm getting more frequent hypos and the clinicians all tell me it's not the metformin, but I'm really convinced it is. Any thoughts from similar experiences would be welcome.
 

Antje77

Oracle
Retired Moderator
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19,834
Type of diabetes
LADA
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Insulin
Do you test with a fingerprick when feeling hypo? How low do you go?
How long will the mixed meal test take? I hope it will be an extended one, considering it can take 4 hours after eating for you to get symptoms.

With an hba1c at 60, your average blood glucose is likely in the 9's. This in itself can make normal BG feel like hypos, especially if you're dropping quickly.

What type of diet do you eat?
 
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MarthaD

Active Member
Messages
38
Type of diabetes
Other
Treatment type
Tablets (oral)
Do you test with a fingerprick when feeling hypo? How low do you go?
How long will the mixed meal test take? I hope it will be an extended one, considering it can take 4 hours after eating for you to get symptoms.

With an hba1c at 60, your average blood glucose is likely in the 9's. This in itself can make normal BG feel like hypos, especially if you're dropping quickly.

What type of diet do you eat?
I go to about 3.5. The lowest I've gone to is 2.9. I eat a relatively low carb diet and I'm not overweight in any way. When I eat a small amount of carbs I can be up to 16 two hours after, then drop quickly over the next or 3 hours. The appointment letter told me the appointment would be about 6 hours, but I'm not sure how long the test will be.
 
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Lamont D

Oracle
Messages
16,474
Type of diabetes
Reactive hypoglycemia
Treatment type
I do not have diabetes
I've been a type 2 for about 18 months now but have been experiencing hypos for years. Sometimes about 4 hours after a carby meal (not always), but always after activity (e.g. a 30 minute walk or mowing the lawn). After battling for months for a referral, I finally saw a very sympathetic endocrinologist who is sending me for a mixed meal test for suspected RH. I'm nervous it will be "normal" and they'll dismiss me with no resolution. I'm on metformin and my hba1c is worsening slightly (latest 60). They've upped my dose but I'm getting more frequent hypos and the clinicians all tell me it's not the metformin, but I'm really convinced it is. Any thoughts from similar experiences would be welcome.

Hi, @MarthaD the mixed meal test is to test intolerance to carby foods.
This should be the first in a series of tests to determine which other conditions you may have. These elimination tests are necessary, as there is no direct test for RH.
I hope they told you it is a fasting test.
You may experience the rollercoaster symptoms of a high BG level, then symptoms of a hypo or a sugar crash.
Ensure you only have a low amount of carbs, it you do go hypo, as you could suffer from as recurrence of the symptoms known as the rebound effect.
The test is usually around five hours. To see the effect of the meal, the test has to last that long.
Mine was about 4 hrs & 45 minutes.
I go hypo from my eOGTTs around 3 hrs & 30minutes to 4 hours.
It is not the metformin. It is the intolerance to carbs, that causes the symptoms.
But my specialist endocrinologist, took me off metformin straight away.
Let us know how you get on.

Best wishes.
 

Ro9998

Well-Known Member
Messages
45
I've been a type 2 for about 18 months now but have been experiencing hypos for years. Sometimes about 4 hours after a carby meal (not always), but always after activity (e.g. a 30 minute walk or mowing the lawn). After battling for months for a referral, I finally saw a very sympathetic endocrinologist who is sending me for a mixed meal test for suspected RH. I'm nervous it will be "normal" and they'll dismiss me with no resolution. I'm on metformin and my hba1c is worsening slightly (latest 60). They've upped my dose but I'm getting more frequent hypos and the clinicians all tell me it's not the metformin, but I'm really convinced it is. Any thoughts from similar experiences would be welcome.
Low carbprogram? lower carb diet?
 

Ro9998

Well-Known Member
Messages
45
I've been a type 2 for about 18 months now but have been experiencing hypos for years. Sometimes about 4 hours after a carby meal (not always), but always after activity (e.g. a 30 minute walk or mowing the lawn). After battling for months for a referral, I finally saw a very sympathetic endocrinologist who is sending me for a mixed meal test for suspected RH. I'm nervous it will be "normal" and they'll dismiss me with no resolution. I'm on metformin and my hba1c is worsening slightly (latest 60). They've upped my dose but I'm getting more frequent hypos and the clinicians all tell me it's not the metformin, but I'm really convinced it is. Any thoughts from similar experiences would be welcome.
Are you a natural burner of carbs. My mum knew someone had had to have lunch early or she’d get tired her body actively burned carbs.
 

MarthaD

Active Member
Messages
38
Type of diabetes
Other
Treatment type
Tablets (oral)
Just had my MMTT. I thought I'd have a hypo because I often do but didn't come close on this occasion. They almost aborted to give me insulin at the 2 hour mark but decided to keep going. I've no idea what any of this means but not reactive hypoglycemia, it would appear. Just have to wait for my results.

Fasting BG 15.6mmol (my highest ever. I came off Metformin three days before the test and ate about 100g carbs yesterday)
One hour BG 22.9
Two hours BG 25.5 (another record high)
Three hours BG 20.5
Four hours BG 13.9
Five hours BG 11.9
 

Lamont D

Oracle
Messages
16,474
Type of diabetes
Reactive hypoglycemia
Treatment type
I do not have diabetes
Just had my MMTT. I thought I'd have a hypo because I often do but didn't come close on this occasion. They almost aborted to give me insulin at the 2 hour mark but decided to keep going. I've no idea what any of this means but not reactive hypoglycemia, it would appear. Just have to wait for my results.

Fasting BG 15.6mmol (my highest ever. I came off Metformin three days before the test and ate about 100g carbs yesterday)
One hour BG 22.9
Two hours BG 25.5 (another record high)
Three hours BG 20.5
Four hours BG 13.9
Five hours BG 11.9
I just wonder the overall effect of the MMTT had on you.
I will try and explain.
So instead of your FBG being 15mmols, it was in normal range, 5mmols.
Your one hour reading (23) would have been 13mmols. Which would have been high for the test.
Your two hours (25.5) would have been15.5. Extremely high from normal.
Then the rapidity downward to below the pre test reading, 4mmols below at five hours.

I can only imagine what would have been the symptoms if they ad given you insulin.

As I have tried to say, if that was myself in normal fasting reading. Those high spikes and rapid drops is classic RH.I'm
When I was misdiagnosed with T2, my readings would have mirrored those. It wasn't until my hba1c and fasting levels got down to somewhere around normal, that the symptoms became more prominent.

I do hope that they took bloods and some c-peptide etc. To see insulin levels through the test. As that would be key to diagnosis.

I am not at all saying you have RH, as that would need further tests to rule out other conditions. But interesting all the same.
Please do keep us informed.
But continue to ask for more diagnostic tests.

Best wishes.
 
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Lamont D

Oracle
Messages
16,474
Type of diabetes
Reactive hypoglycemia
Treatment type
I do not have diabetes
Thank you @Lamont D That's very interesting. They did take insulin and c-peptide throughout and I should have some results in about 2 weeks.
That shows they do have an idea what may be going on!!!!!
Ha!
Update us, but in my experience, it should be more tests!

I was given a series of tests, to rule out other conditions. As there is not just one diagnostic test for these types of conditions.

keep safe
 
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MarthaD

Active Member
Messages
38
Type of diabetes
Other
Treatment type
Tablets (oral)
@Lamont D I got this letter from my consultant. I am feeling very frustrated because there's no acknowledgement of my regular hypos. I've a virtual appointment coming up, so will ask questions, but it seems he doesn't think I've reactive hypoglycemia. I'm wondering if you've any thoughts? Thank you.
20240410_192643.jpg
 
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Lamont D

Oracle
Messages
16,474
Type of diabetes
Reactive hypoglycemia
Treatment type
I do not have diabetes
@Lamont D I got this letter from my consultant. I am feeling very frustrated because there's no acknowledgement of my regular hypos. I've a virtual appointment coming up, so will ask questions, but it seems he doesn't think I've reactive hypoglycemia. I'm wondering if you've any thoughts? Thank you. View attachment 67120
my first impression of this report is the high reading that peaked at three hours, it doesn't put your pre test reading in the report. But that reading is excessively high.. And it is interesting your labs results are awaiting, so it's like I said, tests, more tests and so.
The endo wouldn't commit to RH, cos you didn't go hypo, it probably would have been prudent to test after the four and five hours. I say this cos my peak was within the hour, and it took another two to three hours for the hypo.
It does seem your endo is curious about what is causing the hyper, hyperglycaemia during a mixed meal.
He/she alludes to the rare imbalance of glucose/ insulin levels throughout and especially the first two to three hours citing the extreme insulin resistance.
This could be the typical first phase imbalance in hypoglycaemia but also in uncontrolled T2
However, and as you probably are aware, there are many reasons for this and many different types of hypoglycaemia and T2.
More tests are my suggestion, and let's see what your endo comes up with.

At least he/she can see that there is a rare condition going on.

And finally acknowledgement of how well your dietary regime is helping.

Hopefully, the labs come through by the time you see your endo.I
Welcome to the weird rare condition club.


Best wishes and let us know how you get on
 
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Catkysydney

Well-Known Member
Messages
101
@Lamont D I got this letter from my consultant. I am feeling very frustrated because there's no acknowledgement of my regular hypos. I've a virtual appointment coming up, so will ask questions, but it seems he doesn't think I've reactive hypoglycemia. I'm wondering if you've any thoughts? Thank you. View attachment 67120

Hi Martha,
I can feel your frustration and confusion…
I had this test but only 4 hours. Then my blood sugar was 3.2mmol/L . They told me not below 3.0mmol/L, so it was not hypo. I had severe symptoms..
Even my GP told me that 3.2 is normal .
Then today he told me that I am too thin, so eat more sugar..
I am totally confused ….
 
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MarthaD

Active Member
Messages
38
Type of diabetes
Other
Treatment type
Tablets (oral)
my first impression of this report is the high reading that peaked at three hours, it doesn't put your pre test reading in the report. But that reading is excessively high.. And it is interesting your labs results are awaiting, so it's like I said, tests, more tests and so.
The endo wouldn't commit to RH, cos you didn't go hypo, it probably would have been prudent to test after the four and five hours. I say this cos my peak was within the hour, and it took another two to three hours for the hypo.
It does seem your endo is curious about what is causing the hyper, hyperglycaemia during a mixed meal.
He/she alludes to the rare imbalance of glucose/ insulin levels throughout and especially the first two to three hours citing the extreme insulin resistance.
This could be the typical first phase imbalance in hypoglycaemia but also in uncontrolled T2
However, and as you probably are aware, there are many reasons for this and many different types of hypoglycaemia and T2.
More tests are my suggestion, and let's see what your endo comes up with.

At least he/she can see that there is a rare condition going on.

And finally acknowledgement of how well your dietary regime is helping.

Hopefully, the labs come through by the time you see your endo.I
Welcome to the weird rare condition club.


Best wishes and let us know how you get on
Thanks for your thoughts. Always appreciated.
 
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MarthaD

Active Member
Messages
38
Type of diabetes
Other
Treatment type
Tablets (oral)
Hi Martha,
I can feel your frustration and confusion…
I had this test but only 4 hours. Then my blood sugar was 3.2mmol/L . They told me not below 3.0mmol/L, so it was not hypo. I had severe symptoms..
Even my GP told me that 3.2 is normal .
Then today he told me that I am too thin, so eat more sugar..
I am totally confused ….
I'm sorry you're experiencing similar frustrations. It's hard to navigate.
 
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Lamont D

Oracle
Messages
16,474
Type of diabetes
Reactive hypoglycemia
Treatment type
I do not have diabetes
Hi Martha,
I can feel your frustration and confusion…
I had this test but only 4 hours. Then my blood sugar was 3.2mmol/L . They told me not below 3.0mmol/L, so it was not hypo. I had severe symptoms..
Even my GP told me that 3.2 is normal .
Then today he told me that I am too thin, so eat more sugar..
I am totally confused ….
Where did your doctor train?
Was it clown school?
Below 4 in most medical books is a hypo.
Below 3.5 is definitely a hypo.
We have verified by spacialists, advice in our information to those looking for advice titled pages, when you come onto the website.
I even received an e-mail today from the site about hypoglycaemia.
Yes 3.2 can be a normal reading but not if your metabolism or hormone levels are in imbalance.
So if you are getting the symptoms, 3.2 is not a normal reading.
As for having sugar.
OMG!
I'm gobsmacked.
And unless your physical health is suffering being thin is not a modern-day bad thing.
Do you think he was thin shaming?
I'm flabbergasted.
Reminds me of a locum, who told me to lose weight, so I could sleep better.
Not knowing the reason behind it all, and not interested in my health at all.

Keep asking, cos there is nothing worse than confusion and not knowing.
Best wishes.
 

Lamont D

Oracle
Messages
16,474
Type of diabetes
Reactive hypoglycemia
Treatment type
I do not have diabetes
Thanks for your thoughts. Always appreciated.
adding to my previous reply @MarthaD
can you describe the symptoms you had during the test, especially the high BG levels. And of course the drop to near hypo BG levels?
If you have symptoms that are similar to T2 and what is termed as a sugar crash.
How were your eyes?

Keep asking.

Best wishes.
 

Catkysydney

Well-Known Member
Messages
101
I'm sorry you're experiencing similar frustrations. It's hard to navigate.

Yes, my doctor does not agree that I have hypo.
He does not refer me to a specialist unless I need surgery .. he diagnosed me with type 2 diabetes .. but recently he said I don’t have diabetes.. I feel I am stuck..
 
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Lamont D

Oracle
Messages
16,474
Type of diabetes
Reactive hypoglycemia
Treatment type
I do not have diabetes
Yes, my doctor does not agree that I have hypo.
He does not refer me to a specialist unless I need surgery .. he diagnosed me with type 2 diabetes .. but recently he said I don’t have diabetes.. I feel I am stuck..
Think that you need to change your doctor. Get a second opinion..
If you kept a record of your BG levels and showed another doctor, you just might some better help.
Hope you're feeling a bit better and have some control.