Non-diabetic hypoglycemia leading to a diabetes diagnosis?

Hello all!
I am reaching out in hopes to talk with people who might have any insight or at least just get support. For at least a year now I had been having symptoms of low blood sugar. I bought a meter and began testing when I felt “low” and I was indeed low. I would be anywhere from 50-60s. This happened occasionally but not enough to raise concern. Over the past month it has became more prevalent in my life to the point it interrupts my daily activities. I made an appointment with my PC doctor who referred me to an Endo. I visited the endo and told them what was happening. It was actually funny because they did a spot glucose check in office and my BG was 62. I think that made the endo actually believe that this was a real issue. My endo ordered bloodwork to check thyroid, adrenal functions, and insulin levels. My thyroid and adrenal functions came back normal, but my insulin levels were really low. That luckily rules out an insulin producing tumor but also means at some points throughout the day my pancreas isn’t producing enough insulin. At my second visit my endo diagnosed me with unspecified hypoglycemia and prescribed the Freestyle Libre 2 CGM. I’ve been wearing it now for 5 days. In that time, I’ve found out that I have lows during the night and don’t know it. I’ve had my Libre alarm go off every night with my glucose in the 50-60s and dropping fast. I’ve also found out that my BG at some points during the day are in the low 200s and it doesn’t seem to correlate with meals or eating. I am a fairly fit person and I eat very healthy. I work out 5 times a week. I’m just very perplexed as I’m not sure what’s happening. Could this be leading to a diabetes diagnosis? Can hypoglycemia be a signifier that I will later develop type 1? I appreciate any insight anyone has!

Welcome @mag1819. I am glad that you have an endo that is taking this seriously. From what you describe he is in the process of figuring this out.

I am in no way an expert on the symptoms you are describing and the only thing I might suggest is reactive hypoglycemia as a possibility. Reactive hypoglycemia happen when you pancreas over produces in response to a meal, it most often occurs 4 hours after a meal.

Please do not take my words as a diagnosis but rather use them in discussions with your doctor, he is the expert and the one to rule out or confirm my suggestion.


Hi Mag:

Welcome to the forum. I am sure you will find a lot of useful help here and advice (some useful and some not) from others that have gone through similar symptoms.

If you are hitting BG in the low 200’s during the day, you are diabetic, unless you have bogus Libre 2 readings. Over 125 is the cutoff. When you hit the high numbers according to your cgm, test once or twice with your BG meter to see how close the numbers match and make sure you don’t have an equipment issue.

Until you are able to divulge more information of what you ate in terms of Carbohydrates and Protein and how soon after eating you are seeing high numbers, it is hard to rule out food correlations. If I were to eat a small piece of white bread, for example, I would see the results on my CGM for 3 days. It also depends if you are a super lightweight person, your numbers will look different from an individual carrying extra weight.

In short, there are too many unknowns at this time to help you much, but read through the threads or even better use the search bar above to get more educated as the entire process will take you several weeks to understand. Once you get a better feel, take one baby step at a time toward improvement.

You can do it!!!

Keep in touch

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Thanks for your reply! Reactive hypoglycemia has been mentioned and I am keeping a food log but my endo and I have yet to find a correlation with certain foods. I appreciate your input as this is all very confusing for me!

Thanks for the reply! I am keeping a food log and testing with my meter when I have higher numbers than normal on my cgm. The numbers are close enough to match so the CGM is working.

In terms of how food and numbers would effect me. I’m 5’6, 140lbs so pretty average. As I said, I’m keeping a food log but I’ve yet to see a correlation with certain foods and high numbers or low numbers. I will say though, at points my BG rises so fast that my cgm doesn’t compute the number and I feel awful when it rises that fast! It’s also the same for dropping though it’s never dropped so fast that it can’t compute the numbers.

I hope to figure this out soon as it’s really effecting me!

Relax, sleep well, and watch your stress level. You can easily rapidly stress yourself into some pretty high numbers.


@CJ114 makes a good point. blood glucose in the 200 range is not normal blood glucose.

I did a little research before my first reply, one thing I learned is that reactive hypoglycemia can lead to diabetes, while it can happen it is not always the case.

I don’t want to armchair doctor so again I urge take what I or anyone else here might suggest as merely information to be used in discussions with your doctor.


There are a lot of possibilities. The 2 general things to consider is if it is reactive, as you mentioned. Or if it is related to your eating, or exercise, or other hormonal things.

In addition to the testing you are doing, a food log is a good place to start, to make sure you are eating the right amounts of the right types of food. For example, if it is reactive, a high amount of sugar can cause your body to release too much insulin. In the case of reactive hypoglycemia, slower releasing carbs would be better.

Another thing that can help - if it is reactive hypoglycemia - is if you eat small snacks frequently. But that depends on the cause of the issue.

And it may also be that your alpha cells are not supplying enough glucagon. Alpha cells are the part of the pancreas that produce glucagon, and glucagon signals your liver to release stored sugars.

If it is not that your alpha cells can’t produce enough glucagon, it might be that your signaling is not working correctly - like either your body does not pick up the signals that your blood sugar is low, or your liver does not recognize the glucagon. (These issues would match up more with the low insulin levels you mentioned rather than the reactive hypo.)

It could be other hormones that are insufficient. Like cortisol or adrenaline. But you mentioned that you already had those tested.

It could be that your diet is not supporting your activity. Like if you are losings lot of weight too quickly.

There are so many possibilities, and it will take testing and good analysis to recognize the cause of the issue.

If you are comfortable with the doctor you have, that is really helpful to work with them on it.


One thing I forgot to mention is that my fasting BGs most days are above 110 and often it’s in the 120s. There’s a few times it’s in the normal range but most mornings it’s higher than normal.

That is pretty consistent in top and above of pre-diabetic range. Don’t be afraid of insulin, if that is recommended, especially with your low episodes as it is much easier to control diabetes with insulin than with oral medications. Even on orals, I doubt you would be happy with your results very long and still need to deal with your hypos, so sort of worst of 2 worlds to be in.

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I really appreciate all your insight! I meet with my endo next week and we will go over my cgm logs. My endo doesn’t know I’ve been having these higher BGs as they’re also new to me and I had no idea I was having them. Insulin hasn’t been mentioned as a form of treatment yet but I’ll see what my endo says next week.

I’ve also been reading about LADA on the fourms and it seems like it could be something I mention to my endo. I’ve seen a correlation of hypoglycemia and then a diagnosis of LADA on these fourms and it’s been really insightful.

Don’t worry about your type, just learn all you can on how to best control your diabetes to keep yourself healthy and lead a long and fruitful life. I have been diabetic for over 30 years, am in my 70’s and Joslin, the foremost diabetic clinic is still scratching their head trying to type me. I do not fall into any of their myriad of diabetic categories. We all just know that I am insulin dependent and that fast acting insulin keeps my BGs and A1C in normal range. Long acting insulin gives me night time lows. So just do whatever works for you and don’t worry about all the various types that are out there.

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It is not uncommon to have blood sugar dysfunction in the months/years before a diabetes diagnosis. I was diagnosed with Type 1 at age 24 but have memories from high school and college where I had shakiness, sweating, etc. that I later knew were probably symptoms of low blood sugar. I have read of others mentioning the same thing, both with Type 1 and Type 2. Of course with me this was in the 1960’s-1970’s so there were no CGMs or even blood glucose monitors to track what was going on.


Hypo’s, whilst generally associated with diabetes are not the markers you should necessarily be looking at here. any extreme exertion can cause Hypo’ readings to occur, work/ play/ sport. The low 200’s are a defined sign that something is not right on a diabetes scale. Whilst it could be that you are in the ‘honeymoon’ phase, I think your endo’ will have recognised that and advised accordingly. Worry about this could be a self-fulfilling prophecy; and my recommendation is to just keep a check on what your levels are doing and act accordingly as I am sure your endo will have mentioned. I’ve been a t1d for 62 of my 64 years on this earth, been there/ done that and got the tee-shirt. If I may be of any help please let me know;


I like your Doc, mag. I feel like you have an unusually competent Doctor. I like this guy.

Libre has an alarm for low blood sugars??
I did not even know it had a alarm and I’ve since it first came out!
Where can I get more info???

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I really like her too! Though I’m a bit nervous to go back next week and see what she has to say about the higher numbers as she doesn’t know that I’ve been having them yet.

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I’m anot super familiar with all of the Libre systems but I have the Libre 2 and if you go on your receiver into settings you can set the range you’d like for alarms to go off!

Thank you very much. I’ve been using the Libre 2 since they first came out but did not know they have one that gives alarms for high/low glucose.

I just called Freestyle Libre to get more info. It requires a new Rx (same cost) so also called my endocrinologist for new Rx.

I try to keep up with new/changing technologies but just plain missed this one.

Mighty good, and appreciated, info.

Again, thank you very much.

| mag1819
March 10 |

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I’m not super familiar with all of the Libre systems but I have the Libre 2 and if you go on your receiver into settings you can set the range you’d like for alarms to go off!

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I think it alerts you when you scan, not in real time. I know it marks Iows in red on the graph. I don’t know if beeps or pops up a message. My wife just started using the Libre. I’m trying to get her to use the Dexcom.

As far as hypoglycemia, I was DX-ed w/ it ~1 year before I was DX-ed w/ T1, 47 years ago. Also lows can trigger the release of counter regulatory hormones, causing a rebound high. If your pancreas is being attacked by your immune system, it may be irratic and might be delayed correctting for the rebound. Maybe it can overcorrect. Check for correlation between the highs & Iows.

I have two brothers DX-ed T1 in their early 50’s. One took less than 5U/day of insulin for about a year. He probably could have managed w/o those low doses of insulin, but it likely helped extend his honeymoon peroid. And since his pancreas was still partally functional, he probably had better control during the honeymoon.

It sounds like you have a good doctor. Good luck and best wishes.

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