Blood sugars in the 40s and precribed Metformin?

[commit2exc]

Hello,

Last Thursday I had an insulin resistance test. My fasting blood was 81- then went to 85, 61, 48, and 48. When I met with the doctor he asked how I felt during the test. I stated that other then some vision problems I really don’t know what is causing what anymore (I also have a serve gastroparesis, GERD, IBD diagnosed 3 years ago, hypothyroidism, as well as a series of explain neuropathy , seizures and list of strange symptoms). He stated that I must have been suffering from this for a very long time not to notice the profound drop in blood sugar. I was diagnosed with a severe hypoglycemia, and he also stated that based on other key factors (above) that it was academic to also diagnose me with insulin resistance. Because of my serve gastroparesis he is starting me out slower on Metformin at 500 mg twice a day, 1000 mg cinnamon and no more then 30 grams of carbs per meal and 15 for a snack. My body does not seem to react well to medication.

I don’t meet with a dietician and counselor until next week, and I am really struggling and have several questions.

I am confused about what metformin does, are others on this when they have really low blood sugars?

Also metformin is causing my gastropareies symptoms to get worse i.e. nausea, acid reflux, how long should I expect it will take for my body to get use to the medicine?

If sugar causes my blood sugar to drop, why is it when I research hypoglycemia it recommends me to eat sugar?

I wasn’t given anything to monitor my blood and I am sure it’s wise for me to do this so I can start understanding symptoms verses blood levels?

I am so restricted on what I can eat already due to my GP so I am struggling with getting enough calories. And average per day has only been 700 and I am lucky if I ever hit 1000 calories a day. I cant really afford to loose a lot of weight, as I am already ready at a normal to lower weight. Any other GP suffers that can help?

Thanks so much for your help!

[themarquis]

I don't know a ton about hypoglycemia like you describe, but I agree that it sounds profoundly weird (and maybe dangerous) to be taking metformin (a blood sugar lowering medication) for having low blood sugar. :confused: :confused:

What is your blood sugar at other times during the day? You might want to get a meter and test it yourself at various times when you feel the symptoms come on. I agree that having a bg of 40 and taking metformin does not sound good to me. The metformin will end up lowering your bg all the time by a certain amount. So say metformin lowers it by 10 points, you end up with a bg of 30, which could make you pass out or worse!

I don't really understand why your doctor hasn't tried to figure out exactly what's going on with you medically. Have you been diagnosed as diabetic? I couldn't tell from your post. If you're not diabetic, not taking insulin, etc., and your blood sugar is abnormally low in combination with various unexplained other symptoms, somebody needs to really be investigating this!

I know there are some hormonal problems that can cause hypoglycemia (hypopituitarism?) so you should be evaluated by an endocrinologist.

[ShottleBop]

Metformin (http://diabetes.emedtv.com/metformin/metformin.html). It is not usually associated with causing low blood sugar.

[commit2exc]

Thanks for your reply themarquis. This doc is an endo, and is suppose to be one of the best... He gave me a diagnose “insulin resistance” in addition to the hypoglycemia. I am assuming that the metformin was prescribed to balance my levels, as insulin resistance is causing the hypo, but I honestly have no clue. He also mentioned gastroparesis and “other factors” to be part of a metabolic syndrome that confirms his diagnosis. (Yet I am not overweight and I don’t have high blood pressure?)

I have been soon sick for years and continue to be and through several doctors. This is the first doc to test for diabetes even though it is a number one cause of gastroparesis. I have felt no improvement since Thursday, and actually feeling worse, but am guessing it will take a while for my body to adjust.

I have not been tested for pituitary issues, other then I had a brain MRI say I have “fullness” in the pituitary? I wonder the same thing if this diagnose is really the cause or just another symptom? I am really lost at this time.

[commit2exc]

Also I am assuming that since my fasting BS level was normal, that i have a reactive hypoglycemia. I understood most med conditions that cause hypo are fasting hypos?

[butterflykisses]

I recommend that you do a search for Celiac disease, see how your problems compare. Much of the symptoms, and even diseases like the hypothyrodism, possibly even gastroparesis, neuropathies, could all be caused by the destruction of your small intestine brought on by gluten (the protein in wheat, barley and rye).

[commit2exc]

Thanks butterflykisses, I have been tested three times via celiac panel, and twice via biopsy during an endoscope.

[themarquis]

I don't know -- the whole thing still sounds weird to me. What other information did your endo have to diagnose you as insulin resistant? I know when they said I was IR (before the diabetes diagnosis) that was based on my fasting insulin level (I think they can also do C Peptide), which was high.

It seems fishy that they did a glucose tolerance test, your bg dropped the whole time, and based on THAT they diagnosed you as IR. Did your bg increase initially during that test and then decrease? (I see it increased from 81 to 85, but that's not much of a rise! When many folks have reactive hypoglycemia, they go say from 70 to 180 to 70 or something like that in an hour or two.) Or did they just see a steady decrease? And how did they decide you must be IR in the absence of any other information? How have they ruled out other types of hypoglycemia, for example, caused by other endocrine abnormalities? Have you actually documented with a meter that your bg is rising then dropping significantly (not just a few points!) after meals and causing symptoms?

Sorry -- so many questions! I can see that the thinking on the metformin is to prevent your bg from rising a lot after a meal (therefore preventing a big drop). But since we maybe don't know if your bg is even doing that in the first place (??) that might not make sense. So if you are just having low blood sugar all/most of the time, giving you metformin is just going to make it get even lower. Not the best thing to do.

I don't know what "pituitary fullness" would be. Have you had tests of various hormone levels -- for example, tsh (thyroid), cortisol, growth hormone, etc.? My endo did a ton of these sorts of tests when I first started seeing her, just to rule out other stuff. It seems like you need a full workup because something weird could be going on!

[commit2exc]

I am still trying to understand this. I honestly have no faith in doctors anymore. As I mentioned I have has several health problems including a severe gastroparesis (my gastric emptying study was almost 800 min). I was vomiting several times a day, and couldn’t even keep baby food in, literally almost dyeing from malnutrition, tons of surgeries and meds later, I decided to STOP all of the medications and doctors, and go to a homeopathic treatment. While not cured, I was able to start managing my GP a little better and could get some foods with our getting violently ill. I seemed to be ok until about a year ago when it just seemed like just when I had my health under control another wheel on the bus would fall off.

I started feeling very tired all the time, vision problems, memory. Brain fog, migraines, night sweats, ect. My immune system was shot, and I kept getting one virus after another, infections, then the antibiotic would cause a serve thrush, I just have never been able to pick my self back up.

I decided it was time to find a doctor again. The first doctor diagnosed me with hypothyroidism/hashimotos and adrenal insufficiency and prescribed a steroid and synthroid. I was relived thinking this is my problem, so as soon as I can get it back my levels back to normal I will feel good again, but this never happened.

Then about a month or so later I ended up in the hospital with my entire left side numb and I couldn’t function and I literally felt as I was mentally retarded. I started having seizers and it was the scariest thing I have ever gone through. After more confusing “assumptions” and two more seizures days afterwards, I decided to go to an endo doc to help me understand all the deficiencies in my blood work and help me get (what I thought was my hormones under control).

This new endo doc looked at my blood work and asked why I was taking steroids, as he sees no evidence of adrenal/cortisol problems) and also said I am being over medicated on thyroid medicine. He noted neuropathy in my left side and explained the other tests results to me. Low potassium and low vitamin D, low WBC the list goes on…. He instructed me to slowly get off the steroids and stop taking them, and reduced my thyroid medication 75%. He asked if I have ever been tested for diabetes and I showed him the only test I had had which was a non fasting test A1C of a normal 5.2%. He scheduled an insulin resistance test to be done in 3 weeks after I have been off the steroids.

To answer your question this is the first insulin resistance test and the above A1C the only one to my knowledge. I do not have a meter yet, I meet with a counselor on Thursday. When looked back all of my cbcs my glucose levels have run normal 85s to 90s and the highest I have seen is about 111. I had never seen a low level before this insulin resistance test. I don’t know if any prior doctors would have found my hypoglycemia without this test, since my blood sugar didn’t drop into the 40s until given 75 grams of sugar! All I know is what the doctor explained to me is that I must have been sick with this for a very long time not to notice the extreme drop in blood sugar, and that in addition to severe hypoglycemia, he is giving me a diagnosed insulin resistance based on the fact that my spike in insulin is inappropriate to sugar levels, in additional to the gastroparesis, hypo and metabolic X. He said regardless he would treat IR and Hypo the same. I can’t tell you what my levels are now, and the metfomin had caused my gastroparesis to flair up with a vengeance, so I have been extremely nauseous and horrible reflux and no symptoms have seemed to let up. While I have learned not to take a doctors opinion as grace, I am so tired of being soo sick and I just want to feel better. I really do not have not choice but to see if this works (once I get my glucose meter I will be able to tell). I pray this is a cause and not another symptom but I also agree that it may mean yet another problem is still undiagnosed… GURRRR!!

[Moonglo]

If you are reactive hypoglycemic, my understanding is that the reason the sugar eventually causes lows is because your body overreacts to highs by letting out too much insulin, causing you to have a hypo. My guess is that the reason the doctor gave you metformin is because, if you can keep your bg from going high, you may not experience those extreme lows because your body will not go into panic mode. If that makes sense.

And yes, metformin will cause gastro symptoms for a while- generally the first few weeks. My advice is to try eating fewer carbs per meal and see where that takes you, because I know the met will make me sick if I eat something super starchy. The doctor's recommendations of 30 grams of carbs at meals and 15 at snacks may be more than your body can handle right now. You may want to play around with this idea and see how you do... and of course keep glucose tablets, juice, or something else sugary with you at all times in case I am wrong and your bg starts to drop too low.

Sorry you're feeling so lousy... I know that can't be fun.

[Moonglo]

BTW, I would imagine your A1C would be lower if your bg was not going high at some point to make your average look normal with those hypos coming on.

[commit2exc]

Thanks Moonglo for your thoughts! I have been sticking to lower carbs per meal; I rarely will get over 15carbs, because really with my GP I can’t eat a meal, so all of mine are snacks. I do have a question; do you have to eat carbs in each "meal"? I just wondered if sugar caused my lows, it would make since to avoid it?