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Why don't insulin-resistant people experience reactive hypoglycemia?

Coolifornia

Active Member
Messages
26
Location
Los Angeles
Type of diabetes
Reactive hypoglycemia
Treatment type
Diet only
We know that hypoglycemia is caused by excess release of insulin, and is considered to be a rare phenomenon in those of us who do not have diabetes but have been diagnosed with reactive hypoglycemia.

People who have insulin resistance have high levels of insulin, because their pancreas has to secrete more since their cells are no longer responding to it correctly. Yet, it is very rare that a person with insulin resistance complains about reactive hypoglycemia.

How does all that extra insulin not do to them what it does to us? Is there something I've misunderstood? Considering how many people have insulin resistance, you would think that RH would be rampant.
 

To be hinest, there are folks on here who are bith insulin resitant and have Reactive Hypoglycaemia. I'll tag my colleague @Brunneria , who is one such person, and she may be able to think of a few others too.
 
I believe for many who experience reactive hypoglycemia, they are rarely serious enough to lose consciousness, hence it is rare only because it is often being dismissed by healthcare providers with the recommendation to just eat something...

And those of us who later progressed to T2D in life, and come to understand about reactive hypoglycemia, it became obvious that it was a large part of why we were not able to control our ravenous hunger. Nothing to do with will power actually. It is a hormonally driven event.
 
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Thanks @DCUKMod

Yes, I have fairly severe IR and get RH episodes.

The existence of IR just means the body produces even more insulin to deal with both the IR and the blood glucose. In my case this causes a very sharp drop in blood glucose and then a huge release of stress hormones to halt the drop and push blood glucose back up.

Fortunately this is now rare, because I have my carb intake under control, but only this week I had a situation where some hidden carbs in (bought) food that appeared to be low carb (but actually weren't!) caused an RH episode with my blood glucose under 2 mmol/L

Of course, the amount of insulin needed to overcome IR and drive the bg this low then pushes IR up even higher for several days. Then trying to use exercise to reduce the IR risks more hypos (in my case) because my body’s capacity to keep blood glucose stable is always off balance for a few days after a hyper/hypo swing.

Edited for grammar!
 
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Many, many people move towards type 2 diabetes after developing RH, and the two conditions can exist side by side.

Since T2 is usually a condition of insulin resistance, then RH and IR can easily (and frequently do) coexist.
 

I believe you are correct in your logical assumption that the symptoms of both RH and type two diabetes is very similar and you would think there would be more actual diagnosed patients with RH!
The difference is something I discovered by reading all sorts of reports and papers on why RH is quite rare and type two is as you say rampant.
You can have T2 and also the condition of RH.
You can have T2 and also the symptoms of RH.
If you only have the condition of RH, and if you have fasting levels of normal blood levels, you cannot have diabetes!
There is a distinction between RH the condition and having the symptoms of RH.
They are different in diagnosis and treatment.

The diagnosis of hyperinsulinaemia (high levels of insulin) is common in T2. It is relevant in the diagnosis of insulin resistance.
A weak insulin response to carbs, is indicative of insulin resistance.
Hyperglycaemia is caused by insulin resistance.
High spikes are caused by a weak insulin response.
The difference between T2 and RH, with these circumstances, is with RH, during fasting times, your blood glucose levels returns to normal, whereas a T2, will return to diabetic levels.
I would imagine there are many more, like I was, misdiagnosed with T2, and having normal fasting levels, but because of rampant hyperinsulinaemia, hyperglycaemia, and all the symptoms, the doctor doesn't have the knowledge to know the difference.
Why would they know?
Most doctors would never have the training and the diagnostic tools to get a true diagnosis.
I believe that it is becoming less rare with time and more knowledgeable endocrinologists.

Best wishes
 
In RH there is an overshoot in the amount of insulin produced which drives the blood glucose too low. In Type 2's with insulin resistance the amount of insulin released, while excessive, is just enough to control the blood glucose so it never goes too low causing a hypo.
 
Hi @Lamont D

I agree with quite a lot of what you say, but i think you are wrong to claim that people with T2 diabetes can’t have normal fasting levels.

Do you have any studies to support what you say? I would be interested to read them, if you do.

We get many posts from people with T2 here on the forum who have ‘normal’ fasting levels (the term needs clear definition). They may achieve this with diet, lifestyle or medication, but they are still T2.
The www.bloodsugar101.com website lists studies showing that rising fasting blood glucose may, in quite a few T2s, be a late symptom after high glucose (and T2) have been established for a long time. It is one of the reasons that NICE chose that HbA1c became a more commonly used diagnostic tool. Too many people were going undiagnosed, because their FBGs did not reflect the extent of their T2.

I also disagree that RH is rare.
It is rarely diagnosed, but that doesn’t mean it is rare.
It is a fairly common precursor to T2, although rarely symptomatic enough to get diagnosed.

It was found (mild form) in 24% of healthy young men in this study, where bg was significantly lower after glucose than before glucose
http://diabetes.diabetesjournals.org/content/23/3/189.short

It was found in 12% of study participants without a diagnosis of glucose dysregulation here:
https://www.tandfonline.com/doi/abs/10.3109/00365513.2010.491869

And in 17% of a polycystic ovary group of participants here:
https://academic.oup.com/humrep/article/31/5/1105/1750223

I think diagnoses only happen when the symptoms get extreme, since many RH symptoms are easily attributable to other things, such as fatigue, hunger, stress, anxiety and PMS.
certainly in my working career I have sat in offices with several (many?) individuals lurch from one pick-me-up to another, to avoid those symptoms, with the pick-me-ups varying from sweets, chocolate, crisps and other snacks, to coffee and cigarettes. And I have lost count of the people who say, ‘i HAVE to eat, or I go all funny...’
 
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That could be me, I used to bounce through coffee to buiscuits to crisps etc to beat sleepy episodes through the day. Some of which were brutal if I did not have some nibbles.
Now after getting a pre diabetic near miss and dumping carbs for a keto diet my life is a polar opposite now.
All day on a couple of black coffee's. I would have laughed at you 6 months ago. Now it's easy.
Did 48hrs earlier this week due to circumstance and felt even better.
This weekend I have had no carbs except for some peanuts yesterday and again I feel superb.

No idea on any rh effects but the sleepies have dogged me for 30years, not eating carbs they have gone, so maybe I am too?
 
I did not infer, that T2s cannot have normal levels. Of course they can. I probably should have said it differently.
I did say that RH is becoming less rare. But symptomatic RH is present in most endocrinologist conditions. I was trying to offer a differential.
And yes! Most diagnostic tests are done when extreme symptoms are present.

In hindsight, I should have been more discerning about the difference between RH the condition and the RH symptoms present in other endocrine conditions.

The secondary insulin response called an overshoot is important to RH diagnosis.
 
Lamont D said:
I did not infer, that T2s cannot have normal levels. Of course they can. I probably should have said it differently.
Click to expand...

I am one of these. Right from diagnosis I have had good fasting and pre-meal levels, weekly averages never out of the 5s, usually the lower 5's and sometimes 4's. I can't say the same for my post meal levels at the beginning of my journey. As is so often said on this forum. We are all different. If diagnosis were made entirely on a fasting level, I would never have been diagnosed.
 
Resurgam said:
I am pretty sure I had episodes of HR in my late teens and early 20s which were dismissed by the doctors, and also on my way back towards normal after diagnosis two years ago.
Click to expand...
HR!
Lol!
I would imagine that the symptoms of RH, have been felt by most people!
 

Thank you for your explanation Lamont! OK, So type 2's have a weak insulin response to carbs, which makes their blood glucose stay too high. Meanwhile, RH's like us have an overly powerful insulin response, which makes our glucose drop too low. We have high postprandial insulin, but our fasting or "background" insulin is normal - meanwhile, Type 2's have weak postprandial insulin, but high fasting levels? And that background insulin doesn't lower their glucose because their cells aren't letting it in. Meanwhile, as RH's our cells do receive extra insulin all too well.

I think that is right? It's starting to make more sense to me anyway! Thanks!
 

Hi Brunneria, thank you so much for your reply, as always! May I ask if you had high levels of fasting insulin when you were diagnosed with insulin resistance? Mine came back normal which is why I was confused about how I could have RH, but if the insulin "overshoot" only happens after I eat, it makes sense that my body would've cleared it overnight (I think! It's so confusing and my doctors haven't been interested in discussing it with me).
 
Some Type2's have a weak insulin response but mostly they have insulin resistance which means that they need excessive insulin to clear the glucose.
 

Hi,

No medic that I have ever seen has shown the slightest interest in my insulin levels, so I have never had a diagnosis of insulin resistance.
In fact, the first measure ever taken was a self funded fasting insulin test around a month ago - which showed... DRUMROLL... the high insulin resistance that I know I have had since childhood.

How do I know this? Well it was kind of inevitable.
All of the following are likely to cause insulin resistance
- childhood onset of RH continuing into adulthood
- polycystic ovary syndrome onset during teens
- a pituitary gland tumour (produces excess prolactin) in my late teens
- medication for the prolactinoma that is known to raise insulin resistance
All of which led to obesity (which raises insulin resistance further)
With Type 2 diabetic level blood glucose arriving a few years ago, some 40 odd years after the dominos started to fall.

Its one of the reasons I am always banging on about T2s and RHers playing a long game.
In my opinion, it really isn’t enough to just control your current symptoms.
Play the long game.
We need to look after ourselves well enough now, so that we delay or reduce the deterioration (from age, stress or other health issues) so that we can continue to have our health for decades. So many of us start young, and have many decades ahead. Might as well enjoy them
 

Almost right...

What most T2D don't realize is that at the point of diagnosis while we have lost our 1st phase insulin response, we would typically still have a delayed powerful phase 2 insulin, but may not be enough to overcome the insulin resistance. Hence we get the high postprandial glucose reading and a drop off after the 3rd-4th hour. And we may still have up to 10 years before we lose all that insulin response as we continue to exhaust our beta cells due to the constantly high insulin demand and high glucose environment.

Hence an insulin lite lifestyle will help preserve and perhaps restore some of its capacity. The high insulin condition is often lost in the current glucose focus narrative for T2D...

 
In my own case, as in the case of those with my condition, it is due to a poor first phase insulin response.
It is well documented in Conn's syndrome.
Derek
 
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