New T2 with hypos

[MarthaD]

Hi there. I'm a 48 year old woman, reasonably fit, with a BMI of 23, who has recently been diagnosed as a T2 diabetic (hba1c of 61 - jumped from 45 three months ago). All of this despite following a reasonably low carb diet for years. I've been getting hypos on and off for a couple of years but hadn't been measuring my BG until more recently. Now on metformin and hypos are much more frequent. I self monitor and these are genuine hypos (between 2.8 - 3.9mmol). I feel like GP and nurse not taking them too seriously. I'm trying to understand this more so wondering if anyone else experiences hypos as a type 2? Thank you.

 

[EllieM]

Hi @MarthaD and welcome to the forums.

I'm going to tag in @Lamont D who knows a lot about hypoglycemia in its various forms.

Though its most common cause is external medication such as insulin there are other causes, and some of those can be linked to T2. My understanding is that you really need an endocrinologist to work out the exact cause in your case.

My first thought is that you should push your GP for a referral.

Good luck.

 

[Smiter55]

I too am t2. Been recently having hypos overnight every night around the same time. I'm on metformin, rosiglitizon and glimepiride. I've tried all sorts to try prevent them and nothing working even had a slice of wholegrain with half banana before bed last night and still very low at around 3 am. I'm currently monitoring with libre 2 which shows a definite pattern with spikes all day every time I eat, regardless of how few carbs, then lows all during the night. My gp doesn't seem to be interested as my a1c is going down but surely extreme highs and lows can't be good.

Hints and tips to prevent the serious lows would be great.

 

[Lamont D]

I too am t2. Been recently having hypos overnight every night around the same time. I'm on metformin, rosiglitizon and glimepiride. I've tried all sorts to try prevent them and nothing working even had a slice of wholegrain with half banana before bed last night and still very low at around 3 am. I'm currently monitoring with libre 2 which shows a definite pattern with spikes all day every time I eat, regardless of how few ctarbs, then lows all during the night. My gp doesn't seem to be interested as my a1c is going down but surely extreme highs and lows can't be good.

Hints and tips to prevent the serious lows would be great.

Hi, @Smiter55, as @EllieM has said it is probably to do with your meds.
Do consult your GP, he will adjust your dosage and suggest other advice.

 

[Melgar]

@MarthaD, @Smiter55 I am T2 and get hypos - as low as 1.9, but mostly 2's and low 3's. They are real ones, I'm not just looking at my Libre, and thinking oh I'm low, I finger prick. They are not reactive lows either due to bad eating habits. I get them at night and I get them after exercise. I am waiting for an appointment with an endocrinologist. My Dr and my DN told me to increase my carbs at night about an hour before I go to sleep. At night I make sure I am between 8-10. My morning fasting sugars are mainly in the 6's. It has worked, the night lows have eased a lot. Exercise same thing, I make sure my carbs are up. I know this goes against the grain of low carb diets, but the carb increase has decreased / stopped my hypos. Now I'm not on any meds so likely a different reason for mine. I'm lactose intolerant (quite bad), GERD, IBS and Gluten sensitive, I'm also dodgy with animals fats. It could be a digestive thing with me, I don't know. I do get peptic ulcers and I have been tested for Heliobacter pylori, a stomach bacteria, but negative. I read a medical research paper that said Heliobacter pylori can cause lows. I also read a paper that pointed to pre-symptomatic LADA as a potential cause. I'm not suggesting either of these, but just interesting. I'm very active and eat healthy, normal weight. I go for blood work tomorrow for GAD antibody tests etc. I was pre-diabetic for about 2 years and now I am slightly Diabetic Ac1 6.5. ​

 

[Lamont D]

Hi there. I'm a 48 year old woman, reasonably fit, with a BMI of 23, who has recently been diagnosed as a T2 diabetic (hba1c of 61 - jumped from 45 three months ago). All of this despite following a reasonably low carb diet for years. I've been getting hypos on and off for a couple of years but hadn't been measuring my BG until more recently. Now on metformin and hypos are much more frequent. I self monitor and these are genuine hypos (between 2.8 - 3.9mmol). I feel like GP and nurse not taking them too seriously. I'm trying to understand this more so wondering if anyone else experiences hypos as a type 2? Thank you.

hi @MarthaD and welcome to the forum.

The reason why your GP and DSN doesn't understand is because they have not had the training about hypoglycaemia that they understand the science behind it all. As a type two, in the medical books, it doesn't happen unless you are taking blood glucose lowering drugs, I take it you're not?

I have a condition that I go hypo from certain foods.
I create too much insulin.
Before I got a true diagnosis of reactive hypoglycaemia, I was diagnosed with T2, and I was advised to eat healthy food. But it was this healthy food, such as porridge, wheat, potatoes that was making me ill.
Try telling a nutritionist that!

Metformin is a good drug for some T2s, if you are actually T2. I was taken off it by my endocrinologist.
And if you are having hypoglycaemia episodes, you need specialist care, an endocrinologist who understands how and why you do hypo. Ask your GP to refer you.

My advice for now, is to keep a good diary, and record your daily blood glucose levels, especially around meals.
Pre meal, and hourly after, to record the information.
What are your fasting levels? By this I mean before eating in the morning, but not straight after waking?

We have a forum for reactive hypoglycaemia, but it is about non diabetic or type two with reactive hypoglycaemia. Many more types or forms of hypoglycaemia exist, which most health care practitioners know nothing about.

Keep asking.
Keep recording.
Keep testing when you go hypo.

If you are having a hypo don't eat or drink too much sugary or carby drinks or foods just nudge your blood glucose levels up slowly with a low carb snack, something with good fats and protein, to not spike too high. A piece of cheese for example. Too much will cause a spike you don't want and maybe another hypo.

Can you give us a list of your normal diet. Maybe there is something that you are not aware of.

Best wishes.

 

[MarthaD]

hi @MarthaD and welcome to the forum.

The reason why your GP and DSN doesn't understand is because they have not had the training about hypoglycaemia that they understand the science behind it all. As a type two, in the medical books, it doesn't happen unless you are taking blood glucose lowering drugs, I take it you're not?

I have a condition that I go hypo from certain foods.
I create too much insulin.
Before I got a true diagnosis of reactive hypoglycaemia, I was diagnosed with T2, and I was advised to eat healthy food. But it was this healthy food, such as porridge, wheat, potatoes that was making me ill.
Try telling a nutritionist that!

Metformin is a good drug for some T2s, if you are actually T2. I was taken off it by my endocrinologist.
And if you are having hypoglycaemia episodes, you need specialist care, an endocrinologist who understands how and why you do hypo. Ask your GP to refer you.

My advice for now, is to keep a good diary, and record your daily blood glucose levels, especially around meals.
Pre meal, and hourly after, to record the information.
What are your fasting levels? By this I mean before eating in the morning, but not straight after waking?

We have a forum for reactive hypoglycaemia, but it is about non diabetic or type two with reactive hypoglycaemia. Many more types or forms of hypoglycaemia exist, which most health care practitioners know nothing about.

Keep asking.
Keep recording.
Keep testing when you go hypo.

If you are having a hypo don't eat or drink too much sugary or carby drinks or foods just nudge your blood glucose levels up slowly with a low carb snack, something with good fats and protein, to not spike too high. A piece of cheese for example. Too much will cause a spike you don't want and maybe another hypo.

Can you give us a list of your normal diet. Maybe there is something that you are not aware of.

Best wishes.

Thanks @Lamont D . I've been eating a pretty low carb diet for years, but over the last few months - before being diagnosed as T2 - I've noticed two things that cause my hypos - eating carbs (I spike and then crash) or exercise (even a 30 minute walk - unless I eat something like a banana beforehand). Have told my GP and nurse about this 'trend'. I'm only on metformin about 3 weeks but it has already increased my hypos although I'm eating more carbs to try to counteract that (which seems counter intuitive). My nurse has said metformin doesn't cause hypos, but I'm definitely having more. Yesterday, for example, I had porridge for breakfast. My glucose was 15.9 two hours later and down to 4.1 about 2 hours after that. Yesterday evening I had wholemeal toast and poached eggs. I was 8.2 two hours later and went down to 3.6 about 90 minutes after that. My GP wrote to endo for advice (while I was prediabetic, but not since) but they weren't overly concerned so I feel at a loss. I've read a lot about reactive hypoglycaemia and have wondered about this. My GP has also suggested LADA and has said we might explore that but wants to see how I get on with the metformin for three months. My morning fasting is about 8 now but was 12 before starting on Metformin. Coming down a little every day. I'm recording everything now and will feel better armed with information when I go back to my GP so hopefully she'll properly refer me then.

 

[MarthaD]

@MarthaD, @Smiter55 I am T2 and get hypos - as low as 1.9, but mostly 2's and low 3's. They are real ones, I'm not just looking at my Libre, and thinking oh I'm low, I finger prick. They are not reactive lows either due to bad eating habits. I get them at night and I get them after exercise. I am waiting for an appointment with an endocrinologist. My Dr and my DN told me to increase my carbs at night about an hour before I go to sleep. At night I make sure I am between 8-10. My morning fasting sugars are mainly in the 6's. It has worked, the night lows have eased a lot. Exercise same thing, I make sure my carbs are up. I know this goes against the grain of low carb diets, but the carb increase has decreased / stopped my hypos. Now I'm not on any meds so likely a different reason for mine. I'm lactose intolerant (quite bad), GERD, IBS and Gluten sensitive, I'm also dodgy with animals fats. It could be a digestive thing with me, I don't know. I do get peptic ulcers and I have been tested for Heliobacter pylori, a stomach bacteria, but negative. I read a medical research paper that said Heliobacter pylori can cause lows. I also read a paper that pointed to pre-symptomatic LADA as a potential cause. I'm not suggesting either of these, but just interesting. I'm very active and eat healthy, normal weight. I go for blood work tomorrow for GAD antibody tests etc. I was pre-diabetic for about 2 years and now I am slightly Diabetic Ac1 6.5. ​

Very interesting. I too am active, eat healthy and normal weight. I've no other health issues though, other than some minor GERD. I feel like I can take steps to prevent the hypos (like eating more frequently and more carbs than I'd like to) but would really like to bottom out what is causing them. I don't get them at night, but after exercise or if I've had some bad carbs. I'll need to push more for further tests.

 

[Melgar]

Very interesting. I too am active, eat healthy and normal weight. I've no other health issues though, other than some minor GERD. I feel like I can take steps to prevent the hypos (like eating more frequently and more carbs than I'd like to) but would really like to bottom out what is causing them. I don't get them at night, but after exercise or if I've had some bad carbs. I'll need to push more for further tests.

I just want to know why too. I research for reasons why, but really it's no more than a guessing game without specialist help. I will know more when I finally get to see an Endo. If I were you I would definitely go back to your GP. The CGM devices enlighten us to what is going on. Just finger pricks don't tell you a lot, just enough to know what is going on before your meal and 2 hours after. I often use blood draws to test how accurate my CGM is. CGM devices shine a whole different light. Before I started to use the sensors I would wake up at night thinking I had had a nightmare

 

[Lamont D]

Thanks @Lamont D . I've been eating a pretty low carb diet for years, but over the last few months - before being diagnosed as T2 - I've noticed two things that cause my hypos - eating carbs (I spike and then crash) or exercise (even a 30 minute walk - unless I eat something like a banana beforehand). Have told my GP and nurse about this 'trend'. I'm only on metformin about 3 weeks but it has already increased my hypos although I'm eating more carbs to try to counteract that (which seems counter intuitive). My nurse has said metformin doesn't cause hypos, but I'm definitely having more. Yesterday, for example, I had porridge for breakfast. My glucose was 15.9 two hours later and down to 4.1 about 2 hours after that. Yesterday evening I had wholemeal toast and poached eggs. I was 8.2 two hours later and went down to 3.6 about 90 minutes after that. My GP wrote to endo for advice (while I was prediabetic, but not since) but they weren't overly concerned so I feel at a loss. I've read a lot about reactive hypoglycaemia and have wondered about this. My GP has also suggested LADA and has said we might explore that but wants to see how I get on with the metformin for three months. My morning fasting is about 8 now but was 12 before starting on Metformin. Coming down a little every day. I'm recording everything now and will feel better armed with information when I go back to my GP so hopefully she'll properly refer me then.

I do believe that you are trying to control your bg levels and have taken steps by going low carb. But if you have read anything about T2, RH, or most of those that have a carb intolerance, just how bad it is, depends on the individual and how low carb you are actually.
If your intolerance is as bad as mine, then having porridge, any grain and most carbs will create too much insulin.
Now, most T2s, have a mechanism called glucogenisis, which prevents the body going hypo. Or its called a liver dump. This stops hypos happening.
When you have hyperglycaemia, hyperinsulinimia, due to insulin resistance and a poor insulin response to carbs, this creates a lot of problems. You haven't been tested for insulin levels, because it is insulin in the blood, that drives blood glucose levels down which causes the hypo. But it is the high spikes from carbs and the useless insulin that is the trigger, why it is, you are getting these readings.

having been given those readings after carby meals, wholemeal bread contains the same amount of carbs white cheap bread. Not good for an intolerant like me. It does seem that RH could be presumed from that,
ditch the porridge, it is so high in carbs. Find another breakfast or like I do, don't eat, till later.

You need a referral, not for LADA, but for the hypoglycaemia. You need a specialist that has experience in hypoglycaemia and the reason why you do. If it is not RH or a type of RH, then the reason why your pancreas is over producing insulin, could be something else. Don't be fobbed off.

Keep asking.
Keep testing.

And I'm not convinced that metformin is making the difference. It is your low carb dieting.

 

[Resurgam]

As a bog standard type 2, I suspect that going so low in blood glucose indicates that there is something non standard going on - I really struggle to lower my BG levels below 5.5 and that it requires specialist consultation.
GPs being happily blaze about things they do not understand seems to be becoming more common these days, but it is proving somewhat disastrous for some of their patients.

 

[Smiter55]

I just want to know why too. I research for reasons why, but really it's no more than a guessing game without specialist help. I will know more when I finally get to see an Endo. If I were you I would definitely go back to your GP. The CGM devices enlighten us to what is going on. Just finger pricks don't tell you a lot, just enough to know what is going on before your meal and 2 hours after. I often use blood draws to test how accurate my CGM is. CGM devices shine a whole different light. Before I started to use the sensors I would wake up at night thinking I had had a nightmare

I was waking during the night in a panic and thought it was my heart as I do have occassional af problems.

 

[Daibell]

First, the Metformin is unlikely to be the problem as it never has that much effect. Have you considered having Reactive Hypoglycemia? This is where the pancreas produces excessive amounts of insulin after eating. Do suggest this to your GP and do ask for a referral.

 

[Valanne]

Very interesting. I too am active, eat healthy and normal weight. I've no other health issues though, other than some minor GERD. I feel like I can take steps to prevent the hypos (like eating more frequently and more carbs than I'd like to) but would really like to bottom out what is causing them. I don't get them at night, but after exercise or if I've had some bad carbs. I'll need to push more for further tests.

I am similar. Can get hypos when walking briskly although we aren't supposed to. Tried a Libre and realised I was getting hypos at night as well. Always about 3am. Extra carbs before bed has helped. GP took me off my one metformin in November. Now my numbers are creeping up despite a fairly low carb diet. If I go really low carb I lose too much weight. A bit of a bind. I am 71 and HbA1C is always around 39.

 

[Lamont D]

I am similar. Can get hypos when walking briskly although we aren't supposed to. Tried a Libre and realised I was getting hypos at night as well. Always about 3am. Extra carbs before bed has helped. GP took me off my one metformin in November. Now my numbers are creeping up despite a fairly low carb diet. If I go really low carb I lose too much weight. A bit of a bind. I am 71 and HbA1C is always around 39.

If you are getting hypos under 3.5mmols. And not on meds. If it is exercising, then I believe it could be other than the T2.
As for dietary, weight control, the answer is finding a balance of low carb fresh food, tailored for you, and enough protein and saturated fat to both maintain weight and satiate.
I would recommend a website called dietdoctor.com. Or have a look through our low carb forum for ideas to help you.
I would definitely ask your GP to ask why you go hypo. It could be a pancreatic condition.

Best wishes

 

[KennyA]

Hi there. I'm a 48 year old woman, reasonably fit, with a BMI of 23, who has recently been diagnosed as a T2 diabetic (hba1c of 61 - jumped from 45 three months ago). All of this despite following a reasonably low carb diet for years. I've been getting hypos on and off for a couple of years but hadn't been measuring my BG until more recently. Now on metformin and hypos are much more frequent. I self monitor and these are genuine hypos (between 2.8 - 3.9mmol). I feel like GP and nurse not taking them too seriously. I'm trying to understand this more so wondering if anyone else experiences hypos as a type 2? Thank you.

Hi, I also get hypos, or a form of hypo, from time to time. No medication. I'd noticed a pattern of nightmares, waking up drenched in sweat and disorented around 4 am, but had never associated it with low BG. However when I tried a Libre for a month the nightmares/sweats correlate with a rapid drop over 30 mins or so to BGs of 3ish. My liver kicked in at that point and BGs quickly naturally and steadily recovered to usual levels.

These only happen at night, and come and go - not had one since early September.

 

[Lamont D]

Through my own experiences of Technicolor vivid dreams, it is quick blood glucose level drops that probably causes these bouts of night time dreams.

 

[JAT1]

I often have nightmares and wake up feeling awful. I check my blood sugar at such times and sometimes it's a hypo and sometimes not. I also have sharp drops after eating carbs even though as a type 1 I have bolused following my ratio. I find that in order to get through a night, it works more for me to have a very low carb dinner with plenty of fatty protein.