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Repeat ogtt

Discussion in 'Reactive Hypoglycemia' started by Kirstyr, Jun 4, 2019.

  1. Kirstyr

    Kirstyr · Member

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    Today had my second prolonged ogtt. (The first one I didn’t hypo in 4 hours but did hypo after the test had finished at 6 hours. Today I hit a hypo at 4 hours, which took 90 minutes to come back up (and again after their ‘food’ at the end!)

    Today I managed to get down to 2.7 (Although this May not be low enough for the lab to test insulin, c peptide etc levels, but I’m hoping the consultant will still want it doing as I think this is key to what is going on as I’m not a typical reactive hypo patient)

    My hypos happen anytime between 2-6 hours post eating, I spike very high sometimes (when eating very little carbs) - yesterday I hit 22 afternoon eating chicken and green beans (no one can explain it to me!) often I then dip and have a plateau of several hours after eating just above the normal range where they then crash within minutes to a low number... I’m terrified of driving and having a low so do use a libre sensor with alerts using a Miao Miao and spike app set up. I always test pre driving anyway.

    My worst hypos are generally exercise induced so the fact the ogtt result didn’t go below 2.5 wasn’t unexpected, but I’m glad I went below 3... I get down to the 1’s on exercise... with no symptoms...

    The other thing is I’m noticing is a reduced hypo awareness. If I have nighttime lows (often unreadable on my sensor) I’m sleeping through. Previously I’ve noticed the period just before a hypo and when I go sub 4, currently I’m not noticing anything (apart from a slow fuzzy brain...). I’ve always woken up when my sugar drops to around 3 but no more... Any suggestions for this, except not having the hypos in the first place? (Which I know can be managed with Lchf to some degree but for reasons below I can’t follow this long term)

    I still have hypos with lchf , as I’m mega sensitive to any type of carb (including low carb vegetables - hence the 22 yesterday with a few green beans!). Reducing carbs even further really messed my liver function up. This has resolved since upping the carbs slightly but has led to erratic blood sugar control and many more hypos.

    I’m hoping when I see the endocrinologist next there is a plan - i would like to try sitagliptin to reduce the spikes but I think they want to try acarbose, which I don’t think will work as that works on the carbs I eat (which is minimal)... I’m ready for a educated debate!!
     
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  2. Kittycat_7_

    Kittycat_7_ Type 2 · Well-Known Member

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    Good luck with your appointment
     
  3. Discovery22

    Discovery22 · Active Member

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    I hope you find your answer. I too think that mine isn't just pure reactive as some days I'm fine the next day I'm not, even by eating the same stuff. I either have no hypos or have 2-3 in a day and it wears me out. You could try the hypo programme to help with hypo unawareness. It may help
    Good luck
     
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  4. Brunneria

    Brunneria Other · Moderator
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    I find that exercise, stress and sleep deprivation make my body handle carbs very differently.
    One day, one meal will have a totally different result, depending on whether there is a sudden stressful physical event (urgent dash for bus in the rain and stress of missing appt), or whether I slept well the night before.

    It ends up being a habit to retrace events and food to work out what happened. And why. And how to avoid it next time... Nowadays, a bad night's sleep means I automatically reach for a large protein breakfast and a drink with cream in it. Sleep deprivation messes my blood glucose up so much that I need to eat slow release protein, bolstered by fat or I get full blown hypos and carb cravings like a roller coaster. Stress used to be an exciting challenge, now it is a finely tuned torture device. :)

    I really hope your appt goes well and that you get a good discussion and explanation.
     
  5. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    Going hypo at four hours is classic ' Late Reactive Hypoglycaemia'!

    I'm so glad you have got this test done. It is a necessary elimination test, to show you actually have the spikes and hypos.

    How did the hospital treat the hypo?

    I think you will have to accept that the Hypoglycaemia is caused by your exercise, and will have to find a way to exercise without going hypo, the same as with carbs, you are carb sensitive, carb intolerant, and without doubt, avoidance is better than anything else that I have come across, yes, I do take sitagliptin but this is in case I do make a mistake, with my exercise, I work too much, or I eat the wrong foods, it will not stop the hypo, it just helps lower the initial spike.
    From what I have read, the drug acerbose is to reduce the effect carbs have, but as you have said, carbs in any amount, is causing symptoms and blood sugar levels to be effected. Personally, I would avoid the acerbose!
    I got my hypo awareness back when after a few weeks of going low carb, I can't tell you anything else. What I believe happens is because of continuous good control, your body adjusts to the low levels of insulin, your insulin resistance becomes better and you then become more aware of rising or lowering of your insulin levels or your blood sugar levels. Your awareness as described should return.
    Again, with the liver function, with very low carb, you will find that your liver function results will improve, mine did and have had no issues since diagnosis and starting low carb.
    I hate to repeat myself, but once you begin avoiding those foods that you are intolerant to, and you are already discovering some of them. Until you do, your body will still react to those foods.
    My best advice has always been about control.
    You don't require carbs, for a better future health, avoidance is so important.
    I believe that you are still at that stage, as per having hypos, having no or little hypo awareness, that your insulin levels are still too high during the day, especially after food, that even though you have had a good start to getting to grips with eating lower carb, you are getting hypers and hypos, and not achieving where you need to be.
    It takes time, it takes patience, keep experimenting, keep testing and recording because your endocrinologist will want to see the results.

    Best wishes.
     
  6. Kirstyr

    Kirstyr · Member

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    Went back today to the endocrinologist.

    We are starting acarbose. We believe my body won’t tolerate a full keto diet due to other conditions, and despite following it for several months before referral to him it created a rather bad liver profile, and obvious stress on the body despite using the right supplements and didn’t totally resolve my hypo scenario (although it was the best route I’ve found so far) Low carb also doesn’t give me full relief, and it’s strange that I have varying reactions to the same food dependent on the day! Little and often creates a high that lasts a whole day and crash in the evening, high gi seems to work better than low gi which seems to be the opposite of what they would expect too..

    Anyone with experience of acarbose? he is still waiting on my insulin tests etc to come back from the ogtt hence not going the gliptin route... I’m not convinced it will work, but I’ll try anything to say it’s been tried...

    In terms of my ogtt the nurse let me self resolve the hypo!! But then they fed me a white bread cheese sandwich = rebound... but never mind... they got it half right!

    I’m also restricting driving, I can still drive but where possible not to... I have libre and Miao Miao turning it to a cgm with appropriate testing and snacks before driving... Should save some pennies on fuel! (Which I’m spending on the prescription charge!)

    I’m going back to see him again in a month to review...
     
  7. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    I know it's not what you expected, and you do sound disappointed, but the glucose test did tell you something that you already knew, whatever is causing the trigger to give you excess insulin, is causing the hypos.
    You cannot go back to eating the foods, whichever they are, that will still turn to glucose and trigger the insulin overshoot.
    This is I believe what the acerbose is for, your endocrinologist is convinced that having carbs is essential, and the acerbose will help slowing down the digestion process to slow the spikes, but not enough to stop the trigger.
    You now know for definite that after a hypo you should not have quick acting glucose, because of the rebound effect. That is something you must insist on as you are different to every diabetic that has hypos! You are hypoglycaemic, not diabetic.
    Also, I had bad liver function and a non alcoholic fatty liver that was a worry at the time, but with very low carb, my results became very good! My liver function tests vary but no concern!
    Try reducing your meal times, or intermittent fasting, you might be still eating too much, I found little and often didn't work after I had had better control for a while. I only eat now to get enough to live.
    Are you keeping a food diary?
    You can convince your endocrinologist, what is working, and of course what you are intolerant to.

    Best wishes
     
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