"This site changed my life...thanks for everything, Steph!" -Olivia, San Diego, CAThe Prediabetes – Reactive Hypoglycemia Myth
Filed under: PRH Facts | 6 Comments »I’ve read in dozens of articles across the internet that reactive hypoglycemia is one of the first signs of diabetes. According to many prominent researchers (including Achim Starke, MD and Jean-Frederic Brun), it isn’t. In a recent email to Dr. Brun, I asked him why reactive hypoglycemia is often linked to prediabetes. His response was that in “medical studies emphasis is always put on pathologic situations.” Most of the time, says Dr. Brun, prediabetic hypoglycemia occurs late after the meal (more than 4 hours) while reactive hypoglycemia (hypoglycemia at 2-3 hours) is “…on the opposite (lowered risk of diabetes).”
In other words, if you have true reactive hypoglycemia (with symptoms appearing at 2-3 hours), the statistics say you are more likely to have a lower risk of diabetes. This article will help explain why even my own doctor got it wrong.
How can so many physicians get it wrong? As a mathematician who teaches statistics classes at the college level, I have a pretty good idea. Giving a patient a diagnosis of reactive hypoglycemia (or prediabetes) involves looking at a few numbers, analyzing those numbers, and coming up with a diagnosis for the patient. Unfortunately, physicians frequently misread health statistics, and do not know the probability that someone has a particular disease given the results from a screening test. That’s according to a report by the journal Psychological Science in the Public Interest published in US News.
One example given in the above article is a woman given a positive result on a mammogram. One hundred and sixty gynecologists were asked “What are the chances that the woman has breast cancer?”; only 20% got the right answer (which was that the woman had a 10% chance). Another 20% said she had a 1% chance, and an incredible 60% got it wrong and said she had an 81 or 90 percent chance of having cancer!
In order to illustrate why it isn’t easy to give a diagnosis for any particular disease, here is a graph of two patients who have just had a Glucose Tolerance Test (GTT). The patient with the red line is overweight (with most of her fat around the hips and thighs). The patient with the blue line is normal weight.
Which patient is at risk from diabetes? The overweight red patient? The normal weight blue patient? Or both?
Here are a couple of pieces of information to help you make up your mind:
1. Normal blood glucose values for a 75-gram oral glucose test are (from the National Institutes of Health):
- Fasting: 60 -100 mg/dL
- 1 hour: less than 200 mg/dL
- 2 hours: less than 140 mg/dL.
(Between 140 – 200 mg/dL is considered impaired glucose tolerance or prediabetes. This group is at increased risk for developing diabetes. Greater than 200 mg/dL is a sign of diabetes mellitus)
2. Prediabetic patients typically see hyperglycemia (>180 mg/dL) and hypoglycemia (>60 mg/dL) at the same time,
The correct answer is, you really can’t answer the question…at least, not from this test. The blue patient certainly looks like they could be prediabetic (and suffering from what doctors call glucose intolerance), but we don’t know anything about this patient’s other risk factors. The red patient looks borderline, but the GTT cannot be used to accurately diagnose reactive hypoglycemia (to find out why, see my article on tests for reactive hypoglycemia). Additionally, the red patient has excess body fat around her hips, which actually protects from diabetes! Here’s a quote from researcher Dr. JF Brun from page 10 of his report on Postprandial Reactive Hypoglycemia:
“…reactive hypoglycemia is frequently found in women with moderate lower body overweight…This situation seems to be associated with
a lower incidence of diabetes.”
In essence, if you’ve received a GTT result that looks like the red patient and if your doctor has told you that you are at risk for diabetes, ask for a Hyperglucidic Breakfast Test, especially if you don’t have other risk factors for diabetes. A Hyperglucidic Breakfast Test is the only test that will be able to tell you if you have a high sensitivity to insulin (and therefore a lower statistical risk of diabetes) or a low sensitivity to insulin (and an increased statistical risk for diabetes).
Blood glucose levels alone tell you practically nothing about your possible prediabetic status!
*update, Sept 20: despite having pretty severe reactive hypoglycemia, my endocrinologist confirmed that not only I am not prediabetic, but there is no evidence to link reactive hypoglycemia to diabetes. I am actually at “low risk for diabetes” (in my doctor’s words).
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Reactive Hypoglycemia
Read this webpage.
http://www.phlaunt.com/diabetes/16422495.php
It’s very interesting because it explains how doctors and diabetic associations have it all wrong about diabetes risk.
It seems that what we considered risk factors are not that relevant. It seems that a high fasting blood glucose is not even necessary to be diabetic and that it is the worse predictor of diabetes. It seems that fasting blood glucose as low as 95 are already sign of impaired glucose metabolism. It seems that a reading above 145 at any moment in the glucose tolerance test is the best predictor of diabetes.
There are economical interests as to why the Diabetic Association don’t change their criteria for diabetes diagnosis and risk.
Considering this data it seems that many people with Reactive Hypoglycemia are indeed at risk for diabetes, because they have an impaired glucose tolerance. Reactive Hypoglycemia when connected with diabetes can be understood as resistant phase 1 insulin but excessive phase 2 insulin, whereas diabetes is resistant phase 1 insulin but unadequate phase 2 insulin. They seem to be the flip sides of the same metabolic issue.
I have been diagnosed with Reactive Hypoglycemia. My highest reading is 250 and my lowest is 39. There are many diabetics in my family and none of them have diabetes markers: they are all thin, with no large waist and with low blood pressure. There have never been an overweight person in my family but still many are diabetics.
Hi Daniel,
Wow, that’s certainly a high (250) and low. From what I’ve read, that’s definitely defined as “prediabetes” (b/c you have hyperglycemia and hypoglcyemia together). However there’s other literature that suggests such a low score would indicate further testing to find out the cause. I wonder, have you had any further tests?
Thanks for the link…EXCELLENT ARTICLE, Thanks! Yes, there’s no doubt the diabetic community has some of it wrong.
Best,
Stephanie
[...] prediabetes, so it’s a little misleading. I have a lengthy discussion about those numbers in this article). Glucose Level [...]
I have had reactive hypoglycemia for about 25 years. It took about five years to get the appropriate diagnosis. My specialist at the time (who was a clinical researcher in the area) warned me that I might get diabetes later in life if I let my weight increase too much (i.e., it wasn’t a forgone conclusion that RH leads to diabetes). My understanding was that RH+weight gain put more of a strain on the pancreas, resulting in a higher chance of diabetes. In recent years I’ve had fasting blood sugars and A1c tests that put me in the ‘near diabetic’ ranges, but exercise (easily the *MOST* important thing someone with RH or diabetes needs to be doing) has brought me back down into the safe area again. RH does *NOT* need to be a direct path to diabetes – but if you can’t control your diet (95% of that specialist’s patients quit the diet in less than a year), and don’t get enough exercise, the resulting weight gain and insulin yo-yoing for years will almost certainly result in Type-2 diabetes.
If you can stay the course (being extremely stubborn as I am does have its advantages
and keeping up a reasonable level of exercise (walking a few hours per week is all that is really needed – I now cycle about 4-5 hours per week and feel even better – and I’ve contract rheumatoid arthritis to go with my sugar issues!) truly makes a world of difference. Sitting on the couch, eating that litre of Oreo Cookie ice cream (yes, I remember the carbo-munchies!) will lead you to diabetes just as fast as the non-RH crowd.
If you are just discovering your RH – please understand that it takes time for the carbo-cravings to subside. The first couple of months were the worst, and overindulging a little on the “fat side” helped – just don’t do it forever. It took me a good 12-18 months for the cravings to fully subside, but eating a diet containing a balance of protein (I am not vegetarian), fat, and (after a couple of months) very complex carbohydrates worked for me. Vegetables (not grain-veggies like corn!) are you friend!
I couldn’t eat any potatoes at all for about five years, and still consider them a ‘condiment’ rather than a staple. I do better with rice, but even after 20 years I only consume a few tablespoonfuls with my meal.
I have not found a reason to avoid meat, but do best when I also include a sizable amount of vegetables.
Richard,
I’m glad you found out what works for you. Thanks for sharing (but for many health related reasons..I would still drop the meat!).
Stephanie
i find that there doctors here in australia do not use hypoglycemic evidence to diagnose pre-diabetes. indeed there is little interest in pre-diabetes, as the article suggests the focus is pathology not the warning signs.