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Understanding Rh And Insulin

L

Lbeth

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what usually is going on in the pancreas when RH is happening. Two years ago when I was diagnosed with RH, it was explained to me that RH is usually due to insulin resistance and the pancreas’ attempt to over-compensate. Just had my insulin and c-peptides checked (along with glucose) and my insulin actually went down when my glucose went up. Fasting glucose was 77, insulin 2.4 and c-peptide .55 Postprandial glucose 178, insulin 2.3 and and c-peptide .66 If it was Insulin resistance, wouldn’t my insulin rise with my glucose? Obviously a 5 hour gtt test with insulin readings would give a better picture of what is happening when I go hypo, and when I see an endo next week, I will request it. But I want to go into my appointments prepared, and knowing what I’m talking about. The notes on my lab report said that high glucose with low insulin indicate type 1 diabetes. My hba1c is great at 4.7, but more and more my pp sugars stay high longer and I have less frequent hypos. Is this potentially RH turning into diabetes? Or is this just the normal course of RH, that the phase 1 response doesn’t work and phase 2 over compensates?
 
I found that, over time, I got higher blood glucose and moved into type 2 diabetes blood glucose levels.

I assume it was a combination of rising insulin resistance and my body just slowly wearing out.

One of the reasons I encourage any RHer to clamp down on their carb intake BEFORE their body deteriorates enough to get a T2 diagnosis.
 
Hi @Lbeth, Could you clarify please: the post prandial readings you quoted were ? 2 hours after the glucose feed ?
 
I’m working hard on cutting down the carbs. I’m still new to calculating carbs, but I estimate today lunch to have been about 35 grams of carbs and it sent my blood sugar up to 240 . I guess it’s time go completely grain free. Now I’m just watching my sugar like a hawk waiting for that sweet spot where it’s low enough to eat again, and to catch it before it crashes.
 
Lbeth said:
Sorry this was not a glucose test. It was just a test of fasting, and 2 hours post meal (of glucose, insulin and c-peptide)
Click to expand...
Thank you. So the usual ranges for 2 hours post prandial GTT would not apply as your meal might not have had the same amount of potential glucose as the usual GTT and the absorption of your meal would have been slower than glucose and so that influences insulin response etc.
So the results are perhaps ambiguous? but the low insulin and highish BSL at 2 hours makes for an argument for a formal GTT And to check on RH said GTT needs to be prolonged so an argument for 5 hour GTT.
If insulins levels are allowed to be tested on GTT testing where you live so much the better !!
Best Wishes !
 

Hi, and welcome to our forum.
First of all RH is not dependent on being insulin resistant, but it would not help in the initial stages before diagnosis and going very low carb. Insulin resistance will make your pancreas work harder and most of any surplus insulin will more than likely turn into visceral fat.
What happens is the pancreas does overcompensate because the initial release is not enough to the amount of glucose derived from most carbs and sugars. The blood sugar levels spike quickly , that is when you get the insulin overshoot, which after time lowers your blood sugar levels into a hypoglycaemic episode.
I would definitely express a desire for a fasting extended OGTT.
This test will give your specialist a lot of information, it won't actually diagnose RH but it's another step for a true diagnosis. Your Hba1c, and other tests so far do indicate something close to some type of insulin imbalance in your blood.

If it is something similar to Hypoglycaemia, then dietary control is the only treatment that will work. That means avoiding foods that trigger the insulin response.

Have you a glucometer to record your blood sugar levels and record it in a food diary? Then you can see what foods you are intolerant to, by tracking your levels before and after eating.

What sort of dietary advice have you had so far?

I have been in total dietary control for over four years and have not had a hypo since my last eOGTT!

You are asking the right questions.
Be truthful with your specialist, write down your symptoms, tell your specialist, that you need the tests to get a true diagnosis and you want to find if allergies or intolerance to foods particularly reducing carbs and sugars will help you cope with whatever condition you end up having!

Best wishes
 
I was diagnosed with RH two years ago. Basically the endo said with a normal hba1c, and glucometer readings that show highs and seemingly reactive lows, with normal insulin(two years ago my insulin was in the normal range) it can either be RH or pre-diabetes. I also had high cholesterol and enlarged liver, so she said classic metabolic syndrome and probable IR(though my BMI was underweight then) My only dietary instructions were avoid sugar and eat every two hours. I have monitored my sugars at home with a glucometer, but during a pregnancy last year my RH completely went away, so I stopped monitoring. It wasn’t until about 6 months ago that I started noticed I was having hypos again and started monitoring my bs again. That’s when I noticed I was having longer lasting hyperglycemia with less hypos than 2 years ago. So I requested the lab repeat all my tests I had 2 yrs ago and realized I’m seemingly healthier(cholesterol is good, hba1c is lower) but my insulin isn’t rising when my blood glucose is. my strategy right now is stick with as low carb as possible and monitor with my glucometer my response to every thing I eat, trying to stick with meals that keep me under 140. I guess I wonder if it’s worth it keep digging for answers or just keeping digging into what works on my own to keep my bs down. I guess I want to know if the low insulin indicates I’m becoming diabetic. I’m an American living in India so the medical system here is a bit frustrating. Doctors typically don’t want to do any digging unless they’ve prescribed a medication and it doesn’t work. I’m hesitant to go to the endo without good reason. I imagine they’ll think it’s silly that I have aglucometer at all since my hba1c is so good. The good thing here is you don’t need a doctors prescription to get lab work done, and it’s relatively cheap. So I could get the 5 hour t st done without even seeing the endo first. How is the test usually performed? Do you just go back a forth to the lab, or are you admitted to the hospital for observation? I know from my own experiments at home that the 3-4 hour mark I’ll drop below 50, so I’m nervous to do it not under a drs supervision in case I pass out.
 
Sorry, can’t answer questions about the 5 hr GTT because I have never had one - but all the ones I have heard of were run in hospital, I think.

You may find it interesting to test a few of your current meals by testing every 15 mins from first bite until your blood glucose returns to where it started.

We are all v different in our highs and lows, but with RH the 2 hr reading gives v limited info. I think it is more important to spot the peak. By knowing how high you go, and then seeing how fast and how low you go after, you will get a better idea. I always think the 2 hr post prandial reading is rather like pinning a tail on a donkey...

Have you heard of the Freestyle Libre?
Marvellous gadget.
It has made my life sooooo much easier - and I only need to stick in a sensor every couple of months to keep up the same level of understanding and stay on top of things.
 
I don’t think there are any personal continuous glucose monitors available here. but will bring it up to the next endo, and if not, I’ll look into next time we are in America. It does sound wonderful.

And for sure the 2 hour test is like pin the tail on the donkey . When I did an at home pseudo glucose test with my glucometetr, I got a 250 at 1.5 hours, but 130 at 2 hours‍
 
The eOGTT is always done under supervision in a hospital.
But if you want to, you can always test yourself, as in what you eat and test every fifteen minutes as suggested. And a cgm is always a great tool to monitor what happens.
I would still ask for the eOGTT, otherwise why would they advise eating every two hours? That means that they are worried about your going hypo after a while.
My Hba1c and all my other blood panel results are normal. But I still go hypo if I don't control my food.
You will always question what exactly why you are getting these symptoms, so keep battling for a true diagnosis. Then from there you can stop worrying about why and concentrate on how to get the right treatment for you.
I would continue the low carb approach as it does seem to be working for you.
And I would not be anxious about having a glucometer, how would you find out what is going on without one?
The more you record your readings before and after food, will help you and your doctors. I would certainly be lost without mine. It is your own diagnostic tool.

Don't settle for less, keep battling.

Best wishes
 
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