Any suggestions? Glucose goes down 30 min after eating (no meds)

Type 1 and LADA
1

I have to contact my endo about a few things including this but wanted to see what others are doing first to get an idea of what might work. My first impression was to add Levemir so my body could store insulin for meals and maybe this wouldn't happen. I was on a VERY small amount of Met and that did help a little but it was happening then too (about 25% of what is going on now). I discontinued taking the Met 2 months ago - I feel somewhat better off of it except for these lows.

I am insulin sensitive FBS typically 90 BMI 22, have the high risk genes for T1 (DQ8), have Celiac + the start of thyroid issues. I need to start iron replacement since my ferritin 9. I am neg. for antibodies for diabetes. However, I still think posting under LADA was where this needed to be posted. Last c-peptide was 1.7 with a 90 something as a FBS (this was two years ago. I am missing first phase but at that time had good insulin levels - not high, not low - correct?).

Ok...that's me...and this is what is currently going on. At night around 2 - 3 am I feel like my heart is being crushed. Very uncomfortable to say the least. I've tested and got BG at 90 but from what I learned yesterday the symptoms only come after the real low. So I suspect it's from a low. I didn't eat while on a job the other day and it started again. I had to run for a piece of candy & that helped (the only thing available - it was a children's event).

Here is what is happening when I eat - if I'm stricter on carbs of course it doen't happen. But I've had to be very strict and I'm dropping weight (slowly but it's not sustainable).

pre-meal of 35 carbs (10 of which were from walnuts the rest from a lower carb sugar free pudding - ok, not the wisest choice...but who is always wise?)

95 pre-meal (ok, didn't record this but that's most likely what it was)

15 min 83

30 min 67

1 hour 108

1 1/2 hour 106

2 hour 99

Ok, not horrible, horrible...but the symptoms I am getting now are really frustrating!! I get tight in the chest (that's the worst one by far), cold, sweaty palms, odd breathing (guess you would call that shallow) irritated and on this one I felt like throwing up but wasn't close to doing so - I was only heaving a little.

Cut carbs to a Bernstein diet? add the met back on? - even with it not working completely and apparently it lowers ferritin - high ferrritin and inflammation are associated with T2 and Met does work on that (I have a normal Cardio-CRP at .8 and ferritin is horrible) . Add on a basal insulin like Levemir to try to store insulin for meals? Or as my GP stated...if you don't want to go on another T2 drug...then deal with it. I don't care for that either!! I can't get my work done and I work for myself...no work=

Thanks!!! I'm only looking for what others have done or any insight to get my brain thinking of what is best. I'm not bad off but I'm sick of feeling sick.

2

I guess I am confused. Are you diabetic? You tested negative for antibodies, so you are not T1a. Your c-peptide of 1.7 (ng/ml?) at a BS of 90 mg/dl is normal. Your response to 35g of carbs is apparently non-diabetic (remember meters are accurate to +/- 20%). Why do you think you don’t have a phase 1 response? Apparently, you had a strong phase 1 response, it in fact led your actual glucose surge.

I’m sorry you are not feeling well. Normally, a BS of 90 mg/dl would not cause hypo symptoms. If you had been running high for a time that might explain it. Perhaps something else is going on.

3

It looks like your phase one insulin is OVER reacting to me, but I’m not sure why that would be.

These post meal numbers are all within the non-diabetic range.

Are you getting the symptoms 30 minutes after eating? Or later?

4

Yes, I am diabetic. Took 3 different OGTT and failed them all - start 99, 1/2 hour 197, 1 hour 208, 2 hour 228, 3 hour 97 (something like that.but that’s close) Last one was done with insulin levels and they go up but stay within range not high and not low.
A few months ago if I ate 30 carbs of gluten free cookies I would go up to the 200’s after 1 hour.
The symptoms come after my glucose starts to rise slightly again.
Thanks for your response.

5

The symptoms come right after the low - within a min?? - that’s what I can fiugre since they are the worst after I recorded that 67. I am wondering if it’s because I have healed to a point since being gluten free for the last 1 1/2 year?? I’m off to give the endo the info and let her work it out. My case isn’t horrible but I guess it’s kind of complex with a little of this and a little of that.
Thanks!

6

Were those problems due to diabetes or hyopothyroidism? Thyroid problems can throw off your blood sugar control and regaining proper thyroid levels can sometimes restore normal blood sugar control. Have your thyroid problems been related at all to your blood sugar problems?

7

You are feeling symptoms of the low, I guess. If you have not had lows frequently, then this might be why they are so dramatic? (I feel my lows below 70, but I don’t feel HORRIBLE until below 50).

It might be a good idea to check if you are going low 30 minutes after eating at multiple time during the day. Or if it only occurs under certain conditions (for example if you are more active).

Hope that your endo is able to answer.

Another condition just to be aware of is MODY. I’m not sure that any of your symptoms are consistent, but this is a rare genetic form of diabetes.

8

I have to correct you on something. The body does not store Levemir. Levemir is a slow acting insulin that controls your blood sugars during the times your not eating food. Now, although Levemir is a slow acting insulin, IT’s STILL INSULIN, meaning so long as you have any insulin in your body, and if your body needs it, it will use it. This is one of the reasons why diabetics have to adjust their basal when you are involved in extreme exercise.

Second, it’s always a good idea to have an additional meter for emergencies. Compare your numbers with your spare meter. Try also using the control solution designed for your specific brand of meter.

if your body has had high blood sugars for a long time, your body may be trying to adjust to normal numbers. Yes, a low blood sugar can sometimes feel like your entire chest is caving in!! However, this will pass as you get used to your new levels. If it really is a concern, talk to your doctor about adjusting your Levemir. Start with a lower dose so that your chest will not feel so uncomfortable; then increase your dose once your body has adjusted to THAT level.

Personally speaking, I did not have a good experience with Met. I would try adjusting your insulin first (at the discretion of your dr.).

Hope this helps…

Good luck…

9

You are correct. But in some diabetics find that they are using all of their available natural insulin production just keeping their fasting blood sugar in control and no longer have any phase 1 response. The addition of a basal insulin is enough support to enable them to naturally store their natural insulin and restore a phase 1 insulin response.

10

That is what I was thinking and wanting to attempt.
On the thyroid…besides my ferritin being in the basement my thyroid is starting to get closer to normal (no meds). I left my notes to my endo…we will see what she things. Thanks

11

Thanks! I’m not on Levemir - I am suggesting it to my endo for the purpose of giving my system a rest and maybe I can get even better. I highly suspect that going gluten free has done EXTREME good (there is proof on my last 3 labs) and maybe this is the next step or it’s the next thing to tend to??? I’m so confused!!
My numbers were higher on the Met.
I get those coupons for free meters with strips so I’ve got a few meters to choose from :slight_smile: One of those numbers from above was double checked with another meter (different brand) and it was exactly the same number. I used a bayer contiur for this test and do find the contour to be pretty correct.
Thanks again for your comments!

12

I’ve pretty much cancelled out MODY. Kind of fits but not completely.
Odd thing was when I was on the little bit of Met my A1c was slowly going up. Then I go off of it and it’s now down and I’m having these mild lows more often. When I was sick (2006) I was put on Met and had a horrible experience on it - I started to go numb. It never should have been given to me…but that may be a different issue all together so when the endo said for me to try it again I did. Then a few months later I tried gluten free and anything inflammation wise (which wasn’t much) went to normal (LDL, Cardio-CRP, TSH lowered, psoriasis started clearing - I’ve had that since age 16) I have an odd case…my siblings and I are coming down with glucose issues regardless of weight or activity level. We really don’t have diabetes in our family (only one uncle who was obese for years, drank, smoked and wasn’t active got it after open heart surgery in his mid 70’s) There are many other family members who fit the T2 risk profile and they don’t have it. My brothers and I are coming down with issues in our mid 40’s.
Thanks!

13

This was going to be my question, as well.

14

Here are my thoughts:

It is unclear to me whether you are truly diabetic. There are other factors that can raise BG including illness, dehydration, and (as bsc mentioned) thyroid issues. In fact, the OGTT is no longer the standard for a diagnosis of diabetes. You didn’t mention what your A1c was, but that would be a much stronger indication.

The symptoms of low BG are not just felt after the “real low.” Back when I used to feel lows (I have severe hypo unawareness now), I would get that shaky feeling long before I went “really low.” I could even get it while in a normal range, but dropping quickly.

Moreover, the symptoms you describe (tightness in the chest, cold, sweaty palms, odd breathing, etc.) are not typical low BG symptoms. Honestly, they sound more like the symptoms of a panic attack (which I am very familiar with). Obviously, different people have different symptoms, but I believe the most common ones are: sweating (and feeling very hot), shaking, hunger, dizziness, rapid heartbeat, and blurred vision. For me, there are many more: numb lips, crying, irritability, and trouble speaking.

Also, it’s important to note that without any kind of meds, it is extremely rare for a person (diabetic or not) to become hypoglycemic. In fact, your 30 minute number is actually quite common for a non-diabetic, and it shows that your phase one response is strong. In a non-diabetic, a BG of 67 mg/dl is unlikely to cause any symptoms of low BG.

I have not heard of the “high-risk” gene for T1. It has always been my understanding that T1 is not a genetic condition (although it does sometimes occur in multiple family members). I am the only member of my family (going back for many generations) with T1. After writing the above, I decided to do a little research. I found the following:

"The inheritance patterns of Type 1 diabetes are complicated, with many different genes influencing a person’s risk. Because of this array of genes, Type 1 diabetes is not inherited in a clearly dominant or recessive manner. Instead, a person may have one gene that increases their risk (a DR3 or DR4 allele, for example) and other genes that decrease their risk (a long VNTR region). Together, these 20 genes along with environmental factors determine a person’s overall risk for developing diabetes.

With so many variables to consider, researchers are still a long way from a genetic test for Type 1 diabetes."

Next, your c-peptide is exactly what you would expect in a non-diabetic. With a fasting BG of 90 mg/dl, a c-peptide of 1.7 is exactly what all labs consider “normal.”

With respect to your insulin sensitivity, you wrote that you are very insulin sensitive, but you didn’t give any indication as to how you know that. The fact that you responded to “a very small amount of Met,” which I assume is Metformin, would indicate that you are insulin resistant. Remember, a low BMI is not always an indicator of insulin sensitivity.

Finally, if you are negative for antibodies, it is extremely unlikely that you are T1/LADA:

“The most common test for LADA is one that looks for GAD (glutamic acid decarboxylase) antibodies. However, a small number of people with autoimmune diabetes will not have GAD antibodies, but they will have islet cell antibodies and/or tyrosine phosphatase antibodies.”

I strongly suggest that you get a second (or third) opinion because at worst, I think you might be “pre-diabetic.” At best, I think you just had a wonky OGTT.

15

It is unclear to me whether you are truly diabetic.
I am mildly diabetic. If given 60 or more carbs you would see a different reaction. I would go up to approx 250 instead of going down like I am on 35 carbs.
The main symptoms now are felt after the low but do start before (I guess I should have been more accurate with that but to me it’s odd that the major one gets to it’s worst as my body is trying to correct). Yes, I used to get the numb mouth and lips - that was right before I started the metformin. Now that hasn’t been happening. Maybe my system is having it’s own panic attack? I’m really not prone to those. Had a couple in my life but that’s it. I would not be surprised if the thyroid is part of things - it has been stressed.
I have not heard of the “high-risk” gene for T1.
The DR4 is typically associated with DQ8 (almost always/very much so in caucasians). This is what I was talking about. All diabetes is complex but the genetics are being found out.
Some more about DQ8 (second one is from Joslin’s book on diabetes) From what I understand…DQ8 is fine if there is no autoimmunity - like Celiac. Once you can connect one dot then there are risk factors that go higher. I am not saying I have the start of T1 but I am saying I am sure I have some genetics for it and I believe there is an interplay to get me where I am at - ‘non classic diabetic’ (which isn’t bad but if I can do anything now to make it better I will)
http://en.wikipedia.org/wiki/HLA-DQ8
http://books.google.com/books?id=ohgjG0qAvfgC&pg=PA405&lpg=PA405&dq=percent+DQ8+get+diabetes&source=bl&ots=yHDj9GMaIs&sig=loBIJ1DEyQNt2YwLavq_3TXtE0U&hl=en&ei=QcT0ScK0H5msMtm8ucAP&sa=X&oi=book_result&ct=result&resnum=2#v=onepage&q=&f=false

Yes, my c-peptide was completely normal 2 years ago. I was using Metformin not for IR reasons but to supress liver glucose output. To do this, I was taking part of a regular met during meals. Metformin has this action also. It has been used by others for this reason without IR.
I had my insulin levels done on my last OGTT - that was the only way I would do it and the endo stated I’m insulin sensitive. I wasn’t surprised - I do not have high BP or triglycerides. In fact I look great that way. My labs do look great until you see I have a diabetic glucose tolerance.
I do have a small amount of GAD’s but not for diagnosis. Some people believe that is abnormal. Who knows…?? But an autoimmune attack for diabetes for myself right now…most likely no. An autoimmune disease causing / affecting diabetes - I think so.
I strongly suggest that you get a second (or third) opinion because at worst, I think you might be “pre-diabetic.” At best, I think you just had a wonky OGTT.
How about 6th or 7th? Ya, I tried so hard after the first doctor (quack) to take the diabetes diagnosis off my record. Nearly got it but then…I failed the OGTT again. Finally got to the endo and she tried to help me get it removed. Failed and was given the antibody testing. I haven’t won on that one - I am self employed and to have this diagnosis isn’t a plus insurance wise. Going gluten free has helped - for sure.
Oh well…
Thanks!

16

Kristin -
I think you mis-typed. It’s the second phase over-reacting. First phase is very quick of stored insulin. Second phase starts after (10-20 min). For me, it’s clearly second phase that over did it since it’s 30 min at the dip.
http://www.phlaunt.com/diabetes/14046621.php Here is what Jenny has about it.
Thanks!

17

http://www.annals.org/content/121/12/945.full
http://care.diabetesjournals.org/content/26/5/1485.abstract

Not saying that’s my issue. But glad you brought up the chest pain and questioned it. Apparently, it is associated with hypos but…can be also CAD. I’m having this way too often to put aside & not what I wanted to read.!! There are heart issues on my dad’s side of the family BUT fortunately I haven’t show any heart issues. At least I took the info to my endo and I did state the chest pain stuff was the worst of what I was experiencing. It’s daily and more than once a day. And it is a food issue.