Low blood sugar

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ds9127 posted on Tue, Jan 13 2009 3:48 PM

I have had type II for about a year... take a gylburide lowest dose in the morning and a metformin 500 at bed time... have exercised and eaten right and lost about 60 lbs... still have about 60 to go... but now about 3 times a day my sugar goes down to the 60's and it does not feel good... I have to eat more to keep it up... and I do ballance about 2000 cal and 200 carbs a day... but now I have to take in more to keep this from happining... I exercise for about one hour every day... I guess I need to see the Dr... so my question is... has this happened to others... is there something I might be doing wrong to cause this to be happining... I have not changed my habits... maybe a month ago I started to have a diet soda once a day... but other wise its about the same... just don't like dropping the sugar... it gives headaches and funny feelings...

Dave Starr

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Simi_Papa replied on Tue, Jan 13 2009 5:00 PM

To me it looks like you are taking your meds in the wrong order.  Metformin works to reduce insulin resistance and should be taken in the morning.  With your weight loss you may not need the other medication, it is the one that is taking you low,not the metformin.  You are also taking the lowest dose of Metformin, ask your doctor about taking more metformin and eliminating the other med.  You also have to be sure you exercise after eating (between 30 and 60 minutes after eating) which will also help you not go low.  Congratulations on losing that much weight! 

Bill

"May the Force be with you!"

Diagnosed in 1997; Off all meds except Metformin!! Smile

www.nvhealthy.com

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I've done some interesting research on low blood sugar lately.  Firstly, there is not any universally accepted blood sugar level that always requires treatment (eating a fast acting blood sugar).  I am frequently in the 60s, and occasionally in the 50s, I don't worry about it, and don't treat it, as I am usually on a ketogenic diet.  fed infants run very low blood sugar numbers also, the reason given is the same, they don't need high blood sugars as they are powered by ketones, as I am.

Many worry about severe hypoglycemia, which is a legitimate worry.  It can lead to coma, brain damage, and even death.  However, this kind of severe hypoglycemia usually only happens with diabetics on insulin, and to a much lesser extent, to those on a sulfonylurea.  Your feeling bad, might not be due to the absolute blood sugar level, but to the relative value, that is a sudden drop in blood sugar.  Some people may feel hypoglycemic symptoms even with higher than normal levels, if their blood sugar levels have dropped too quickly.

One thing to discuss with your physician, is to reduce your medications, rather than increase your food intake.  The low readings may even be a good sign, that your body's glucose tolerance or insulin resistance is actually improving, thus it may benefit you to reduce or even eliminate a medication.

Generally, I'd listen to my body as much as I'd look at the meter.  If you feel bad, treat it, if you feel fine, as I do, with low readings, wait a while and test again.  Most type IIs have functioning counterregulatory mechanisms, meaning that they are very capable of correcting low blood sugars, just not able to handle high blood sugar levels.  With time, you may find that these kinds of readings will not be a problem for you.  There is something called hypoglycemic unawareness, but again, that mainly is a type I problem.

 

 

 

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kat replied on Thu, Jan 15 2009 10:13 AM

Hi, Dave, and Welcome!

When I lost 65 lbs about five years ago, I experienced the same symptoms you have -- and on the same meds and dosage.  First I went off glyburide.  Then I tried taking Starlix, a before-meal med.  On that I got low blood sugar, shook, turned white, and felt awful.  One dose of that was all I took.  In another month or so I also went off metformin, kept my AlC in the high 5 and mid-6 range for about six years.  Recently my AlC crept up, and I am back on metformin -- and getting occasional low blood sugars again, probably because I am eating fewer carbs.

Why do you take metformin in the evening?  Do you have high fasting b.s.?  If not, perhaps you could take metformin in the morning rather than at night.  If I were you, I'd also check with my doctor about discontinuing the glyburide and perhaps adding Starlix or Prandin before meals. 

T2, diagnosed 12/98.  Diet and exercise 2/03 - 11/08.  Now back on metformin 500 ER.

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nance replied on Sat, Jan 17 2009 12:20 AM

Dave ~ when I lost 40 pounds during the first 6 months of exercising every day to control blood sugar, I had the opposite problem, with blood sugar running a little higher for a while, until I figured out that since I weighed less, I needed to exercise MORE, (and also eat less) but I wasn't on any meds, having dropped them at the end of the first 6 weeks.  So, I'm thinking that the lower numbers you're experiencing may be due to an increased sensitivity to your meds, with your 60 pounds lighter weight.  Another thing you might consider is cutting back slighlty on the exercise, rather than increasing food. OR possibly just cutting back on the meds, which would probably be my first choice.

Nance, T2 dx 7/98; diet and exercise/no meds 11 yrs; 500mg Glucophage XR 4/day, 5mg Glucotrol XL 3/day; A1c av. in 6s.  Treadmill, elliptical, biking, Arc trainer, dumbbells, other resistance moves -- 30-60 minutes a day.

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Ron AKA replied on Sat, Jan 17 2009 1:08 PM

ds9127:
I have had type II for about a year... take a gylburide lowest dose in the morning and a metformin 500 at bed time... have exercised and eaten right and lost about 60 lbs... still have about 60 to go... but now about 3 times a day my sugar goes down to the 60's and it does not feel good...

Glyburide can be a difficult drug to work with. It stimulates insulin 24 hours a day, including times when you don't need it. This will cause low BG's. I would ask your doctor about switching it to Prandin which only lasts for about 2 hours, or just discontinuing the Glyburide and increasing the dose of metformin.

Ron

Not a med prof. Just diabetic type 2 on Prandin, Levemir, ramipril, bisoprolol, & Crestor. Diag. Feb/01.

"I have not failed. I have just found 10,000 ways that don't work." - Thomas Edison

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zrebiec replied on Sat, Jan 31 2009 2:10 PM

No More Carbs,

Our research shows that after your blood glucose drops below 65 mg/dl there is a change in your functioning - there is a slowing down of thinking and problems with concentration, even if you have no physical or mood symptoms. In addition, many people can get too low to function because they wait too long to treat a low blood glucose. Our research also indicates that the majority of people who have diabetes are not very accurate in predicting blood glucose levels based simply on how they feel. So I strongly disagree with your recommendation that "if you feel fine with a low reading wait  a while." In fact, we train people to treat immediately as soon as they recognize that they are low, even if they do not have symptoms. I would agree that if you are taking insulin the risk is much higher for a low blood glucose than if you are not taking insulin.

John Zrebiec, MSW, CDE

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Mr. Zrebiec,

Certainly, I'd agree that if someone is acclimated to high blood sugar levels, a level below 65 may induce symptoms of hypoglycemia including confusion.  However, not all medical authorities would agree with you that a level of 60 actually constitutes  hypoglycemia.  Note this from the University of Tennessee Health Center:

http://www.utmem.edu/campusrec/hypoglycemia.html

Further, what is the bottom of the normal range of A1c for a non-diabetic, and what AVERAGE blood sugar does that equate to?

Merely running higher than normal blood sugar levels (barring DKA) won't kill you immediately, severe hypoglycemia can.  That said, I wish that when I began the quest to normalize very high blood sugar levels, that I knew what healthy levels really were for non diabetics.  I was happy with post prandial readings of less than 180 or less than 140.  Today I have an A1c less than 5, I would not have known that that was even possible had I read only the opinions of the 'mainstream' authorities.  I would love to know how many diabetics not on insulin or sulfonylureas have been admitted to a hospital with severe hypoglycemia?  I'm quite confident that it's a very small percentage.  If someone feels that if it happens to just one person, that it's unacceptable, I'd suggest that they not ride in an automobile either, I think the risks are comparable.

If someone is treating their diabetes with diet and exercise, or with metformin alone, and has a reading of 60, I've seen nothing to suggest that they face horrendous consequences by waiting fifteen minutes or so, and testing again.  Obviously, if someone is really concerned that they might go down to below 40 or 30, they should treat their condition immediately.

For a diabetic in poor control, and especially one on insulin, a sulfonylurea, or a heavy drinker, the risks of severe hypoglycemia are real.  Some cutoff point for treatment is needed, some doctors may not want such a diabetic to ever be below 120, others may set 80 as a limit.  But my opinion, is that if a diabetic can obtain normal blood sugars with diet and exercise alone, they do not need to panic with a reading of 60.  Eating some fast reacting carbohydrates will bring the blood sugar level up, but so would their body without such treatment, and they would be one step closer to truly normal glycemic control.

For the majority of diabetics, I believe your recommendations are right on, my remarks are solely for the minority who aspire to truly normal blood sugar levels experienced by the healthiest of non diabetics with fully functioning pancreases. 

 

 

 

 

 

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Ron AKA replied on Sat, Jan 31 2009 8:00 PM

NMC, have you ever had a real low? I have without taking insulin, and I can tell you you feel like crap and don't want to do it again. Further you do not act in a rational manner, and are not safe driving. I think it is reasonable to take steps to avoid the situation. I am not in the camp that you can condition yourself to either low or high BG. You pay the price either way. Non diabetics have extremely efficient BG control compared to diabetics and can run real close to the line without ill effects. Real diabetics don't have that luxury.

Ron

Not a med prof. Just diabetic type 2 on Prandin, Levemir, ramipril, bisoprolol, & Crestor. Diag. Feb/01.

"I have not failed. I have just found 10,000 ways that don't work." - Thomas Edison

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Dee replied on Sat, Jan 31 2009 8:47 PM

I agree whole heartedly with Ron on this one.  I have always had low blood sugars, the lowest was 29, that was when I was diet and exercise controlled, and it was a horrible experience.  I was on Metformin only for years, then added Prandin, and I had more frequent lows that were unavoidable and still very unpleasant.  Now I seldom have lows and currently am on Metformin and Byetta.  Another reason I have always had lows is because I am also hypothyroid, and the medication can sometimes react with diabetes meds.  I have had to train myself when feeling symptomatic to test, treat, test.  The reason I have done this is simple, my thinking is altered when on the way down.  I would advise any diabetic to test, and re test until levels are acceptable.  I can not ever judge my condition on feelings, testing is the only way for me to stay safe.

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Ron,

Twice, I experienced hypoglycemic symptoms, I didn't have a meter with me so I don't know my readings.  I was very hot, weak, and sweated an incredible amount, I knew what was happening even the first time.  I drank a coke and recovered very quickly.  Both episodes occurred in the brief period of time that I took glucovance, which consists of glucophage combined with glyburide, a sulfonylurea.  That was about eight years ago, since then, I have never experienced the same symptoms, so I have measured blood sugar readings as low as the high 50s.  On the other hand, it is only in the last year, that I have begun to frequently see blood sugar levels in the 60s and 70s.

I would disagree with you as to the idea that diabetics' have impaired counter regulatory systems, most do not.

http://www.healthcentral.com/diabetes/type-II-diabetes-000060_5-145.html

 

If one is not on insulin or a sulfonylurea, they most likely have a functioning counter regulatory system.  Certainly, I've tested mine sufficiently the past year, that I'm confident that a low reading will be handled by my body. 

 

hypoglycemic unawareness is principally a type I problem.  So, unless someone for some other reason, is prone to severe hypoglycemia, I am of the opinion that low readings, not accompanied with hypoglycemic symptoms, can be watched for a short period of time, without eating fast reacting carbohydrates.   Of course, if someone is worried about severe hypoglycemia setting in, by all means treat the low blood sugar level.  But my reading of the literature is that a type II diabetic not on insulin or a sulfonylurea is at very low risk of severe hypoglycemia.  Why run any risk?  Because I want to maintain my A1c levels below 5, which some studies indicate is correlated with the lowest risk of CVD, the most serious complication of diabetes.

 

 

 

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Dee,

 

29 is truly a seriously low hypoglycemic number.  You will get no argument from me on that score.  Since you know that you are vulnerable to seriously low hypogycemia, my comments would not apply to you.  Again, according to the literature I've read, your case is rare (doesn't that make you feel special?).  Perhaps, as you suggest, it is realted to the hypothyroidism.

This article covers some of the points I was trying to make, that type II diabetics rarely experience severe hypoglycemia, unless on insulin or a sulfonylurea.

http://www.healthcentral.com/diabetes/type-II-diabetes-000060_5-145.html

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zrebiec replied on Sun, Feb 1 2009 3:59 PM

No More Carbs,

While there still exists some academic disagreement, the formal definition of hypoglycemia is a blood glucose level below 70 mg/dl. I still strongly disagree with your suggestion that even people with type 2 diabetes, not on insulin, can wait to treat a low blood glucose level. Again, we know from our research that response to low blood glucose levels can be unpredictable. One of the reasons that people get into serious trouble is because they assume that they have plenty of time to react to a low blood glucose based on previous experience - our research indicates that this is a dangerous assumption because the response to the next low blood glucose level may be quite different than the last 100 times. I will grant that the risk is different - studies indicate that people who take insulin experience at least 2 hypoglycemic events per week, while people who do not take insulin experience, on average, 2 hypoglycemic events per year.

John Zrebiec, MSW, CDE

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mrfino replied on Mon, Feb 2 2009 11:10 AM

John Z:

Do I understand your point? An event that may be unlikely to occur, for example hypoglycemia twice a year, is still something to be prevented since the potential harm from a single episode can be so unpredictable and so dire.

John

Type 2 since '95

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zrebiec replied on Mon, Feb 2 2009 12:47 PM

Correct - no matter how infrequent, always need to play it on the safe side, rather than risk becoming too low to function, physically or cognitively. By the way, this does not mean running blood glucose too high in order to prevent it from becoming too low.

John Zrebiec

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