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Permalink Reply by Brian (bsc) on January 31, 2013 at 4:25am

I have to tell you, for many, reactive hypoglycemia is a harbinger of diabetes. You normally have two sources of insulin (Phase 1 and 2).  You actually store insulin and release it when eating. This is called your phase 1 response. Then you can produce insulin and just dump it (instead of storing it), that is the phase 2 response. In a non-diabetic, they can eat something and the phase 1 response can release all the insulin that is needed and even if you eat 20 Twinkies (which you can no longer do since they went out of business) your blood sugar will hardly move.

Now, diabetes rears it's ugly head. Your body becomes insulin resistant and/or you don't produce enough insulin and all the sudden the phase 1 response is really poor and you are left with only a phase 2 response to deal with meals. Unfortunately, the phase 2 response is slow, weak and sluggish, so you go high after a meal and then finally when you start producing enough insulin, you overshoot and that is what causes a low. While some individuals have other conditions that cause reactive hypoglycemia, I am pretty confident your problem is diabetes. You can deal with reactive hypoglycemia with a low carb diet and significantly reduce the effect.

And unfortunately, I have to back up what others have said. When your blood sugar is > 200 mg/dl 2 hours into the OGTT, that is diabetes. Not pre-diabetes. Definitive clinical diagnosis of diabetes. And while your A1c and fasting glucose may well be fine, it is important to understand they are "lagging" indicators of your diabetes. The OGTT is perhaps the most sensitive test for diabetes, it really shows how our bodies react to meals. The OGTT is usually the first indication of diabetes. And when your blood sugar is still high after 2 hours and starts to get constantly high all the time, your body cannot even lower your blood sugar between meals and you fasting blood sugar and A1c rise. But they only rise after things have gotten really bad. So while diabetes is a devastating thing to have, you have it early and prompt action can really address the situation.

ps. I also suffer from sleep apnea, which not only causes me to feel tired (cause I wake up all the time), but it also is a high risk factor for diabetes. I am not being treated for the apnea.

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Permalink Reply by RobinA on January 31, 2013 at 4:52pm

Brian,

Thank you for your reply to my post. The phase 1/phase 2 information makes total sense. It is so frustrating.

I have a Lark wristband that I wear every night and it tells me that I wake up between 10-35 times a night, most of which I do not remember. My PCP has been bugging me about getting a sleep study done but can't afford it right now.

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Permalink Reply by Nori on January 31, 2013 at 7:01am

I don't know but it sounds like LADA. There is not a lot of literature on it, so that makes it hard. I was also Dx as T2, then about 2 yrs later as LADA. I had many symptoms that you describe. I'm still learning a lot myself. Did they check a GAD65 or c-peptides? Maybe you are at the begining of LADA, read up on it and see if it helps.

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Permalink Reply by RobinA on January 31, 2013 at 4:04pm

Nori,
I have read up on it, and it made total sense to me. I am 29, normal body weight, with some family history of autoimmune disease. But my endo was adamant that because my antibody test was negative, that he was right, and I don't have LADA (he didn't want to run the test, but I insisted). So frustrating- today I had a pretty low carb lunch and spiked to 205, and 40 mins later I had dropped to 101. That is not normal for a non-diabetic.

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Permalink Reply by Zoe on January 31, 2013 at 5:02pm

Did you do a full panel? GAD is only the most common LADA antibody. Melitta has posted the full list...somewhere around here!

Here is what she wrote: "Hi Robin: I would ask to see the actual results of the antibody testing. Was the full suite run? Too often, doctors only order GAD, when GAD, ICA, IA-2, and zinc transporter all should be run. Don't just take the doctor's word for it, ask to see the actual lab results"

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Permalink Reply by RobinA on January 31, 2013 at 6:36pm

No, I'm pretty sure he only did GAD, but I'm not certain about that because I never actually saw the results and didn't know enough to ask for all of them. Why is it important to run all of them? Will some of them give a false negative? I was negative for GAD (or whichever one he tested me for).

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Permalink Reply by Melitta on January 31, 2013 at 10:48pm

Hi Robin: It's important to run the full suite of antibody tests because, although GAD is the most common, a high percentage of people with adult-onset Type 1 diabetes are only ICA positive. So I think it is worthwhile to get the full suite of testing and insist on seeing the actual lab results.

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Permalink Reply by guitarnut on February 1, 2013 at 12:06am

Oh, Robin, I'm so sorry that you sound just like me!

I was diagnosed with reactive hypoglycemia at 16 because my father has it, too. Simple diagnosis, simple treatment (low carb), right? Wrong. Though I had a "normal" OGTT, within 6 months I started to see highs. They've gotten worse over the years and when I started to spike to near 200 on a regular basis (almost always falling below 140 by the 2 hour mark, but this happened several times a day), my endo decided it was an enzyme deficiency and pulled me off of grains, which helped some. (I think that's because I'm not eating many carbs at this point.)

Have you had a c-peptide done? What about an insulin level? Those are important to see whether you're insulin resistant or low on insulin. My c-peptide is 9.7, where the normal range is between 2 and 4. I'm young and thin and active and eat well--no way I'm THAT insulin resistant. I'm going to bring that up with my endo when I see him at the end of February.

I've heard of reactive hypoglycemia being the extremely early stages of LADA (and yes, sometimes if it's very early those tests may not come back positive for LADA), but I've also heard of it being the early stages of T2. I personally have had 2 reactive hypos in the last few weeks but otherwise haven't had them for months. What everyone has said about over-compensation by the pancreas for high blood sugar is absolutely true, and I have the stories to prove it.

My family also has some autoimmune floating around in it, but I have more immune issues than everyone in my family put together. Yay for me! My antibodies (as of the summer of 2011) are also normal. Go figure.

As far as being tired is concerned, there could be a few things at play. One could easily be Hashimoto's disease (autoimmune low thyroid), which I happen to have and would fit in with your family's history of autoimmune. Another could be that interrupted sleep you were talking about--interrupted sleep is pretty exhausting. A third could be the blood sugar swings. On any given day, if I've been low or high, I'm usually left with a pretty bad migraine and exhaustion that doesn't go away even after I treat the migraine. The worst are days when the differences in BG could stand as blood sugars on their own (like a day I had last week where I was 174 and then 63 an hour later--that's a difference of 111 mg/dl, which could stand by itself as a rather nice blood sugar).

Finally, an A1c will only show highs or lows if you spend a significant amount of time there. Being 275 2 hours after a meal sounds pretty high, but if it happens once a day and let's say you drop within the hour, that's 3 hours of being high and 21 hours of being normal--so that's only about 13% of your day being high. Though that can certainly make you miserable, it won't have a large impact on your A1c, especially if you hang out under 120 for the rest of the day. My A1c is also normal--I think my latest was 5.1, despite the fact that I was seeing multiple highs above 160 every day for months before it was drawn. 

I wish you the best of luck, and may you search for answers for less time than I have!

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Permalink Reply by RobinA on February 11, 2013 at 1:59pm

Just an update: saw my endo today for the follow up from my CGM period. My highest reading was 205 (which is not even as high as my OGTT- 235), and my lowest was 44. He is not concerned with any of it, does not think I should be doing anything about it, and still is not even considering me pre-diabetic. He told me he would see me one more time in 6 months, but that he thought that would be the end of it. I'm so frustrated right now- to the point of tears. I told him that I've lost 10 lbs (almost 8% of my body weight) in the last month and a half (no exercise- except at work), a decent diet change (for the better), and I've hit the 200 (BG) and beyond mark more since January 1st than I did Sept-the end of Dec. Also, my fasting BG (which has always been good) has been creeping up too, and I woke up to a BG of 119 yesterday :( my first fasting over 100. I told him all of this and he was not concerned at all.

He did tell me that I have reactive hypoglycemia, but even after telling me this, he didn't recommend any thing be done (lifestyle changes, etc.). I am so incredibly frustrated, and what makes this harder is that I truly like the man as a person. I'm intimidated, but frustrated enough to seek a second opinion. Nothing my PCP, nor anything anyone on here has said makes any of this sound normal. He insists this is nothing to be concerned about for a NON-DIABETIC! I don't get it? :(

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Permalink Reply by Brunetta on February 11, 2013 at 2:21pm

RobinA,I would get a second opinion. Do you need a referral from your PCP to see someone else? You may like this doctor personally, but we are talking about your health here. He may not be concerned about it, but it is YOUR body.Losing weight, high blood sugars and uncomfortable symptoms are NOT normal for a non-diabetic!! I would try to go to a state-run University-based endocrinology clinic. Many of them have a reduced payment scale if your insurance coverage is limited.
God bless,
Brunetta

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Permalink Reply by Kathy on March 4, 2013 at 2:10am

I would say your doctor is right and you can have both reactive hypoglycemia and diabetes at the same time. As a result I would treat you as if you had both. Usually reactive hypoglycemia is a precursor to diabetes so you don't want to ignore it. Since your 2 hour number at the 2 hour mark was so high I would definitely agree with your doctor about the diabetes and you don't want to ignore that.

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