Is this a valid belief (I was told this by more than one medical professional)? If so, why does it happen? What is the underlying biology of it? If anything, you’d assume reactive hypoglycemia would be an early symptom (the body can’t absorb all the glucose, so it releases too much insulin causing hypoglycemia) rather than having hypoglycemia due to fasting for 8-12 hours.
Also what all forms of hypoglycemia are there? I know there is reactive vs fasting. Are there others? What distinguishes hypoglycemia from too much insulin vs too little glucose?
Is hypoglycemia due to problems with glycogen storage different from other forms of hypoglycemia? With glycogen storage problems (especially liver glycogen) you’d assume the liver wouldn’t be able to regulate blood sugar as well.
I am not a medical professional, but this is the way that medical professionals explained it to me, along with my own research into the topic (I’m diabetic).
The way your body regulates its blood sugar is that your cells have insulin receptors on them, and cells in your pancreas produce insulin. There are different ways you can end up with diabetes. Though the luck of simple genetics, your cells might not have as many insulin receptors, or your pancreas may not produce as much insulin. But one of the most common ways (and applicable in my case) is that you just get overweight and fat blocks the insulin receptors. This makes the cells in your pancreas work harder and the strain can kill off those cells. Most cells in your body regenerate, but a few don’t, and these are on the “don’t” list. So when these cells get damaged and die, they are gone forever. Lose enough cells that your body has a hard time regulating its blood sugar, and you have type II diabetes.
When you eat, your blood sugar spikes up. After a while, it starts going back down. If you are diabetic, it drops more slowly, so if you measure your blood sugar an hour after you eat and it’s still very high, you have a problem. If you measure it a couple of hours after you eat and it’s still high, then you really have a problem. So in a way you can tell just how severely diabetic you are.
If your diabetes is caused by being overweight (like mine), if you drop the weight your body may be able to regulate its sugars correctly. Some people call this “cured” but you aren’t really cured. The damage to your pancreas is permanent. This is where I’m at. I’ve lost weight and my fasting blood sugar levels are normal, but I know I have permanent damage to my pancreas. I don’t have to be on medicine, but I know that I am still technically diabetic.
If you are damaging your pancreas and becoming diabetic, your fasting blood sugar will be high long before you have any other symptoms.
The OP asks some wide-ranging questions, too wide for me to address simply. But here are some basics about hypoglycemia in adults.
Per UpToDate.com, Hypoglycemia is defined as a blood sugar under 55 in a non-diabetic, taken from a venous blood sample and run on standard laboratory equipment, NOT on capillary blood from a fingerstick on a home glucometer.
Hypoglycemia diagnosis is based on Whipple’s triad. All 3 criteria must be met to diagnose it:
●Symptoms consistent with hypoglycemia
●A low plasma glucose concentration measured with a precise method (not a home glucose monitor) when symptoms are present
●Relief of those symptoms after the plasma glucose level is raised
Causes of hypoglycemia in adults fall into 6 basic categories, some of which have subcatagories:
Ill or medicated individual
Drugs: Insulin or insulin secretagogue, Alcohol, Others
Hormone deficiency: Cortisol; Glucagon and epinephrine (in insulin-deficient diabetes mellitus)
Nonislet cell tumor
Seemingly well individual
5. Endogenous hyperinsulinism: Insulinoma; Functional beta cell disorders (nesidioblastosis) such as Noninsulinoma pancreatogenous hypoglycemia or Post gastric bypass hypoglycemia; Insulin autoimmune hypoglycemia such as Antibody to insulin or Antibody to insulin receptor; Insulin secretagogue; Other
Accidental, surreptitious, or malicious hypoglycemia: I.E. accidentally or on purpose taking meds to lower one’s glucose.
As for the OP’s title question: Low blood sugars being predictive of impending diabetes? That’d come from autoimmune hypoglycemia; the pancreas releasing insulin untimely as it’s destroyed. Afterwards it will lack the ability to make adequate insulin. This is uncommon, however. And the vast majority of cases of hypoglycemia do not predict future diabetes.
When you are hypoglycemic, glucagon is secreted from your pancreas. The glucagon tells your liver to break down stored glycogen into glucose to bring your blood sugar back up. The liver is also involved with a process called gluconeogenesis, which manufactures glucose, also when you are hypoglycemic.
(Both of these processes are nothing more than quick fixes and are not sustainable for any significant period of time)
With glycogen storage disease, these processes do not function well because of specific enzyme deficiencies.
mmm
The author of Lord Emsworth’s favourite book, The Care of the Pig. The writings of Mr. Whiffle (also known as Whipple) exert a soothing influence on his Lordship in times of stress, especially in “The Crime Wave at Blandings”, during the momentous events of which the Earl frequently requires Whiffle’s soothing balm on his stretched nerves.
In Galahad at Blandings (in which the name is Whipple once more), we learn that the great pig-expert is known to Gally, who spoke to him while writing his memoirs to get details of Mr Whipple’s grandfather, who grew a second set of teeth at the age of eighty, and used them to crack Brazil nuts (he died at the age of eighty-two, from a surfeit of Brazil nuts). An elderly man with a thin, reedy voice, Mr Whipple is a member of the Athenaeum club (where he once met Colonel Egbert Wedge), and is so impressed by what he hears of the Empress of Blandings that he hopes to visit and see the mighty pig; thanks to Gally, however, he is put off and replaced with Sam Bagshott, but causes trouble by installing himself at the Emsworth Arms, in hopes of catching a glimpse of the Empress.
ICU RN checking in. First off, there is a very profound difference between type 1 (insulin dependent) and type 2 (insulin resistant). In type one, formerly called “juvenile diabetes”, the body just doesn’t produce enough insulin. In type two, the cell receptors are just… let’s call it tired, to use the insulin that the body produces.
However, both result in hyperglycemia - not hypo. Pre-diabetes is a fasting blood sugar from 100 to 125. Normal is 70 - 100. If a fasting blood sugar is below 70, it ain’t diabetes, but it’s still bad. Something’s off*. The causes are varied, but it’s most likely due to excessive alcohol intake or something else that fucks with the liver. Hepatitis. That’ll do it. There are some rarer things like pancreatic cancer** that can cause it, but truly, don’t look at horse tracks and think zebra. It’s alcohol or hepatitis.
*This is assuming, of course, that the patient isn’t a diadetic who took too much insulin. Happens alot.
**Pancreatic cancer is a real bitch, though, and it DOES happen to good people.
Let me add to that. “reactive hypoglycemia” does appear to exist, but it’s rare, the symptoms are mild, and it sure as hell isn’t “fasting hypoglycemia”. The reported symptoms always occur immediately after a meal. It’s 'idiopathic", so take the diagnosis of the disorder with a grain of salt.
Let me add to the medical chorus that the question in the OP isn’t possible to answer, because it’s not widely accepted. (Does that sound more diplomatic than, “it’s not true”?)
I wonder if whoever told you that had learned of the Somogyi Effect and was confused. The Somogyi Effect is a chronic rebound hyperglycemia that happens in reaction to a hypoglycemic state, in people with diabetes. That is, they take a bit too much insulin (either accidentally or because their doctor has prescribed too much), and then they go to bed. The insulin goes to work and lowers their blood sugar. Because they’ve had too much insulin, it lowers the blood sugar too much. Overnight, they become hypoglycemic, but they sleep right through it and don’t notice. Eventually, their liver sorts things out and breaks down a bunch of stored sugar and spits it into the blood stream, and they end up waking with a *high *blood sugar reading. If these people wake up early enough, they can catch their number still at a hypoglycemic value. So, in this tortuous sense, an overnight low fasting blood sugar could be a sign of diabetes, since those of us without diabetes don’t get the highs or lows.
But that Somogyi Effect doesn’t really happen to *undiagnosed *diabetics or those with prediabetes - it’s a result of overuse of insulin at dinner or before bed, and you have to be diagnosed before they give you insulin.
(It’s also worth noting that Somogyi Effect is itself still fairly controversial as a theory, although I’m not sure why. Nurses learn about it as fact, but doctors seem less convinced.)
One last thing, it occurs to me that some of the wording in the above two posts may seem a bit strong, but it’s not meant to be. It’s just very, very informal. Inflection can be lost in text.
As an aside, I’ve always found “Whipples triad” to be so tautological that it borders on complete idiocy. Hypoglycemia is defined as low blood sugar and Whipples triad states that it is diagnosed by symptoms of hypoglycemia and low blood sugar.
Thanks Dr Whipple, that’s a profound insight you have right there.
Yet in the real world outside of ICUs needs to be spelled out.
Having well documented episodes of low blood sugar alone is not enough. Having episodes that clinically sound like low blood sugar alone is not enough. Having episodes that clinically sound like low blood sugar that are associated with well documented low blood sugar is not enough. You also have to show the last bit, that raising the blood sugar relieves the symptoms consistent with the low blood sugar.
Apply it to “reactive hypoglycemia” … how often when that label is attached is it based on even two out of the three? Most often it is symptomatic alone. Yet belief in it seems widespread heavily promoted by those who want to blame wheat for all that ails us, for example.
It is, actually. Lots of people got themselves diagnosed inappropriately because they did not stick with the triad.
A specific value for glucose was not included in the triad because when it was first propounded, the glucose value depended on the method used and the units measured, and those varied (and still do). Currently in the US we use 55 mg/dl for that level. Other parts of the world use other methods.
What conditions fill the first two but fail the third? Symptoms of low blood sugar, diagnosis of low blood sugar but raising sugar levels does not relieve symptoms?
