Newbie with hypoglycemia possibly with LADA or 3c? Looking for guidance please.

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_Abi_

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Hi, I'm looking for some guidance on how to approach by GP and what to ask him to seek a diagnosis.

I've had many symptoms of hypoglycaemic this past 6 weeks (confirmed with a continuous glucose monitor) - fatigue, faintness, headaches, light-headedness, dizziness, brain fog, tinnitus. . . My blood sugar is more stable if I'm careful to eat low gi food (with low protein) every 2 hours(!) but I'm still waking in the night with hunger and feeling really rough much of the time.

I believe I've had blood sugar issues for decades but it's only in the past few weeks that they've become more pronounced and debilitating.

A recent GAD 65 test (done privately) showed that I was at the very top of the 'normal range' at 0.39 (0.4 - 1.9 = positive for autoimmune diabetes).

I also have autoimmune thyroid disease (Hashimoto's), high testosterone, pancreatic insufficiency all of which I believe have be linked to autoimmune diabetes. I also have long term digestive issues, and a weird sweet taste in my mouth often - high insulin?

I'm guessing I have subclinical LADA or maybe 3c as I have pancreatic insufficiency (could it be both?!), but I'm a bit concerned that my GP won't have heard of either of these, and because the GAD 65 test is technically negative and blood sugar is low it maybe a case of computer says no.

I'm in my mid 40s, HBA1c = 4.9, BMI = 20ish.

Any advise welcome. Thanks very much.
 
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Hi @_Abi_ 🙂 Your HbA1C in the more modern units is around 30 so we’ll below the diabetic threshold. That, of course, doesn’t mean that you can’t develop diabetes in future. When did you have the HbA1C done?

@eggyg is our 3c expert so I’ll tag her. I have Type 1 and I was diagnosed because of ketones and very high blood sugar. I only had a GAD test years later. That was part of an antibody test. I think it looked for four antibodies and I had two different antibodies. My consultant said that confirmed I was Type 1.

Who prescribed the continuous glucose meter for you? What did it show? That is, your lowest figure, your highest and the general pattern after meals?

Did your GP order the GAD test? Did you have a C Peptide test too?
 
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Hi @Abi welcome to the forum. According to this Hb1ac conversion chart between the old % value and the not so new mom/mol value you do not have diabetes


however having said that being Anaemic can affect the result maybe other things do as well but I don’t know

Their is a condition called reactive hypoglycaemia, where your blood glucose levels drop after eating, I know very little about it but I think carby foods dop your blood glucose (BG) levels

My understanding of the GAD antibody test is that it can only show those antibodies if you have them when being tested, if your immune system is not doing battle with your beta cells at the time , you won’t have them, however if when your immune system takes a dislike to them , it wakes up and does battle again.

Where a C-peptide test shows how much insulin your pancreas is producing.

You need to keep on at your Gp to do further investigations.
In other words , the squeakiest wheel gets the most oil.

Please let us know how you get on.
 
Hi Inka,

Thanks for your reply.

I ordered the GAD test & CGM myself, The lowest the monitor recorded was 3.4, highest about 7.5 after exercise I think. It generally bobbed along the bottom between 4.5 - 6. All the dips below 4.5 coincided with feeling faint with headache etc, it seemed to go below 3.9 most often at 3-4am or after eating big portions of protein.

I haven't had a C Peptide test yet.
 
Thank you Ljc, I will be a squeaky wheel and ask for a C-peptide test! 😉

I just found my A1c (that myGP did agree to order) it was 3.4, your chart says "Less than 42 mmol/mol (6.0%) – rule out hypoglycaemia" so that's useful to know - thanks.
 
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You might find the Gp will refuse to do the C-peptide test , think it’s due to cost but not sure.
 
_Abi_ said:
Hi Inka,

Thanks for your reply.

I ordered the GAD test & CGM myself, The lowest the monitor recorded was 3.4, highest about 7.5 after exercise I think. It generally bobbed along the bottom between 4.5 - 6. All the dips below 4.5 coincided with feeling faint with headache etc, it seemed to go below 3.9 most often at 3-4am or after eating big portions of protein.

I haven't had a C Peptide test yet.
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Those results are normal @_Abi_ People without diabetes do drop below 4, and certainly below 4.5. You also haven’t gone high and then dropped. Your highest figure is nicely within range 🙂

Some people are more sensitive to their blood sugar. My mum is one. She feels shaky if she leaves too long between meals. She’s not hypo but she can feel weak and like she has low blood sugar. Her HbA1C was normal. You say you’ve developed a way of eating that makes you feel a bit better so that’s good. I’d stick with that, and try to perfect the foods that work best for you.

I can see you’re concerned, so I’d ask the GP for some general blood tests, including extra things like Vit D, and B12, etc. You mention auto-immune problems so you could also ask for a coeliac test, or pay privately for one. You mention pancreatic problems so I’d want that checked out if possible just to rule out any issues.
 
That chart is for folks with diabetes. Your Hb1ac is perfectly normal for a non diabetic.
 
_Abi_ said:
I've had many symptoms of hypoglycaemic this past 6 weeks (confirmed with a continuous glucose monitor) - fatigue, faintness, headaches, light-headedness, dizziness, brain fog, tinnitus. . . My blood sugar is more stable if I'm careful to eat low gi food (with low protein) every 2 hours, but I'm still waking in the night with hunger and feeling rough much of the time.
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Hello and welcome to the forum,
As you have a multitude of autoimmune conditions (Congratulations) I'm wondering how low your cortisol levels are. Have a look at Addison's disease and see if that fits the bill or ask your GP to test your levels.
 
Welcome to the forum @_Abi_

We aren’t able to offer any diagnostic advice, obviously, as we aren’t medically qualified (well, except for our tame ex GP!)

But... your results do seem to be within the normal range in terms of our lay diabetes experience.

Low BG is not a symptom I would associate with a diagnosis of T1 or LADA, which is usually diagnosed following symptoms that result from high blood glucose.

Is it the symptoms of hypoglycaemia that are troubling you?

Do be aware that Libre can quite often show readings lower than capillary glucose would register - especially at the low end of the scale.
 
Inka said:
Those results are normal @_Abi_ People without diabetes do drop below 4, and certainly below 4.5. You also haven’t gone high and then dropped. Your highest figure is nicely within range 🙂

Some people are more sensitive to their blood sugar. My mum is one. She feels shaky if she leaves too long between meals. She’s not hypo but she can feel weak and like she has low blood sugar. Her HbA1C was normal. You say you’ve developed a way of eating that makes you feel a bit better so that’s good. I’d stick with that, and try to perfect the foods that work best for you.

I can see you’re concerned, so I’d ask the GP for some general blood tests, including extra things like Vit D, and B12, etc. You mention auto-immune problems so you could also ask for a coeliac test, or pay privately for one. You mention pancreatic problems so I’d want that checked out if possible just to rule out any issues.
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Thanks for that Inka, Vit D, B12 and other nutrients are all ok.

Yup, I have no choice but to stick with this way of eating as I feel so awful when I don't eat every couple of hours 🙄 (it's hard work).
 
everydayupsanddowns said:
Welcome to the forum @_Abi_

We aren’t able to offer any diagnostic advice, obviously, as we aren’t medically qualified (well, except for our tame ex GP!)

But... your results do seem to be within the normal range in terms of our lay diabetes experience.

Low BG is not a symptom I would associate with a diagnosis of T1 or LADA, which is usually diagnosed following symptoms that result from high blood glucose.

Is it the symptoms of hypoglycaemia that are troubling you?

Do be aware that Libre can quite often show readings lower than capillary glucose would register - especially at the low end of the scale.
Click to expand...
Thank you for that, yes all the ongoing hypo symptoms are quite debilitating, I'm only able to work part time due to fatigue and brain fog, feel rough in the evenings, and haven't been able to sleep through the night without a dip (waking with hunger, often headaches and racing heart etc) for months. The worst feelings closely correlated with the low BG so I'm sure there's something weird going on. It's frustrating.
 
Although quite rare, hypoglycaemia can affect people who do not have diabetes.

There are details 2/3 of the way down this page

www.nhs.uk

Low blood sugar (hypoglycaemia)

Find out about low blood sugar (hypoglycaemia), including what the symptoms are, the causes, how to treat it and how to prevent it.
www.nhs.uk www.nhs.uk

Hope you find a way to reduce your symptoms and incidence of low BG. Reactive hypoglycaemia can be caused by the body over producing insulin following a carby meal, so your strategy of smaller, low GI, grazing meals sounds helpful.
 
@_Abi_ Have you had a general hormone screen to make sure everything is in order? Your CGM results don’t show hypoglycaemia, although I appreciate what you’re saying about feeling rough when you’re at the lower end of normal.

You describe your blood sugar as “sitting on the bottom” between 4.5 and 6, but those are good blood sugars - what it’s meant to be! As CGMs are really for people with diabetes who can have higher sugars and much more up and down. So the graph might show you, a non-diabetic, at the ‘bottom’ but that’s because the scale has to go high enough to cover people with diabetes whose sugar can go high.

I don’t think you have hypoglycaemia but you clearly have something else going on, so look to other causes maybe - thyroid, other hormones, palpitations, etc.
 
Just to be clear - diabetes is about high blood sugar. Mine was almost 30 when diagnosed, others are higher. Blood sugars in the normal range like you have confirmed with your CGM clearly don’t show diabetes. You’ve also had an HbA1C which is well within the normal range ie not diabetic.

It’s not uncommon for people without diabetes to get blood sugar in the 3s and 4s. It’s not uncommon for people (especially women for some reason - I don’t know why) to feel they need to eat regularly. You’ll often hear non-diabetics say their blood sugar is low but what they mean is it’s just in the lower part of the normal range. It’s not actually hypoglycaemia at all.

Cast your net further afield to find out what’s causing your symptoms. Do let us know if anything turns up on tests 🙂
 
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