Too low insulin?

Hi @katejay1991 and welcome to our forum.

it is so refreshing that your endocrinologist has given you the insulin results, wish I could have got mine twenty years ago.

I've never had to interpret from values of insulin, it is usually blood glucose levels. So it may take a bit of explaining.
The first thing, I would have liked to see the three hours insulin levels, have you got it?
If you have your glucose levels to compare, can you post them?
Did they only do hourly tests?
Did they take veinous blood samples from a cannula?
This is why your appointment is so long after the eOGTT, the lab results take time.

Only really guessing from experience. Yes, it doesn't seem quite right because not having the half hour results doesn't give the spikes of glucose levels. Also doesn't show the insulin overshoot.
I can explain the first, second readings of insulin as a first insulin phase response issue, typical reactive hypoglycaemia symptoms. It is not enough to prevent the spike or trigger. This will give you higher than normal blood glucose levels (spike). This is the trigger for the pancreas to supply the overshoot of insulin, I would imagine between two and three hours, hence the hypoglycaemic episode your 2.4mmols clearly shows after three hours and maybe your insulin levels have dropped as well by the readings taken.

To explain why RH is different from other blood glucose/ insulin endocrine conditions.
It is non diabetic. Hypoglycaemic episodes due to too much insulin, delayed after other hormonal response to food. It is food that is the problem, namely sugars and carbs.
The glucose derived from your carb, sugar, starch intake, gives you abnormal high spikes, which is not good.
The overshoot of insulin, because of the spike, gives you an imbalance of insulin. Which again is not good.
Having continuous hypoglycaemic episodes, is not good, in fact it is really awful. I called the period before diagnosis my hypo hell.

Next, you need to change your diet.
Reduce your carb intake slowly but steadily, until you are virtually carb free (ish)
The idea is to keep your blood glucose levels in or around normal blood glucose levels. 4-6mmols.
Depending on your intolerance to foods. How to find out what to avoid. You have to experiment. You need to keep a food diary, with blood glucose readings, if you haven't got a glucometer, ask your GP, if he says no. Then ask your endocrinologist to get you one. You can buy one. And there is also now, continuous glucose monitors, (cgm) available. You will need to record what you eat, pre meal tests, one hour, two hours, three hours. To see how carb intolerant you are. I'm tagging @Rachox to give you the cheapest versions, and the test strips. It is an idea to test the same meal a few times, same portion size.

This will prevent spikes and no spikes means no overshoot, no hypos. No symptoms eventually.
It is not easy, in fact it will be like going cold turkey.

Intolerance is akin to an allergy, I was told from very young, I was lactose intolerant. So I didn't do dairy at all because I would have a severe reaction to it. To gory to detail! So when I was diagnosed with th and my endo suggested a dietary regime but with complex carbs or healthy carbs as they quote. I was still going hypo!
So I started to eat keto. And it worked fantastic! I even persuaded by endo to support my diet.
I don't have hypos. In ten years (ish) since diagnosis, I have only been out of keto four of five times. For reasons I won't go into.

There is a lot to take in, knowing how to stop the hypos is the most important factor in treating RH.T
Avoiding carbs is the only successful sustainable treatment.

There is no cure but you can control it through diet!Th

keep asking, best wishes

katejay1991 said:

I've had a OGTT and can see from the results I have reactive hypoglycemia (drop to 2.4 mmol/L after 30 mins of eating). I'm not seeing the doctor to discuss the results for another month, but can see on the results portal that my insulin levels also seem low, based on this reference I found online:

Insulin Level	Insulin Level (SI Units*)
Fasting	< 25 mIU/L	< 174 pmol/L
30 minutes after glucose administration	30-230 mIU/L	208-1597 pmol/L
1 hour after glucose administration	18-276 mIU/L	125-1917 pmol/L
2 hour after glucose administration	16-166 mIU/L	111-1153 pmol/L
≥3 hours after glucose administration	< 25 mIU/L	< 174 pmol/L

Mine are 22.9 - 30 mins after glucose, 17.1 - 1 hr after glucose, 6.7 - 2 hrs after glucose.

Does anyone know if this could be the reason for the RH? I read that too low insulin means enough glucose can't get into the cells but then I thought that would cause more glucose in the blood and therefore too high blood sugar rather than too low?

I know I could wait 4 weeks for my appointment, but I've been struggling with this for over a year and I just want some answers to feel more settled. So any feedback appreciated (those obviously will also get feedback from the docs!)

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It looks to me you’re basal. dose is not high enough. Your basal dose controls controls a blood glucose between 6.0 mmol and 10 mmol. When you eat something then you give yourself a Bolus of fast acting insulin to absorb the glucose you have eaten. If your waking up in the morning with a high glucose level you need to increase your basal insulin dosage.

glenmoray said:

It looks to me you’re basal. dose is not high enough. Your basal dose controls controls a blood glucose between 6.0 mmol and 10 mmol. When you eat something then you give yourself a Bolus of fast acting insulin to absorb the glucose you have eaten. If your waking up in the morning with a high glucose level you need to increase your basal insulin dosage.

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Hi @glenmoray.
The original poster is exploring her glucose tolerance test for her hypoglycaemia episodes.
She is not on insulin. The hypos are a result of carb intolerance, insulin resistance or first phase insulin response. She is non diabetic. Reactive Hypoglycaemia is non diabetic., And the complete opposite to diabetes because we over produce insulin as a result of carbs and sugar.

Best wishes.