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Dr. Saleem
Dr. Saleem, Board Certified Physician
Category: Endocrinology
Satisfied Customers: 17039
Experience:  Two years experience of internal medicine also adept in the diagnosis and treatment of endocrinology related disorders.
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I am getting repeated episodes of hypogycaemia and need

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I am getting repeated episodes of hypogycaemia and need help.
JA: Any recent weight loss/gain? Are you excessively thirsty?
Customer: I did lose weight by going gym after a diagnosis of T2 diabietes to try to reverse it but no excessive thirst.
JA: Thank you so much for your time. Finally, is there anything else in your medical history you think the Doctor should know?
Customer: Just recent diagnosis of type 2 diabetes but need a check of HBA1C to see what's happened since losing about 10kg.

Hi! I am Dr Saleem. Welcome to JustAnswer.
Thank you for the question. I will be answering your query shortly.

I understand your concern.

Do you get any symptoms during hypoglycemic attacks?

What's the lowest reading of blood sugar you've had so far?

Are you taking any medication for diabetes?

Customer: replied 13 days ago.
Headaches, weakness, levels of less than 1-3 mmol/L on glucometer frequently. Stopped medications for diabetes tpe 2 as soon as hypos started. So no meds now. Just trying to control hypos with sugar and starchy foods as emergency.
Customer: replied 13 days ago.
Alos getting nocturnal hypos

Did the hypo spells settle down after stopping medication?
Can you please share the name of medication you were prescribed?

Customer: replied 13 days ago.
No. Was on metformin and empagliflozin.
Customer: replied 13 days ago.
Stopped both once strated getting hypos but the hypos have not stopped.
Customer: replied 13 days ago.
Can you tell me what I need to get investigated?

Got it. I'm typing your answer now.

Customer: replied 13 days ago.
Also what are the potential causes of hypos?

So, hypo spells may occur once patients with type 2 diabetes lose a significant amount of weight. The effect of insulin on tissues is enhanced in the presence of anti diabetic drugs leading to low sugars. That effect however is more common with drugs like sufonylureas and is not commonly seen with Metformin or Empagliflozin. You should ideally be kept under observation for 24-48 hours and if you get an attack of hypo then blood samples may be collected and tested for insulin levels and C peptide to rule out a possibility of insulinoma which is a rare but important cause. Other causes of hypoglycemia include conditions like

- hepatic or kidney failure

- severe infections

- cortisol deficiency/addison disease

- excessive use of alcohol

It would be prudent to schedule an appointment with your doctor and get evaluated for this.

Please let me know if you have other, related queries. I will be happy to answer. Thanks.

Customer: replied 13 days ago.
What should I do in the meantime before I get investigated? What are the best foods to eat?

Simple sugars are good for quick recovery but complex carbs/starches will have a more prolonged effect. Just consume rice, bread etcetera at regular intervals(like every 4-5 hours) and in case you get an attack of hypo then take simple sugars/sweets. Avoid use of alcohol or any other drugs/supplements you might be taking.

Customer: replied 13 days ago.
Ok, thanks. So I need to measure my insulin and peptide C, what about thyroid function?
Customer: replied 13 days ago.
Why may hypo spells occur once patients with type 2 diabetes lose a significant amount of weight?

I don't believe thyroid testing is needed specifically for hypo attacks but doctors may request screening as multiple endocrinological disorders may exist together.

Customer: replied 13 days ago.
What tests are there to check for pancreas function? Is it possible I'm not producing enough glucagon?

Thats because endogenous insulin has more effect on lean tissue than fat and excess fat causes resistance against insulin.

Customer: replied 13 days ago.
I am still potentially producing too much insulin?

Glucagon production may be reduced in type 1 diabetes but that's unlikely to be the cause in your case. You're probably producing more insulin than needed.

Customer: replied 13 days ago.
How can I naturally reduce the amount of insulin I'm producing to the appropriate amount/level?

You can't do that naturally. Evlautaion would be needed to find a cause first.

Customer: replied 13 days ago.
OK, thank you very much and take care!

My pleasure.

Dr. Saleem and other Endocrinology Specialists are ready to help you