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reactive hypoglycemia and BG spikes after meals

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 Posted 7/1/2013 4:02:22 PM
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Hello all,

I'm a 44 y.o. male, pretty good shape and health otherwise. Probably around 16% bodyfat.  I work out regularly (gym 3x perweek), and I do weights and high intensity interval cardio, and maybe monthly5-10 mile hikes.  I don't eat a lot of carbs - no soda, no juice, easy onthe grains, moderate protein.  I have the occasional glass of wine or 2 ora cocktail (using Stevia), 3 if it's a big happy event.  Non smoker. Sleep pretty well.  No chronic meds.  Job not too stressful. Happy marriage.  I supplement withKrill oil, Astaxanthin, Vit C, and Vit D3 + K2 in winter.  Juicevegetables occasionally.  

I've always known I was sensitive to starch and sugar (high,then crash), and also get hypoglycemic if I wait too long between meals. So in 2006 I got a glucose challenge test:

 Start:     97

1 hour:  91

2 hours: 50

 

So there, reactive hypoglycemia. The BG peak wasn’t recorded. Unfortunately insulin wasn’t measured.

After getting the results, I decided to follow the “Leptineating guidelines”:

-    Cut sugarand starch, especially for breakfast

-     4-6hours between meals, no snacks

-   12hours between dinner and breakfast (no midnight snacks)

I quickly lost 15 lbs, and stayed at my current weight.  I also stopped getting “the shakes” between meals,and can tolerate delayed meals.  This was2006.  I thought my reactive hypoglycemia was cured.

Over the years my fasting blood sugar has always stayed in thehigh 90s, and my A1c has crept up from 5.3 to 5.6.  So I decided to buy a glucometer, an AbbottLifestyle.

It’s not pretty.  

  Fasting sugar: 99-104

  Before meals: 90-95

Now here’s the kicker – the post meal BG spikes.

One lunch was a largish sandwich that I wolfed down (normally I’deat one and not both buns):

before meal: 90

45 minutes:  157, 152(repeated)
60 minutes: 175 (!)
1.5 hours:    134
2 hours:       129
felt sleepy so I did 20 minute of interval cardio then at 3:20 after meal: 84   <-didn’t feel hungry or weak


I then did my version of a glucose challenge test:  an 8-oz sweet potato, steamed, for lunch

 

Before: 89

40 mins: 176 (!)
50 mins: 166

60 mins: 147
2 hours:  85  <- felt famished at this point, so I ate anice fatty tuna salad


I then repeated the sweet potato test, but had 2 plums 30 minutes before … noimprovement in the peak reading

I tried it again, but I drank 2 tbsp apple cider vinegar inwater plus stevia just before the sweet potato … no improvement

 

This morning I had my usual workout, 45 minutes, today was squats,deads, and bench.  At lunch, I had a Mexicanmeal of meat, a cup of salsa / pico de gallo (chopped onions and tomatoes), andguacamole (avocado), and no rice, beans, or tortilla (normally I'd have some of it):

before: no measurement

45 mins: 111

65 mins: 104

2 hours: 101

3 hours: 103

 

Dramatic difference, so the obvious thing is, *avoid starch*.  OK.

 

 I went to a new doc, a generalist, and her suggestions were:

<!--Avoid starch,learn which foods cause spiking

<!--Considerlow dose metformin, so I got a prescription for 2x daily 500 mg

Now for my questions. 

<!--Can metformin dependence appear?  i.e. Istart taking it, it helps, then if I stop, I’m worse off than before I started taking it (assuming I continue to avoid starch)

<!--Should I have asked for the slow release metformin?

<!--Will there be important new information if I get insulin measured during a glucose challenge test?  Or will the effects ofmetformin tell me the same thing?

<!--Whydoes my BG spike so high then plummet so quickly?  Does it suggest an insulin secretion problem?  (e.g. delayed release, then too much is released)

<!--Why is my fasting BG highish?  Why is it higher in the morning than it is before lunch or dinner?  Liver doing too much gluconeogenesis only while I sleep?  Is this always due toliver insulin resistance?

 

Thanks all.    



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Post #9413
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 Posted 7/2/2013 4:54:00 AM
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Welcome to the Forums, giskard.

Although Forums members may have suggestions as to what might be going on with you, only a physician (perhaps an endocrinologist) can provide you with the ultimate answer to many of your questions.

Life Extension has some information concerning hypoglycemia at http://www.lef.org/protocols/metabolic_health/hypoglycemia_01.htm

A search at http://www.drugs.com/pro/metformin.html did not mention drug dependence associated with metformin.

D Dye
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 Posted 7/2/2013 4:50:37 PM
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Hi giskard, & welcome!  

I ran into some blood sugar issues a couple of years back...  Fasting hypoglycemia (shakes, brain fog and sinking spells), and postprandial (after meals) glucose spikes to 140 to 160.  

Treated it much like you are with low sugar/carb diet which helped but did not resolve my problem.  I was 54 at the time and didn't realize my stored iron (ferritin) had been creeping up over the years.  Doctors don't test for iron in routine labs, especially for men as they rarely have trouble with anemia, which is all most GP's see (in menstruating women).  If your doc has not included ferritin in your labs, you may want to add this test.  It's dirt cheap and your doc should not object.  You don't even need to be fasting for a stand alone ferritin test.  You must ask specifically for ferritin or your doc might simply order serum iron which is not a good indicator of iron overload.  

My ferritin was elevated (near 200) but not officially into clinical iron overload, which for men is usually set around ferritin of 300.  It was my only lab that seemed a bit off, and on googling around on high iron and insulin resistance, I found there was indeed a connection between the two.  

I had been a blood donor in the past, so I decided to dump some iron down at the blood bank to see if it would help.  It took a while (each donation lowers ferritin by about 30 points), but the lower my stored iron got, the better my blood glucose swings resolved.  By the time I had gotten my ferritin down to around 50, I was in remarkably better shape.  

It may be a shot in the dark, but you sound like someone who is serious about your health so I thought you might be interested.  Blood donation isn't for everyone...  The needle they use is a BIG one!  About the size of a pencil lead.  There are also donor restrictions you should look at on your local blood bank's website before you go in.  

If blood donation is not for you...  A supplement called IP6 (Inositol Hexaphosphate) will chelate iron if you take it properly...  On a very empty stomach, with a full glass of water.  IP6 is dirt cheap at around a dime a capsule, and one or two a day is all you need.  No side effects for me other than dental sensitivities when I dosed above a gram a day.  Very easy on the stomach.  

More on iron and insulin resistance here: http://www.jci.org/articles/view/44421

I was amazed at how well this worked for me and in researching sub-clinical iron overload have discovered elevated iron can cause other problems besides insulin resistance, most commonly in men of middle age.  Google: Iron, too much of a good thing, and read all about it from the many sources that share this title.  

I'm a low iron crusader now...  My Fountain of Youth!  
Best of Luck to you.  

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 Posted 7/3/2013 10:12:54 AM
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DDye (7/2/2013)
Welcome to the Forums, giskard.

Life Extension has some information concerning hypoglycemia at http://www.lef.org/protocols/metabolic_health/hypoglycemia_01.htm

D Dye
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Thanks!

From the above link:
"Reactive hypoglycemia occurs within four hours after eating if glucose levels rise too rapidly because of underlying conditions (eg, increased absorption of glucose from the small intestine)."

Interesting.  Anyone have links to more detail?
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 Posted 7/3/2013 10:16:43 AM
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synesthesia (7/2/2013)
Hi giskard, & welcome!  

My ferritin was elevated (near 200) ...


Interesting stuff, thanks!  I have donated blood on occasion, and no, I don't look forward to it!  And the ones I donate to pester me for more, every so often, for having "special" blood.

How often do you have to donate blood to maintain your desired ferritin levels?
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 Posted 7/3/2013 4:51:50 PM
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I went in as fast as the blood bank would allow until I got down to my target level of 50 (ferritin).  That was every 2 months for almost a year.  

Now I usually go in with every change of the seasons...  My way of celebrating the solstices and equinoxes!  

Unless your ferritin is into triple digits, twice a year will mimic the female iron loss of menstruation...  Females lose about 30mg of iron a month and each donation taps you to the tune of about 200mg of iron.  When ferritin is into triple digits, each donation should lower it by around 30 points.  

The body will preferentially use remaining blood ferritin to replace lost blood before it starts mining iron out of tissues, so the occasional donation won't pull a lot of iron out of body tissues until excess iron in blood plasma ferritin becomes scarce.  

It takes a bit of doing to get down to that sweet spot of 50, but once you're there, twice a year maintenance is all you are likely to need.  I still go in more often as I've now become addicted to bloodletting!  It's given me back my youth and I shall be eternally grateful.  
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 Posted 7/20/2013 1:55:31 PM
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Synesthesia, thanks for the info.  I've been donating blood on a regular basis for the past 10 years, but after reading your post I immediately went and donated a double reds unit at the Red Cross.

I'm still wondering about my horrible insulin resistance, however. My fasting insulin levels are more than double what they should be despite doing everything I can think of to better my health, including lowering my iron levels --ferritin levels have been consistently around 49 for the past 4 years.  Well, admittedly ,weight is an issue, and probably the biggest factor on those insulin levels, currently about 15 pounds into overweight category-- but losing, (was 20 pounds overweight last month).



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 Posted 8/20/2013 7:09:14 AM
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I've been on the very low starch and sugar, high fat, moderate protein diet for several weeks now, 2-3 meals a day.  Lost 6 lbs since starting it, I now have a 2-pack.  Smile   I don't feel any hypoglycemia at all.  

I also got some add'l blood work back:

hs-CRP:                  0.2  (I think an optimal # is 0.5)
Fasting insulin:      <2  (I'm very happy with this, optimal is 2-4)
rev T3:                   16  (ref 8-25) ... is this slightly higher than optimal?  Adrenal issues?  Some leptin resistance?
ferritin:                   148  (here we go... I'm gonna schedule blood donation)



Later this week I will be getting a saliva test for cortisol and a hormonal panel.

re: iron, Bill Sardi, who is behind the product Longevinex, wrote these.  It contains resveratrol, IP6, and a copper chelator:
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 Posted 9/11/2013 8:19:24 PM
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I just finished my first round of blood donation.  About a month after my 2nd donation, I'll re-test my post-prandial glucose, A1c, and ferritin.


I found this from a Chris Kresser podcast:

http://chriskresser.com/nutrition-healing-obstacles-to-optimal-health-macronutrient-ratios-and-more

[quote]I’d say conservatively 30% of the people that I see — ... have iron overload, and this means they’re storing excess amounts of iron.  They either have elevated ferritin alone or elevated ferritin with increased serum iron, increased iron saturation, and then decreased total iron-binding capacity or unsaturated iron-binding capacity.  And it’s true that ferritin is an acute phase reactant, like C-reactive protein, so it’s a protein that’s involved in the acute phase response, the inflammatory response, so sometimes elevated ferritin can be caused by inflammation, not iron overload, and it’s really important to distinguish between the two . . .

So then I came across, randomly — I don’t even remember how — an article written by Anthony Colpo about how he reduced his ferritin levels because he was having glucose tolerance issues, and that completely reversed that problem . . .[/quote]

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 Posted 9/12/2013 6:20:10 AM
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Thanks for the link giskard...  Here's one for you: http://www.healtheiron.com/iron-diabetes1

The friendly folks at Health-e-Iron have put together a dozen or so studies on the role of iron and insulin resistance / metabolic syndrome / diabetes.  

This is pretty impressive stuff!  Don't know how the doctors in general practice can be so asleep at the wheel on this.  Perhaps they're afraid if they started prescribing bloodletting they might get reported to quackwatch!  
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