Newbie overwhelmed by her IR diagnosis

Hello and welome,

It is really easy to feel overwhelmed. So take a breath it will get better. I don't have reactive hypoglycaemia but I think @Lamont D may be the person to help you so I have tagged him.

Anyway I am sure those with more knowledge will be here soon.

Take care of yourself and welcome.

Elenas said:

This is my labs result showing RH,
Unfortunately my doctor didn't explain me so much about it. She was more focusing about my high fasting insulin and hurry to prescribed me metformin for this fasting insulin to decrease. That's it.

I don't understand why my blood sugar got that low after the glucose, I even didn't spike insulin as well.

How do you guys manage RH. Can you take medicine. I coudn't handle metformin it was making me even more hypo.

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Hi @Elenas and welcome to our forum.

I am taking my time, trying to go through the information that you have provided.
I can't understand why you only had a two hour OGTT. The norm is up to four or five hours. It seems that your fasting glucose is normal but your fasting insulin is high, this might because of insulin resistance or you could have high circulating insulin levels. However, that might distort the test but your first hour result is high for both glucose and insulin resulting in the two hours reading showing that the insulin has achieved the lower glucose levels. By your results, you metabolise the glucose fast, and your insulin response is continually driving your glucose levels down into hypoglycaemia. It's a pity they didn't test the insulin after two to three hours, just to see your insulin levels.
Metformin should not drive the glucose levels down. It is the go to meds for endocrine conditions. It probably won't be any use to you.

I was diagnosed with RH eight years ago, and since then, I have been in a Keto adapted diet. I try to avoid as much carbs as possible.
The reason why is that if you don't eat or drink carbs, your glucose levels remain in normal levels (4-6mmols) around 90 in your numbers. So no carbs, no glucose spikes, no overshoot of insulin, no Hypoglycaemia. It is the glucose spikes that trigger the insulin overshoot.
Even so called healthy carbs will spike you and cause Hypoglycaemia.
Unfortunately there is no magic pill or meds that will stop the hypos or the overshoot of insulin.
Sitagliptin has been used to help with your insulin as you eat, but will not stop the hypos. But it does give you a insurance against really high glucose levels.

Keep asking, keep safe.

I will respond to these other posts in the RH forum.

EllieM said:

There's a whole range of tests that the RH folk go through before a RH diagnosis, because things other than RH can cause insulin issues (eg insulinona, which can be treated). Have you been formally diagnosed with RH or are you still in the investigate phase.

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There is a range of tests usually Hba1c test. Then an extended OGTT, where c-peptide and GAD tests are done at the same time, insulin test s are also done and bloods are sent to a specialist laboratory.
If you have hypoglycaemic episodes after a few hours, that is not a diagnosis because as Ellie says, these tests are to eliminate other conditions that have hypoglycaemic episodes, such as insulinoma and other pancreatic conditions.
I have had a mixed meal test, an allergy tests, then finally a fasting test. This was a stay in hospital for around four days. If after this time and you don't go hypo, then without doubt, this is RH. If you do go hypo then there should be more tests for the other conditions.
It is a lot that will cause confusion and concern.
And not having your doctor explaining why it is happening, is not helping.
With RH, anxiety increases the longer you have symptoms. So it is the RH that is causing some of the feelings and how bad you feel.
I use intermittent fasting and Keto to stop the hypos.
It works for me because I have found my balance of protein and good fats to keep me in really good health, especially for my age.

Keep asking

It's high in the sense, that it will trigger the reaction. And your insulin is high in the sense that it's not doing its job efficiently because of the insulin resistance, by the time that you spike, it should be going lower, not maintain consistently producing too much insulin.
Fasting is really good for you, if you can, because it gives you a break of what to eat.
Wish I had only done a day fasting. Your blood glucose levels stay in normal levels, and it helps with symptoms.
As I'm not vegan, I can't really help you with your diet, I have a lot of salad because I can't eat a lot of cooked vegetables.. If you have a supermarket and they stock meat alternatives, there is quite a good range of vegan food. But be careful because some processed foods are full of sugar and I am affected by Palm oils and similar ingredients in manufactured foods. For example, I can't eat wheat so I looked for an alternative bread, so what I found is a free from gluten brand, but when I looked at the ingredients it said that potato starch replaces the gluten. Potatoes are my nemesis, I have had huge spikes from one ordinary potato.
This should be the time to take stock read up on a low carb, high fat, vegetarian diet.
And testing and discovering what is spiking you. There is a vegetarian forum on here.

I have had to find alternatives to my dietary intake replacing the carbs. Or I just avoid them. I had to find my dietary balance. You would not believe the difference in your health and mind, once you have control in normal glucose levels range. If you are anything like me, the majority of symptoms were caused by eating a supposed healthy diet, but was slowly but surely putting my health at risk, because of the rollercoaster ride of blood glucose levels, up and down, all day, every day for years.
My doctors didn't understand it and told me to eat so called healthy foods.
Healthy food for the majority, but not healthy for me.
My food diary is telling me that what I did since diagnosis, to stop eating the foods that were recommended and discover what didn't trigger the insulin reaction.
And the only treatment is dietary.

Hope this helps.

Keep safe, keep asking.

It's really good that you have numbers. Most people would be ecstatic with a 4.8 A1c and just carry on as normal. Another route to dramatically reduce IR is focused exercise. I think once the habit is got into, it is easier than long fasting.

From what I read short duration HiiT and Resistance / Weight Training would be a useful combination rather than time consuming steady state exercise, which does have an impact with an obvious time burden.

https://exerciseright.com.au/exercising-beating-insulin-resistance/
https://scarysymptoms.com/2016/07/can-lifting-weights-fight-off-insulin-resistance/

I'm just going to agree with @Lamont D that avoiding carbs made a huge difference to my control of my blood sugar levels. Initially like you I just couldn't see how I could survive without carbs. I love them . While I do eat meat, frankly I don't really like it. My daughter though is vegan so I am always worried about how she will cope. There are some options for protein- what about tofu for example? Also when I looked into lactose intolerance (for my son) I think I recall that cooking cheese reduces the lactose or makes it better for those intolerant to tolerate it- maybe I am recalling incorrectly.

Anyway I hope you find some things to at least help you on your journey.

Mbaker said:

It's really good that you have numbers. Most people would be ecstatic with a 4.8 A1c and just carry on as normal. Another route to dramatically reduce IR is focused exercise. I think once the habit is got into, it is easier than long fasting.

From what I read short duration HiiT and Resistance / Weight Training would be a useful combination rather than time consuming steady state exercise, which does have an impact with an obvious time burden.

https://exerciseright.com.au/exercising-beating-insulin-resistance/
https://scarysymptoms.com/2016/07/can-lifting-weights-fight-off-insulin-resistance/

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Hi, I'm sure the OP is grateful for the advice and links, some of it will be really useful.
However, with RH, it is important to tailor your exercise, to not need a liver dump as that will cause a trigger for the hypo.
Long walks or a series of short walks may be the only exercise I can manage, I used to work, and working manually steadily was good for my health. I now climb the stairs, walk, and all the usual, cooking ,cleaning and washing up. Go the shops , and because I'm shielding, other options are limited.

Keep safe

Lamont D said:

Hi, I'm sure the OP is grateful for the advice and links, some of it will be really useful.
However, with RH, it is important to tailor your exercise, to not need a liver dump as that will cause a trigger for the hypo.
Long walks or a series of short walks may be the only exercise I can manage, I used to work, and working manually steadily was good for my health. I now climb the stairs, walk, and all the usual, cooking ,cleaning and washing up. Go the shops , and because I'm shielding, other options are limited.

Keep safe

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Not so sure in this case, as HiiT and Weights tend to increase glucose production with drops over time. I based my answer on the OP's response to fasting which appeared fine.

Mbaker said:

Not so sure in this case, as HiiT and Weights tend to increase glucose production with drops over time. I based my answer on the OP's response to fasting which appeared fine.

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Because of the only treatment we can use, any glucose that is derived from food and spikes you above normal levels range, will cause the extra insulin that will cause the Hypoglycaemia.
So no carbs, no spike, no insulin overshoot, no hypos.
The last thing we need is continually glycogen/glucose supplied by our livers.

Keep safe

Lamont D said:

Because of the only treatment we can use, any glucose that is derived from food and spikes you above normal levels range, will cause the extra insulin that will cause the Hypoglycaemia.
So no carbs, no spike, no insulin overshoot, no hypos.
The last thing we need is continually glycogen/glucose supplied by our livers.

Keep safe

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The OP reports no RH after fasting which would ordinarily produce a liver dump, so there is a risk of paralysis by analysis by doing nothing, or on the other hand using tools known to reduce and reverse IR With fasting IR numbers circa 3 x what Doctors in the low carb realm state they are happy with (Paul Mason, Paul Saladino), I would be minded to act. I got a 118 / 72 for blood pressure at he Doctors this morning, the lowest for me coming from a high numbers years ago. My point is, the literature states not to do heavy weights with hypertension, I have found the opposite is true and not just with blood pressure (always discuss with a healthcare professional a change of activity).