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by bakedoatmeal 835 days ago
What is the connection between being at risk of diabetes and hypoglycemia? Wouldn’t a pre-diabetic be very protected from hypoglycemia?
3 comments

There is something called reactive hypoglycemia.

https://en.wikipedia.org/wiki/Reactive_hypoglycemia

It can occur for various reasons. Personally, I was developing adult onset type 1 (LADA) for a couple of years before I was diagnosed and I had all sorts of effects. While it was of course mainly effects of chronic hyperglycemia and shortage of insulin, I also had some episodes of hypoglycemia. Now that I’m on insulin, I’m very familiar with hypoglycemia resulting from an imbalance of exogenous insulin and carbohydrates. However, I looked back and realized this happened to me a few times before I was on insulin. I recall waking up a few times at night, sweating and shaking, and having a strong urge to consume food. I’d drink some juice or eat chips, feel better in 20-30 minutes and go back to sleep. This occurred after drinking alcohol, which makes sense as alcohol intensifies the effect of insulin and also prevents your body from releasing chemicals which raise your blood glucose level. I didn’t think much about it at the time but now I can see it was related to T1 onset.

My understanding is that essentially the body’s systems which regulate blood glucose are disrupted. This happens a with type 1 in general - not only problems with the system that produces and releases insulin to lower blood glucose by allowing it into cells, but also the part that does the opposite and release glucose to raise blood glucose levels. Sometimes the glucose-raising system doesn’t work at all while other times it’s inappropriately in overdrive. The same is true for the insulin releasing/glucose lowering system as it fails.

Wondered this too. Diabetics are at risk for hypoglycemia because of the insulin they take, not the diabetes itself. Maybe metformin for a prediabetic could have this effect?
Nah, even as a full blown diabetic metformin doesn’t drive you low. It basically just makes the same amount of (naturally produced) insulin do more, essentially.
even as a full blown type 2 diabetic*
No, diabetes is fundamentally a lack of ability to control your blood sugar. This means you get lots of highs but also lots of lows. It's a common misconception that diabetes just means your blood sugar is always high; rather, your sugar is high because your body no longer controls it actively.
I'm pretty certain you're mistaken here. Diabetes is specifically characterized by elevated blood glucose, either due to pancreas not producing enough insulin or your body becoming descensitized to insulin.

You will find that diabetics often do have low blood sugar, but that's because they overestimate how much insulin they need to inect, causing their blood sugar to go too low. The hypoglycemia in this scenario is not caused by diabetes, but rather a dangerous side effect of the treatment.

OP doesn't have diabetes, and (unless he's abusing insulin for body building purposes) isn't taking insulin. His postprandial hypoglycemia is likely a benign case of "reactive hypoglycemia" (https://www.mayoclinic.org/diseases-conditions/diabetes/expe...).

Diabetes mellitus is an insulin problem- either a lack of insulin (Type 1) or insufficient response to insulin (Type 2). Insulin is responsible for lowering blood glucose. The hormones responsible for raising blood glucose (cortisol, IGF-1, glucagon, epinephrine) still function normally.

My understanding was hypoglycemia only occurs in diabetes in the presence of medications used to lower blood glucose (insulin formulations, sulfonylureas, etc.) and not because of diabetes itself, which when untreated invariably leads to hyperglycemia.

It’s not either or, either. Some really unlucky folks end up with a hybrid and have both problems… they don’t produce enough insulin or react well to what they do.
You don't get lows from diabetes
Are you being pedantic on purpose?