What Is Type 2 Diabetes?

[bulkbiker]

to my mind to return to some kind of binary understanding of diabetes ( no production of insulin or over production of insulin) would be very retrograde

Would make treatment a lot less hit and miss.

Well all I know is that I have been diagnosed diabetic for over 21 years, 95% of the time diagnosed as as T2 / non insulin dependant, and have managed to stay on a low dose of Glic and return non diabetic hba1cs as long as I stick with that medication and carefully manage my diet adjusting as necessary when D throws its little curve balls - no progression to insulin here - Ive obviously just not lived long enough to fit the theory!!!

And presumably in all those 21 years you have never had a fasting insulin test.

 

[Lamont D]

The way I read your post: you are still attributing anything that causes a high blood sugar level to lead to an overshoot of insulin response, that does include a high carbs meal whether it contains high fibr contents or not

Correct! The first insulin response to any glucose derived food or drink is weak, so not all glucose is turned to energy by background insulin or first response. So a spike occurs very rapidly, the higher the amount of glucose derived from carbs especially, the higher the spike, the second insulin response is called an overshoot, this is the pancreas creating too much insulin for the amount of glucose remaining. A hypo will follow if prevention does not occur, by eating, but a rebound effect will happen, so once you start the rollercoaster, it is difficult to control. This is why recommended dietary advice is to eat every three hours to offset the hypo.
That is why I avoid these foods or you could say I'm carb intolerant!
Along with wheat, dairy, grains and in particular potatoes.

BUT do you have any backing, any theory or explanation which proves that some intolerance reaction to high fibre foods causes a rise in blood sugar sufficient to cause an insulin overshoot OR that independently triggers an insulin overshoot ?

It is independent, regardless of fibre content, most of the food that advocates high fibre usually contains carbs or grains, starchy vegetables, healthy food, or complex carbs, are not healthy for me.

My history is a long battle with misdiagnosed T2, my eventual diagnosis was as is with most RH ers, is a list of tests designed to eliminate other conditions. I have had quite a few eOGTTs, breakfast test, blood panels galore, 72 hour fasting, c-peptide, GAD test, allergy tests, and of course my own testing and experimentation, my food diary goes back to 2009.
Then I had a scientific paper wrote by my endocrinologist, because of trial s for a drug to offset the hyper. Which was published in 2015.

I was his first Reactive Hypoglycaemia patient. He soon added another woman to the trials. Both results were inconclusive, but showed a big difference in lowering the spike to offset any hyper, so during my last eOGTT, my spike was 8.5, instead of the usual, 13-15mmols from the glucose. But I still went hypo after the three and a half hours.

My condition was at that time very rare, but only because of lack of GP knowledge about hypoglycaemia in general.

The home page for RH is typical of an NHS guidelines for Hypoglycaemia in general, as it is for type two, as is the eat well plate. You must eat complex carbs and other rubbish about fats and proteins and of course being in ketosis.
I'm currently in my fourth year of ketosis.
My health is really great and no hypos since that last eOGTT. Over four years ago now.
I have been released from my endocrinologist, because I have convinced him by my food diary, and my last blood panels, that being in ketosis is the better treatment for my condition. And me.

I have gained so much knowledge about how my body and brain works.

 

[Brunneria]

May I ask whether you have had TTG- (blood test for coeliac disease) measured whilst on gluten ?

I haven’t.
But I haven’t ever had the classic signs of coeliac. So no one would have thought to request the test - including myself.

Once i gave up gluten my psoriasis improved dramatically (which is autoimmune) but i hadn’t expected that

 

[LittleGreyCat]

My understanding is that T2 can involve high insulin resistance and over production of insulin or lower insulin resistance and lower than normal production of insulin, which ties in with the diabetes.co.uk quote in the original post.

In my case I had a fasting test for insulin resistance which showed that I had mild insulin resistance and insulin production on the low side of normal.

This, of course, is confused by the fact that I am in dietary ketosis so my insulin production would be expected to be low and I'm not eating many carbohydrates. Never the less the test confirmed that I do not have a high level of insulin resistance and insulin production. So I am not the "typical" T2 who is over producing insulin but not using it effectively. If there is a typical T2, of course.

 

[Boo1979]

Would make treatment a lot less hit and miss.

And presumably in all those 21 years you have never had a fasting insulin test.

Dont think it would help make things less hit and miss. I was diagnosed via admission to hospital with sugars of 28 and put on insulin pump. Once my sugars were stable a Dr in the endocrinology team came to my bedside and said “Right, now im going to prescribe you insulin and needles, youll be injecting for the rest of your life and youd better watch out or you could end up the size of a house”.
When I questioned her and said “what about tablets or diet? - one of the nurses said they might work?” - the Dr laughed and told me that “would never work because you're far too young, youre only in your twenties!” . She actually said “are you sure?” when I then pointed out that I was actually going to be 40 at my next birthday! After checking my medical file for my d.o.b. She then said “ Ill prescribe you some tablets and come back in a week to see how youre getting on” - unsurprisingly I never saw her again.
All pretty poor hit and miss diagnostics based on assumptions like if youre this age it cant be that diagnosis, if your sugars are so high it must be that diagnosis etc etc etc
Binary diagnostic choices alwayc make for simple but all too often dangerously simplistic diagnostic decisions
No fasting insulin test - NHS dont do them and as I have managed to maintain excellent control and sustain the 10 stone weight loss achieved more than 10 years prior to diabetes diagnosis by doing what Im doing, I dont care enough to pay for one

 

[bulkbiker]

No fasting insulin test - NHS dont do them

They don't indeed although I think they should. It would give a deeper insight into people's conditions and wouldn't cost as much as one Libre sensor. If data is good then more data is better and one misdiagnosis not made would make it all worthwhile.
The joy of internet forums is we can both hold completely opposite opinions so I will continue to think as I do.
As for your years of control I have nothing but the deepest admiration.

 

[Lamont D]

They don't indeed although I think they should. It would give a deeper insight into people's conditions and wouldn't cost as much as one Libre sensor. If data is good then more data is better and one misdiagnosis not made would make it all worthwhile.
The joy of internet forums is we can both hold completely opposite opinions so I will continue to think as I do.
As for your years of control I have nothing but the deepest admiration.

If according, to my medical history, I would have had a fasting insulin test about fifteen years ago, I would never have had the misdiagnosis of T2.
This was described to me during my second eOGTT, when thanks to my endocrinologist, who recognised the symptoms and saw me twice have a hypo.
This test confirmed his theory that my body was creating and storing too much insulin and had high circulating insulin levels. Hyperinsulinaemia.
Hyperinsulinaemia can be the cause of T2 diabetes, and you can get this high levels of insulin years before hyperglycaemia.
High insulin is the precursor of prediabetes.
By testing, if a doctor is worried about someone who could be prone to T2, this is called preventative medicine. It would save money in the long term.
These pre-emptive tests could prevent a lot of metabolic conditions and syndromes.

 

[kitedoc]

I haven’t.
But I haven’t ever had the classic signs of coeliac. So no one would have thought to request the test - including myself.

Once i gave up gluten my psoriasis improved dramatically (which is autoimmune) but i hadn’t expected that

Thank you and my apologies for this belated reply.
In Australia it was near midnight when I posted the question to you. (and do I ever need my beauty sleep) !!
I do not have an answer to explain your troubles with gluten but, if I may, I would like to think upon them. One the the great problems with medicine is, as you have alluded to, that patients are not believed by most doctors when their symptoms and troubles are not easily understood or straightforward. A relative of mine has been in that situation, too. The doctor who leaves no stone unturned to find out what is happening with a patient is a rare bird these days !! I cannot promise anything BUT as a fellow human being (or human bean, as one of my daughters says) I will try to make sense of what is happening. Since gluten is involved, that is why I asked about coeliac disease (CD) blood test, which unfortunately will be unhelpful when gluten has not been consumed for > 4 weeks, (I have a daughter with CD). As I am sure you know CD is an auto-immune disease. Anyway, that is but one line of enquiry amongst others to look at and I shall see what I can find. ? Private message or open post ??

 

[kitedoc]

Correct! The first insulin response to any glucose derived food or drink is weak, so not all glucose is turned to energy by background insulin or first response. So a spike occurs very rapidly, the higher the amount of glucose derived from carbs especially, the higher the spike, the second insulin response is called an overshoot, this is the pancreas creating too much insulin for the amount of glucose remaining. A hypo will follow if prevention does not occur, by eating, but a rebound effect will happen, so once you start the rollercoaster, it is difficult to control. This is why recommended dietary advice is to eat every three hours to offset the hypo.
That is why I avoid these foods or you could say I'm carb intolerant!
Along with wheat, dairy, grains and in particular potatoes.


It is independent, regardless of fibre content, most of the food that advocates high fibre usually contains carbs or grains, starchy vegetables, healthy food, or complex carbs, are not healthy for me.

My history is a long battle with misdiagnosed T2, my eventual diagnosis was as is with most RH ers, is a list of tests designed to eliminate other conditions. I have had quite a few eOGTTs, breakfast test, blood panels galore, 72 hour fasting, c-peptide, GAD test, allergy tests, and of course my own testing and experimentation, my food diary goes back to 2009.
Then I had a scientific paper wrote by my endocrinologist, because of trial s for a drug to offset the hyper. Which was published in 2015.

I was his first Reactive Hypoglycaemia patient. He soon added another woman to the trials. Both results were inconclusive, but showed a big difference in lowering the spike to offset any hyper, so during my last eOGTT, my spike was 8.5, instead of the usual, 13-15mmols from the glucose. But I still went hypo after the three and a half hours.

My condition was at that time very rare, but only because of lack of GP knowledge about hypoglycaemia in general.

The home page for RH is typical of an NHS guidelines for Hypoglycaemia in general, as it is for type two, as is the eat well plate. You must eat complex carbs and other rubbish about fats and proteins and of course being in ketosis.
I'm currently in my fourth year of ketosis.
My health is really great and no hypos since that last eOGTT. Over four years ago now.
I have been released from my endocrinologist, because I have convinced him by my food diary, and my last blood panels, that being in ketosis is the better treatment for my condition. And me.

I have gained so much knowledge about how my body and brain works.

Thank you @Lamont D,
Your experience is hard earned and invaluable. The GI/GL paradigm might have some uses but clearly not for you and others with your condition. I always remember a doctor saying," Pain is what the patient says hurts.". You have proven that what you say, have observed with your condition is to be believed, accepted and learned from.
Best Wishes - and how can RH guidelines be changed ? Would your past endocrinologist go in to 'bat' for changes based on what he had learned from you ??

 

[Brunneria]

Thank you and my apologies for this belated reply.
In Australia it was near midnight when I posted the question to you. (and do I ever need my beauty sleep) !!
I do not have an answer to explain your troubles with gluten but, if I may, I would like to think upon them. One the the great problems with medicine is, as you have alluded to, that patients are not believed by most doctors when their symptoms and troubles are not easily understood or straightforward. A relative of mine has been in that situation, too. The doctor who leaves no stone unturned to find out what is happening with a patient is a rare bird these days !! I cannot promise anything BUT as a fellow human being (or human bean, as one of my daughters says) I will try to make sense of what is happening. Since gluten is involved, that is why I asked about coeliac disease (CD) blood test, which unfortunately will be unhelpful when gluten has not been consumed for > 4 weeks, (I have a daughter with CD). As I am sure you know CD is an auto-immune disease. Anyway, that is but one line of enquiry amongst others to look at and I shall see what I can find. ? Private message or open post ??

Thank you.
I am actually quite blown away by your offer.
I would rather not derail this thread any further, so if you are OK with it, PMing makes sense.

But don’t worry. I am in a good place about this. I have discovered what works and it DOES work. And as with all dietary control, it is up to me to stick to it to reap the benefits.

 

[Lamont D]

Thank you @Lamont D,
Your experience is hard earned and invaluable. The GI/GL paradigm might have some uses but clearly not for you and others with your condition. I always remember a doctor saying," Pain is what the patient says hurts.". You have proven that what you say, have observed with your condition is to be believed, accepted and learned from.
Best Wishes - and how can RH guidelines be changed ? Would your past endocrinologist go in to 'bat' for changes based on what he had learned from you ??

The problem most doctors, dieticians, even most endocrinologists would insist that we must have a certain amount of carbs in our diet. This is to ensure that our brains don't suffer from lack of glucose. Hence the dietary advice to eat healthy, complex carbs, because that advice is crucial to our nutritional needs.
But what do you do, if this basic foodstuff, is what is causing the triggers that causes the symptoms and ill health?
Some might be able to have a certain amount of carbs, some more than others, obviously, I do have problems with all but very little carbs, starch, anything that turns to glucose rapidly because of my first insulin response.
So, after a few years worth of trial and error, experimenting, testing, recording, my endocrinologist actually asked me to trial different ways of how my dietary intake should be, I emailed him the results, I also wrote a blog in the blogs forum. It is called, ' The Idiot diet'! Because I'm not brainy enough to use a truly scientific method of getting the correct balance for me.
What I realised during this thirty days of testing, was that the usual recommended dietary advice of eating regularly was just too much, so having a bite, every hour, two hours or even three hours was a feast every day and unsustainable. I was overeating!
My body, my appetite, my brain could not accept eating that way.
Since diagnosis, then finding that fasting especially intermittent, was really good for me.
So that was my next mission, how do I keep my health care problems away if I was fasting, eating not that much, very low carb and because of my other food intolerance.
So, on some days especially when I'm in work, or on a day off or travelling, I fast until I'm ready to eat, so that could mean, until 3pm or 6pm, or I have cheated and had a bit of meat about 11am. In other words I please myself when to eat. It doesn't effect my blood levels. It helps my body be healthy.
Other days, I have an egg or some berries with some full fat Greek yoghurt to start my day. This will satiate me till I'm ready again for food. But, I don't have hunger. no craving, no hunger pangs or rumbles.
Only if I come out of ketosis do I feel hunger at all, my brain switches my body and I want food and lots! I have to find something to do to keep my mind busy and that is not easy.
So, after talking to my endocrinologist and others who have posted I would recommend for someone who has a similar condition as mine.
For newbies, eat every few hours until your body has adjusted to a very low carb diet.
If you need to, this will help with weight loss, because the insulin is being used not stored.
Once you have control and achieving stability in blood glucose levels, start discovering what you need to avoid. What your healthy balance of protein and fats.
Wether you are vegan or carnivore, eat natural foods cooked, roasted, plenty of salad vegetables. Avoid vegetable oils.
Eat to your meter, avoid the hypers, that triggers the insulin overshoot.
Only eat when you want, if you can fast, intermittent fasting does help.
Exercise, walking, swimming and gentle exercise is recommended. Avoid doing too much which would trigger a liver dump.
Keep a food diary, record all your meals, your pre meal reading and at first, your one hour reading after first bite, then your two hours reading.
This diary will help with how high you spike and if you have intolerance.
It will give you information, when you lose weight or being in ketosis, also portion size of certain foods. For instance one small bite of potato would be okay, but two would be too much.
If you have a hypo, eat something that will nudge your blood glucose levels back into normal blood glucose range. Then check again after fifteen minutes, if normal, eat a low carb small meal. If you are still hypo, try again with a bite to nudge your blood up, then the meal. Do not overdo the hypo treatment because you will have a rebound effect on your blood glucose levels., this will lead to a hypo, if you do not eat anything to offset the hypo. If this happens you will not be in control, having stability is so important.
Planning your meals and shopping accordingly, temptation is only a bite away!
Avoid processed foods, avoid low fat foods, avoid the cause, avoid the hyper and you avoid the hypos!

I know this is too long, but if you understand that finding the only treatment is dietary, so, why not avoid the food that makes you ill. Rather than living with horrible symptoms and feeling really awful, to satisfy the usual medical advice!

I have my endocrinologist phone number, his email, I write to him often, if I need to see him, I only have to get in touch. Not needed yet!
We have discussed at length, why this condition is unusual, weird I call it after one of my previous GPs called it! All my present medical care providers at my surgery are impressed with my health and well being, my attitude and my attention to detail of my dietary treatment. They have been impressed with the turnaround in my health, from my fatty liver, liver function, kidney function, stomach problems including bacterial infections, hiatus hernia and bowel issues.
Small conditions such as piles, migraine, headaches, and lethargy. I have also had hand surgery for carpal tunnel, quite a few endoscopic procedures, tests for this, tests for that and the other.
Then the symptoms from the condition which is listed in our sticky. One of which was anxiety! If you have never suffered real anxiety, I would definitely not recommend it!
So with all these health issues that caused so much ill health, not that I was totally aware! Most if not all have gone.

So by the evidence of all those years battling and discovering why and how, showing the evidence, getting my tests as good as my general health. Not any of my medical care team including my endocrinologist will advise and recommend now, that, other than dietary treatment to avoid all the above is appropriate for Late Reactive Hypoglycaemia.
A very low carb diet balanced with natural foods.

Best wishes

 

[kitedoc]

The problem most doctors, dieticians, even most endocrinologists would insist that we must have a certain amount of carbs in our diet. This is to ensure that our brains don't suffer from lack of glucose. Hence the dietary advice to eat healthy, complex carbs, because that advice is crucial to our nutritional needs.
But what do you do, if this basic foodstuff, is what is causing the triggers that causes the symptoms and ill health?
Some might be able to have a certain amount of carbs, some more than others, obviously, I do have problems with all but very little carbs, starch, anything that turns to glucose rapidly because of my first insulin response.
So, after a few years worth of trial and error, experimenting, testing, recording, my endocrinologist actually asked me to trial different ways of how my dietary intake should be, I emailed him the results, I also wrote a blog in the blogs forum. It is called, ' The Idiot diet'! Because I'm not brainy enough to use a truly scientific method of getting the correct balance for me.
What I realised during this thirty days of testing, was that the usual recommended dietary advice of eating regularly was just too much, so having a bite, every hour, two hours or even three hours was a feast every day and unsustainable. I was overeating!
My body, my appetite, my brain could not accept eating that way.
Since diagnosis, then finding that fasting especially intermittent, was really good for me.
So that was my next mission, how do I keep my health care problems away if I was fasting, eating not that much, very low carb and because of my other food intolerance.
So, on some days especially when I'm in work, or on a day off or travelling, I fast until I'm ready to eat, so that could mean, until 3pm or 6pm, or I have cheated and had a bit of meat about 11am. In other words I please myself when to eat. It doesn't effect my blood levels. It helps my body be healthy.
Other days, I have an egg or some berries with some full fat Greek yoghurt to start my day. This will satiate me till I'm ready again for food. But, I don't have hunger. no craving, no hunger pangs or rumbles.
Only if I come out of ketosis do I feel hunger at all, my brain switches my body and I want food and lots! I have to find something to do to keep my mind busy and that is not easy.
So, after talking to my endocrinologist and others who have posted I would recommend for someone who has a similar condition as mine.
For newbies, eat every few hours until your body has adjusted to a very low carb diet.
If you need to, this will help with weight loss, because the insulin is being used not stored.
Once you have control and achieving stability in blood glucose levels, start discovering what you need to avoid. What your healthy balance of protein and fats.
Wether you are vegan or carnivore, eat natural foods cooked, roasted, plenty of salad vegetables. Avoid vegetable oils.
Eat to your meter, avoid the hypers, that triggers the insulin overshoot.
Only eat when you want, if you can fast, intermittent fasting does help.
Exercise, walking, swimming and gentle exercise is recommended. Avoid doing too much which would trigger a liver dump.
Keep a food diary, record all your meals, your pre meal reading and at first, your one hour reading after first bite, then your two hours reading.
This diary will help with how high you spike and if you have intolerance.
It will give you information, when you lose weight or being in ketosis, also portion size of certain foods. For instance one small bite of potato would be okay, but two would be too much.
If you have a hypo, eat something that will nudge your blood glucose levels back into normal blood glucose range. Then check again after fifteen minutes, if normal, eat a low carb small meal. If you are still hypo, try again with a bite to nudge your blood up, then the meal. Do not overdo the hypo treatment because you will have a rebound effect on your blood glucose levels., this will lead to a hypo, if you do not eat anything to offset the hypo. If this happens you will not be in control, having stability is so important.
Planning your meals and shopping accordingly, temptation is only a bite away!
Avoid processed foods, avoid low fat foods, avoid the cause, avoid the hyper and you avoid the hypos!

I know this is too long, but if you understand that finding the only treatment is dietary, so, why not avoid the food that makes you ill. Rather than living with horrible symptoms and feeling really awful, to satisfy the usual medical advice!

I have my endocrinologist phone number, his email, I write to him often, if I need to see him, I only have to get in touch. Not needed yet!
We have discussed at length, why this condition is unusual, weird I call it after one of my previous GPs called it! All my present medical care providers at my surgery are impressed with my health and well being, my attitude and my attention to detail of my dietary treatment. They have been impressed with the turnaround in my health, from my fatty liver, liver function, kidney function, stomach problems including bacterial infections, hiatus hernia and bowel issues.
Small conditions such as piles, migraine, headaches, and lethargy. I have also had hand surgery for carpal tunnel, quite a few endoscopic procedures, tests for this, tests for that and the other.
Then the symptoms from the condition which is listed in our sticky. One of which was anxiety! If you have never suffered real anxiety, I would definitely not recommend it!
So with all these health issues that caused so much ill health, not that I was totally aware! Most if not all have gone.

So by the evidence of all those years battling and discovering why and how, showing the evidence, getting my tests as good as my general health. Not any of my medical care team including my endocrinologist will advise and recommend now, that, other than dietary treatment to avoid all the above is appropriate for Late Reactive Hypoglycaemia.
A very low carb diet balanced with natural foods.

Best wishes

Again, Thank you for your insight. A uncertain association to add: I note that some people who suffer with coeliac disease develop migraines if they inadvertently take gluten.

 

[kitedoc]

Again, Thank you for your insight. A uncertain association to add: I note that some people who suffer with coeliac disease develop migraines if they inadvertently take gluten.

And, could gastric dumping, the release of gastric contents into the small intestine earlier than usual, where 'usual' is not always a helpful term ! but traditionally, after 20 minutes, 50% gastric contents has emptied out, thence half the remaining volume in another 20 minutes etc) be a factor, as the one hour postprandial peaks have been associated with some dumping ?
Could one of the problems with certain foods for you be their propensity to cause such dumping ? Could the higher fat content of a diet, with avoidance of offending carbs be part of the way things work better for you ? As well as not eating regularly and risking gastric dumping so frequently? I am just making guesses and am aware that simplifications may muddy the waters.
Finally the is/was a medication called generically Acarbose (brand Glucobay etc) which is supposed to bind up carbs and cause their release further down the small intestine, thus delaying the blood sugar spike and allowing an improved match with the peak of short acting insulin. The downside is that in hypoglycaemia, acarbose blocks the breakdown of carbs more complex than glucose e.g. sucrose from being broken down to glucose.
I am only surmising and not saying that acarbose is an answer to RH etc but is does raise some queries. And acarbose is not free of side-effects, either.

 

[bulkbiker]

you bring up a good point. In all the years I have been tested, my glucose has been tested under various circumstances, but never my insulin. I was just reading blood tests from the 80s the other day and noting that by today's standards, I was diabetic. First time I was told, in a letter a couple months after a fasting glucose tolerance test, that I was diabetic was 2001 but there was some prevarication about the diagnosis. So, before and after diagnosis, for 33 years of records, no fasting insulin.

Mind boggling when you think about it.. everyone now talks about hyperinsulinemia but it is never ever measured in the UK.

 

[Lamont D]

And, could gastric dumping, the release of gastric contents into the small intestine earlier than usual, where 'usual' is not always a helpful term ! but traditionally, after 20 minutes, 50% gastric contents has emptied out, thence half the remaining volume in another 20 minutes etc) be a factor, as the one hour postprandial peaks have been associated with some dumping ?
Could one of the problems with certain foods for you be their propensity to cause such dumping ? Could the higher fat content of a diet, with avoidance of offending carbs be part of the way things work better for you ? As well as not eating regularly and risking gastric dumping so frequently? I am just making guesses and am aware that simplifications may muddy the waters.
Finally the is/was a medication called generically Acarbose (brand Glucobay etc) which is supposed to bind up carbs and cause their release further down the small intestine, thus delaying the blood sugar spike and allowing an improved match with the peak of short acting insulin. The downside is that in hypoglycaemia, acarbose blocks the breakdown of carbs more complex than glucose e.g. sucrose from being broken down to glucose.
I am only surmising and not saying that acarbose is an answer to RH etc but is does raise some queries. And acarbose is not free of side-effects, either.

Gastric dumping is a symptom of RH, as well as a condition that you have gastric dumping as a symptom. It works both ways. As does RH!
There is those like me who has the condition Reactive Hypoglycaemia, then there are other conditions that have the symptoms of RH, but don't have the condition. Typically gestational diabetes.
Along with the emptying of the food to the small intestine creating a similar effect of gastric dumping, it is because of this similar scenario that creates the hyper. It is also the weak first response to that dumping, similar to the condition of gastric dumping itself.
You are correct about the saturated fats, the satiety caused by a higher fat content, will slow digestion to a point, but regardless, even if I ate the fats, it's the hyper from eating carbs that will cause a hyper. That triggers the second insulin response.
Fasting helps with getting rid of any excess insulin, and also gives the organs a chance to be normal. (What is normal?) It was truly remarkable after my hospital fasting test, how much energy I had, the brain cleared, the memory worked again.
My health improved dramatically after that. Before diagnosis, I never knew how ill I was! I sometimes wonder if my body is happier not eating!
Finally, I have heard of posters asking about acerbose or being prescribed it, only one!
It doesn't work, it still triggers the symptoms and releasing glucose at the wrong time.
Any sugar ending in 'ose has an effect, in my own case fructose is less 'evil' than the rest, but others have a total intolerance of fruit.
What the drug I trialled and still use is Januvia, Sitagliptin. It initiates a change in improving first insulin response, so lowering the spike if I did have carbs, it is not a cure but insurance against any mistakes I could make, I would still have a smaller spike so I would still hypo!
But being in ketosis is the best treatment for my particular type of RH!

Best wishes

 

[kitedoc]

Gastric dumping is a symptom of RH, as well as a condition that you have gastric dumping as a symptom. It works both ways. As does RH!
There is those like me who has the condition Reactive Hypoglycaemia, then there are other conditions that have the symptoms of RH, but don't have the condition. Typically gestational diabetes.
Along with the emptying of the food to the small intestine creating a similar effect of gastric dumping, it is because of this similar scenario that creates the hyper. It is also the weak first response to that dumping, similar to the condition of gastric dumping itself.
You are correct about the saturated fats, the satiety caused by a higher fat content, will slow digestion to a point, but regardless, even if I ate the fats, it's the hyper from eating carbs that will cause a hyper. That triggers the second insulin response.
Fasting helps with getting rid of any excess insulin, and also gives the organs a chance to be normal. (What is normal?) It was truly remarkable after my hospital fasting test, how much energy I had, the brain cleared, the memory worked again.
My health improved dramatically after that. Before diagnosis, I never knew how ill I was! I sometimes wonder if my body is happier not eating!
Finally, I have heard of posters asking about acerbose or being prescribed it, only one!
It doesn't work, it still triggers the symptoms and releasing glucose at the wrong time.
Any sugar ending in 'ose has an effect, in my own case fructose is less 'evil' than the rest, but others have a total intolerance of fruit.
What the drug I trialled and still use is Januvia, Sitagliptin. It initiates a change in improving first insulin response, so lowering the spike if I did have carbs, it is not a cure but insurance against any mistakes I could make, I would still have a smaller spike so I would still hypo!
But being in ketosis is the best treatment for my particular type of RH!

Best wishes

Thank you for your explanation and thoughts. It makes me wonder how glucagon and liver glycogen stores fit in. It sounds like when in ketosis they are not involved, only when a late hypo occurs. And does that mean another up spike of glucose etc etc ?

 

[kokhongw]

Mind boggling when you think about it.. everyone now talks about hyperinsulinemia but it is never ever measured in the UK.

Which is the point of my original post...it is about time we consider insulin-load/response in the context of T2D...especially obesity related T2D.

 

[Lamont D]

Thank you for your explanation and thoughts. It makes me wonder how glucagon and liver glycogen stores fit in. It sounds like when in ketosis they are not involved, only when a late hypo occurs. And does that mean another up spike of glucose etc etc ?

That is a bridge too far, I'm afraid.
Off the top of my head, the chemical make up changes by the demands of the body and how it reacts to how high the spike or how low you go. Being in ketosis and using ketones for energy obviously changes the dynamic of how our organs cope with a big dietary change.
For me, my health depends on having ketones for my energy and I was concerned about the longevity of the lifestyle, four years is way beyond any medical advice I have researched or heard about.
There is very few trials that back longevity in ketosis.
@kokhongw is for more into the links he has posted, some great information about how Hypoglycaemia and he has graphs and scientific research, which I have become so interested in. A lot of the evidence he has shown links for are contrary to the usual medical advice from doctors, who haven't a clue.

What happens if I have a triggered hypo. Of course I have to get my levels back up. But from mine and others experience, treatment of our hypos is a little bit different.
We have to nudge blood levels back into normal levels, and not create another hyper, because this will cause a rebound effect. Too much glucose will cause a hyper again, then you have to be aware of going low again, like a rollercoaster.

If because, my blood levels go too low, I will crash out, possibly lose conscious. I do believe it has happened but no one has witnessed it or taken readings, it's like nodding off and waking up minutes later, longer, and in one particular episode in an afternoon, a couple of hours, but you have to understand, my hypo awareness was non existent, I was lethargic, sleep deprivation, tired, but every time I have done this, I have tested and it is in normal levels. I can't explain why some of these are slightly different than having a nap but, usually even when I was going through hypos everyday, when I wake up, I am always okay, because not until I ate would the symptoms start, but awakening from an episode like I'm trying to explain. I was always thirsty, really hungry and the big question, where the hell am I? What is happening?

It's very interesting the questions I'm trying to explain and for you to understand.
And I'm willing to continue to answer the best I can.
Can I ask, what has triggered (see what I did there?) The questions?
By your username, I have to ask if you are in the medical profession?
Or just curious?

There is a thread that asks about deciding whether to go alone with dietary advice and how your medical support has helped or hindered your health. I nearly answered but because I was literally alone about how RH affected me and none of the general medical dietary advice, didn't or couldn't apply to me. I had help from my endocrinologist but he was still insistent on complex carbs and only one other poster had any experience of living with the symptoms of RH from a young age.
So my type of hypoglycaemia is different, I had to discover my path forward from diagnosis. It was a whole new concept to get healthy, because of either something that the advice was just so wrong for me. The lower the carb intake and fasting was something that I discovered I had no choice, unless I wanted to return to my hypo hell!
My evidence of how it works is in my food diary and not having the episodes of Hypoglycaemia whilst in ketosis. As I have already stated about my really good health, my energy, my well being It's all down to avoiding the staple western diets.
A balanced protein, good saturated fats, salad vegetables diet.
It sounds boring and unsustainable, but what is the alternative?
I had to educate myself, I had to explain to my family, friends, colleagues and my clubs dietician, why?. When my work involves sporting people, the lifestyle I lead, is not easy to explain and get them to understand. My club doctor, is wary of having an episode, it is new to him, as it is to most people, I am weird!

My battle for my health continues.
With a little help from friends and family!

 

[Lamont D]

Mind boggling when you think about it.. everyone now talks about hyperinsulinemia but it is never ever measured in the UK.

It is, but only by an endocrinologist during diagnostic tests to eliminate other conditions. Such as my diagnosis, all the tests I endured was elimination tests to only leave the only possible explanation of why my body 'reacted' to the usual suspects (carbs!)

 

[kokhongw]

I believe hypoglycemic events has been largely misunderstood because we are always looking only at one side of the equation. Low Glucose.

But the reality is that our brain function with both glucose and ketones. And there has been studies, especially fasting studies in the days when it was not considered inhumane or unethical, demonstrates the fact that we can function very well at low glucose levels...even sub 3.0 mmols. Essentially our entire metabolism is design to be neuro-protective.

But if insulin level is high, constantly high our brain becomes energy starved. It has impaired glucose uptake, AND unable to upregulate ketones production to a sufficient level...

While there is a wide array of glucose lowering agents...there is almost none for insulin lowering...although metformin is believed to have some insulin sensitizing benefits. Perhaps that is the key reason why there is no focus on lowering insulin to improve our healthcare outcome...instead there are lots of smoke and mirrors about purported health risks of fats, fasting, ketones...