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Have a postprandial hypoglycemic reaction to foods with carbs. Gaining weight excessively. Take actos or victoza?

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Endocrinologist
Practicing since : 2001
Answered : 1595 Questions
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Hello Doctor,
I am female and 43.
I have a lot of questions and explanations that I need answered please:
Collected 9/9/11 9:05am
Fasting glucose serum is 75
Bun 17
Creatinine serum 0.71
BUN/Creatinine is 24
Cholesterol, Total 247
Triglycerides 62
LDL Cholesterol Calc 163
Cortisol 10.6 - observation at 8:38 am fasting on 9/10/11
T4, free (direct) 1.26
TSH 1.930
ACTH, plasma 6.9 pg/ml
c-peptide, serum 1.7 ng/ml
insulin 4.5 uIU/mL at 11:49am on 11:49am 9/10/11
Separate testing of 2 hour glucose tolerance test several years back:
fasting 73
glucose, 1 hour 188 mg/dL
glucose, 2 hour 181 mg/dL
I have a postprandial hypoglycemic reaction to all foods that have carbs in them and am gaining so much weight. After trying actos plus metformin I still get sick and react. I get irritable and explosive when I eat carbs and shaky, tired and non functional. The carbs cause major mood swings. even if they are unrefinded and whole grains.

I have been gaining more and more weight, always lethargic and am always hungry and still get those bad hypoglycemic reactions when my glucose reads normal 68-78 range. I am able to tolerate carbs even whole grains and natural ones that are unprocessed or low gylcemic without the post prandial reactive hypo symptoms and everyone says they are necessary for energy and brain function.
Recently I have tried Victoza and that totally reduced my appetite but I was still getting hypo systems with carbs and my mood was going depressive as well so I stopped after 5 days. Before when I had taken Actos I had the mood go depressive also.

Here is what has been suggested to me and I want some further clarification from you please. I have been eating a very high fat diet and eating low carbs as well in order to stabilize mood which it does but I am still always hungry and gaining more weight. I can avoid the reactive hypo symptoms this way also.

I have been told that my insatiable appetite, weight gain and reactive hypo are attributed to high insulin in my system.
The high levels of fats that I am eating are interfering with my insulin working effectively. The fats actually block proper insulin function.
The explanation for my normal glucose readings compared to how I am ready to pass out and get rageful and shaky are due also to high insulin levels and called Neuroglycopenia.
For the first time I now have a name and explanation as to why my head feels sick and my sugars from my finger read normal. Other doctors have told me I am making this hypo feeling in my head but in fact it was true but called Neuroglycopenia.

Would you further explain the Neuroglycopenia to me and how insulin levels are connected to it and the causes?

As of today I have been told to take Actos for one week at night with meal and eat low carb and low fat and then a week later eat switch to a regular carb included diet (whole foods and grains) but again very low fat and inject the Victoza right before lunch time and take the Actos at night to get a grip on this never ending problem I have battled with.
What could have caused my insulin to be so messed up in the first place since I have no family history?

Do you like the sounds of my treatment plan?
What does Victoza do exactly?
How is the Actos different?
How long does it take for Actos to effectively kick in?
Do you think I can ever get balanced out to be healthy and lose this excess weight with the direction I am going in?
Is that really true about fats being harmful and contributing to the insulin problems?
How common is the Neuroglycopenia in people?
Is Actos the only or best insulin controlling medication for insulin resistance?
There does not seem to be much information available on the Neuroglycopenia.
I look forward to hearing from you.
Regards, XXXXXXX
Posted Wed, 18 Apr 2012 in Diabetes
 
 
Answered by Dr. Shehzad Topiwala 21 hours later
Hi,

Thanks for your query.

Please find the answers below.

1 Neither actos nor victoza nor metformin have been approved for the treatment for 'Reactive hypoglycemia'

2 Actos reduces insulin resistance but has a host of potential adverse effects. This weblink has more details in a well summarized manner WWW.WWWW.WW
3 Victoza is an incretin mimetic agent which essentially means that reducing appetite is one of the ways it reduces weight and blood glucose. WWW.WWWW.WW
4 Ask your endocrinologist to consider doing a screening test for a rare condition called Cushings syndrome WWW.WWWW.WW
5 Actos takes several weeks to kick in

6 Neuroglycopenia refers to the neurological type of symptoms and signs that occur when the blood glucose drops below normal ie 60 mg/dl. Some examples include giddy, light headed, imbalance, altered mentation, confusion, passing out and convulsions.

7 Fats do worsen insulin resistance

8 the best way to reduce insulin resistance is exercising and losing weight in conjunction with dietary discretion

Hope I have answered your query. Please accept my answer in case you do not have further queries.
Above answer was peer-reviewed by
 
Follow-up: Have a postprandial hypoglycemic reaction to foods with carbs. Gaining weight excessively. Take actos or victoza? 19 hours later
Dear Doctor,

I requested having you help me with Healthcare Magic because you looked kind and I liked your credentials. I understand you are a busy person, a terrific doctor and are trying to help me. I need more attention and detail than I received from you. For me to come to this website is an act of desperation after spending 10 years with many doctors trying to get to the bottom of my problem and weight gain and getting nowhere. Would you help me and give me as much information and care as possible? Please also help me from your experience rather that just pass off my questions by telling me go check with your local doctor like other doctors have done in the past. If I was satisfyed with that I would not have come to you as a last resort. I really hope you understand my determination to get well. :-)) I really appreciate having the opportunity to work with you here.

What could be the cause of my developing this insulin resistance with the Neuroglycopenia going on?

I do exercise and have not been able to lose weight due to constant high appetite.

Whenever I eat carbs I get the Neuroglycopenia reaction. How can I stop that from happening?

The only way I avoid get the Neuroglycopenia reaction is to eat extremely low carb but all doctors say thes is bad and the brain needs energy from carbs. What are your thoughts?

How can I prevent the Neuroglycopenia from hapening and still eat carbs? I do go for unprocessed whole grains but still get sick and bad reactions.

My exercise program alone has not repaired my insulin resistance and I have not been able to lose weight due to constant fatique as well so how can I get to the bottom of this problem?

I see the risks of Actos and wonder if much of that has to do with propaganda do you?

I was put on Actos as a last measure to control my insulin problems. Is there anything else that could assist me enought to prevent the fatique, hunger and weight can that my high levels of insulin are causing me?

Would I be subjected to bad side effects if I just stay on the Actos for 3-6 months to get some relief?

What are your thoughts about Victoza? do you like that medicine and how can it help me besides curbing my appetite? Is it ok to use with Actos?

Why in your opinion do doctors recommend eating whole grain carbs and natural carbs which still cause a glucose spike and affect insulin levels rather than avoid the items that fluctuate glucose and insulin in the first place?

Would you explain what you know about how fat interferes with insulin levels? Why is the fat a problem?

I had been eating a low carb and high fat diet like Dr. XXXXXXX and never lost weight and now wonder how much the fat contributed to my failure.

Is peanut butter a no no for insulin resistance patients?

Is it true that we are given a certain amount of beta cells in a lifetime and some people could have overindulged on too many carbs earlier in there life and used up a large supply of the beta cells XXXXXXX on now developed insulin resistance and should not mess with their remaining supply and resitrict the use of carbs?

Is constant fatique a result of insulin resistance?

What is the difference between insulin resistance and impaired glucose?

Do testosterone supplements increase appetite in females?

What people usually get Neuroglycopenia related to insulin? Why do I have that and my glucose from my finger reads normal? I need a way to learn to prevent this from happening but do not know how.

I always get so so tired after I eat a meal with even the smallest portion of whole grains or carbs.

How do preservatives in processed foods interfere with insulin?

Is it true that having some sugarfree jello before a meal can coat the stomach soothe the pancreas from being overstimulated once foods are introduced?

How does doing 15 minutes of exercise assist in getting the food to move into the muscles and not be stored as fat? Would you explan that and it is true? How long should I exercise immediately after I eat?

Does metformin cause pancreatic cancer? How is it different from Actos? I did not lose any weight with Metformin. I wonder why.

Have you ever treated any patients who are similar to me with the symptoms and bad carb reactions and weight gain all together at once?

If I came to your office what would you do with me to help bring some relief?

 
 
Answered by Dr. Shehzad Topiwala 1 hour later
Hi,

Thanks for writing back.

Please find my answers below.

Q: What could be the cause of my developing this insulin resistance with the Neuroglycopenia going on?
One must pursue other non-endocrine causes of your symptoms; a detailed examination will help to come to a considerable conclusion about the diagnosis.

Q: Whenever I eat carbs I get the Neuroglycopenia reaction. How can I stop that from happening?

Diet modification, being selective in types of carbohydrates which may not trigger such a reaction is the solution. A dietician can help you here well.

Q: The only way I avoid get the Neuroglycopenia reaction is to eat extremely low carb but all doctors say this is bad and the brain needs energy from carbs. What are your thoughts?

Yes, you are right. Brain does need carbohydrates. Proteins and fats consumed are also converted to glucose in glucose deficient states. Hence it’s not a strict rule that low carb diet will affect brain energy supply.

Q: How can I prevent the Neuroglycopenia from happening and still eat carbs? I do go for unprocessed whole grains but still get sick and bad reactions

As I said above, by modifying diet, consuming selective types of carbs but in low amounts.

Q: My exercise program alone has not repaired my insulin resistance and I have not been able to lose weight due to constant fatigue as well so how can I get to the bottom of this problem?

Exercise is best; it does take time to show good results without causing fatigue.

Q: I see the risks of Actos and wonder if much of that has to do with propaganda do you?

Actos (pioglitazone) modulates the transcription of the insulin-sensitive genes involved in the control of glucose and lipid metabolism in the muscle, adipose tissue, and the liver. As a result, pioglitazone reduces insulin resistance in the liver and peripheral tissues. It helps.

Q: I was put on Actos as a last measure to control my insulin problems. Is there anything else that could assist me enough to prevent the fatigue, hunger and weight can that my high levels of insulin are causing me?

I have treated many patients like you and most do exceedingly well by seeing a dietitian who guides them on the nutritional aspect. Also, in combination with medications.


Q: Why in your opinion do doctors recommend eating whole grain carbs and natural carbs which still cause a glucose spike and affect insulin levels rather than avoid the items that fluctuate glucose and insulin in the first place?

Carbs are first line energy sources, they do prevent fatigue. Hence cutting on them completely is not a good option.

Q: Would you explain what you know about how fat interferes with insulin levels? Why is the fat a problem?

Metformin does not cause pancreatic cancer. It is different from Actos in its mechanism of action. No one knows exactly how it works but it causes some anorexia and also suppresses the liver's production of glucose

It can cause upto 2% weight loss.

I have treated many patients like you and most do exceedingly well by seeing a dietitian who guides them on the nutritional aspect.

Exercise is recommended for about 60-90 minutes daily in order to lose weight, under your doctor’s supervision. It should be mostly aerobic and cardio type that increases heart rate

The jello comment is untrue.

If your finger stick glucose is normal it is most unlikely you have truly low blood glucose. The symptoms are not from neuroglycopenia in that case.

You must pursue other non-endocrine causes of your symptoms.

Testosterone is not recommended to be taken by women.

You can direct your questions on diet related matters to a Registered Dietitian on the same website.

Hope I was of help.

Regards,
Above answer was peer-reviewed by
 
Follow-up: Have a postprandial hypoglycemic reaction to foods with carbs. Gaining weight excessively. Take actos or victoza? 21 hours later
Thank you for your response.

Please aswer thes following questions for final clarification so I do not have to write back again. Some were left unanswered on the last part.

What made you want me to look into Cushings Disease?

Did you see anything stand out in my blood work that I shared with you?

Would you explain what you know about how fat interferes with insulin levels? Why is the fat a problem?

Is it possible that people are giving Actos a bad name with awful side effects. I see the risks of Actos and wonder if much of that has to do with propaganda do you think that is possible?

How does doing 15 minutes of exercise assist in getting the food to move into the muscles and not be stored as fat? Would you explan that and it is true? How long should I exercise immediately after I eat?

How do preservatives in processed foods interfere with insulin?

What is the difference between insulin resistance and impaired glucose?

Is it true that we are given a certain amount of beta cells in a lifetime and some people could have overindulged on too many carbs earlier in there life and used up a large supply of the beta cells XXXXXXX on now developed insulin resistance and should not mess with their remaining supply and resitrict the use of carbs?

Is constant fatique a result of insulin resistance?

Do you like and use Victoza for your patients? What are your thoughts about Victoza? do you like that medicine and how can it help me besides curbing my appetite? Is it ok to use with Actos?

Would I be subjected to bad side effects if I just stay on the Actos for 3-6 months to get some relief?

Thank you :-)
 
 
Answered by Dr. Shehzad Topiwala 3 hours later
Hi,

Please see my responses below:

What made you want me to look into Cushings Disease?
Cushing's disease can also cause insulin resistance and weight gain. That is why I recommended that this condition be ruled out

Did you see anything stand out in my blood work that I shared with you?
Your GTT (Glucose Tolerance Test) you underwent several years ago showed IGT (Impaired Glucose Tolerance). It is compatible with Pre-Diabetes WWW.WWWW.WW Your LDL cholesterol also is elevated. Discuss it with your primary care provider

Would you explain what you know about how fat interferes with insulin levels? Why is the fat a problem?
The fat releases harmful fatty acids that circulate in the bloodstream and eventually reach the cells where they block the effect of insulin. This is how they effectuate 'Insulin resistance'

Is it possible that people are giving Actos a bad name with awful side effects. I see the risks of Actos and wonder if much of that has to do with propaganda do you think that is possible?
Actos reduces insulin resistance and blood glucose but does not have a favorable side effect profile. So in general I avoid using it

How does doing 15 minutes of exercise assist in getting the food to move into the muscles and not be stored as fat? Would you explan that and it is true? How long should I exercise immediately after I eat?
This is not exactly correct. Simply put, any form of exercise has the potential to lower insulin resistance, regardless of its time-relationship to a given meal

How do preservatives in processed foods interfere with insulin?
I am not aware of any scientific literature proving this

What is the difference between insulin resistance and impaired glucose?
See earlier answer. Typically, insulin resistance causes impaired glucose tolerance

Is it true that we are given a certain amount of beta cells in a lifetime and some people could have overindulged on too many carbs earlier in there life and used up a large supply of the beta cells XXXXXXX on now developed insulin resistance and should not mess with their remaining supply and resitrict the use of carbs?
To the best of my knowledge, no such evidence is available

Is constant fatique a result of insulin resistance?
This has not been reported either. But those with insulin resistance and diabetes can experience fatigue especially if the diabetes is poorly controlled

Do you like and use Victoza for your patients? What are your thoughts about Victoza? do you like that medicine and how can it help me besides curbing my appetite? Is it ok to use with Actos?
Victoza is relatively new. In rodents given victoza during clinical trials, they found MTC (Medullary Thyroid Cancer). There is no proof that Victoza causes this in humans. I dont use Actos at all.

Would I be subjected to bad side effects if I just stay on the Actos for 3-6 months to get some relief?
I am not comfortable recommending Actos.

Hope I answered you completely.

Regards,
Above answer was peer-reviewed by
 
Follow-up: Have a postprandial hypoglycemic reaction to foods with carbs. Gaining weight excessively. Take actos or victoza? 41 hours later
I got screened for Cushings disease and the doctor said I am normal and do not have that problem.

How is it that my glucose strips read normal when my insulin feels sky high? it is strange becuase whenever I eat carbs I wake up in the middle of the night with a pool of sweat on my chease just if I eat the carbs only.

If I just ate protein and fat could my body at least create enough glucose from the protein?

Is there any other endocrinological reason why I can not eat carbs without having too much insulin released in my system? And how to resolve it alongside my exercising as much as you suggest?

I wonder why my internest suggests having added testosterone and DHEA supplements. Recently thay also put my on synthroid to help with what they thought were below optimal ranged for those 3 things. Please give your best opinion on them saying I have below optimal range for thyroid, dhea and testosterone. They said ignore the fact that my bloodwork shows in range because that means nothing other than I am alive and included as a normal range without really being so.
 
 
Answered by Dr. Shehzad Topiwala 2 hours later
Hello XXXXXXX

Thank you for writing back.

1. I got screened for Cushings disease and the doctor said I am normal and do not have that problem.

I appreciate your efforts and it is good to know that Cushing's disease has been ruled out.

2. How is it that my glucose strips read normal when my insulin feels sky high? it is strange becuase whenever I eat carbs I wake up in the middle of the night with a pool of sweat on my chease just if I eat the carbs only.

Please see a dietitian to learn how to combat this

3. If I just ate protein and fat could my body at least create enough glucose from the protein?

A dietitian will guide you in detail in this regard

4. Is there any other endocrinological reason why I can not eat carbs without having too much insulin released in my system? And how to resolve it alongside my exercising as much as you suggest?

A medication like acarbose is known to help ameliorate 'reactive hypoglycemia'. Please see an endocrinologist in person to see if this medication is suitable for you

5. I wonder why my internest suggests having added testosterone and DHEA supplements. Recently thay also put my on synthroid to help with what they thought were below optimal ranged for those 3 things. Please give your best opinion on them saying I have below optimal range for thyroid, dhea and testosterone. They said ignore the fact that my bloodwork shows in range because that means nothing other than I am alive and included as a normal range without really being so.


There is no scientific guideline to recommend androgen (testosterone, DHEA) use by women. If the thyroid is working fine, taking thyroid medication is not necessary at all.

Hope I have answered all your questions. Please do not forget to accept my answer if you have no further queries.

Wishing you good health.

Best regards.
Above answer was peer-reviewed by
 
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