Blood sugar drop on Reta?
- Thread starter Hichewgoddess
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I did feel a little dizzy one time and took the opportunity to eat some sugar. I still eat some sugar snacks even though I have cut way back. I usually eat a small meal and a snack for lunch, and a damp meal and a snack for dinner and sometimes two snacks. When I first started I cut way down on sugar so I was easily able to attribute how I felt to needing some sugar at least that is what I figured.Hichewgoddess said:
I usually eat bigger portions of carb before and after my workouts, 3 weeks in and didn't had any drops as for now
I'm drinking 3-4 packets of electrolytes per dayHichewgoddess said:
Be careful. Liquid IV has 500mg of sodium per packet.kobeanbry24 said:I'm drinking 3-4 packets of electrolytes per day
You are so rightBNLFL said:
Lots of FUD here:
"Asymptomatic hypoglycemia" isn't a legitimate concern. This is actually part of the reason why (although I think it would be a great thing) doctors are often opposed to prescribing CGMs for non-diabetics (or even many type 2 diabetics). They know their patients are going to read too deeply into the numbers and start role-playing as if they were type-1 diabetics (e.g. sugar snacks when things go lower and making other bizarre decisions to smooth out the number shown on their phone app). You're also conflating initial common GLP symptoms with hypoglycemia. I experienced those symptoms too initially. I have worn a CGM for years. My blood sugar went down on reta. It regularly hovered in the 50-60 mg/dL range during periods of dose escalation. It's not unusual. Normally I'd have to fast for 4-5 days to get it to hover in that range.
If you're injecting insulin and taking sulfonylureas then you should be tracking your blood sugar and doing things like a sugar snack if you start to see it dip. Otherwise, unless you have something highly unusual going on, you're not going to benefit from role-playing type-1 diabetic behavior.
"Asymptomatic hypoglycemia" isn't a legitimate concern. This is actually part of the reason why (although I think it would be a great thing) doctors are often opposed to prescribing CGMs for non-diabetics (or even many type 2 diabetics). They know their patients are going to read too deeply into the numbers and start role-playing as if they were type-1 diabetics (e.g. sugar snacks when things go lower and making other bizarre decisions to smooth out the number shown on their phone app). You're also conflating initial common GLP symptoms with hypoglycemia. I experienced those symptoms too initially. I have worn a CGM for years. My blood sugar went down on reta. It regularly hovered in the 50-60 mg/dL range during periods of dose escalation. It's not unusual. Normally I'd have to fast for 4-5 days to get it to hover in that range.
If you're injecting insulin and taking sulfonylureas then you should be tracking your blood sugar and doing things like a sugar snack if you start to see it dip. Otherwise, unless you have something highly unusual going on, you're not going to benefit from role-playing type-1 diabetic behavior.
I don’t see anyone in this thread concerned about asymptomatic hypoglycaemia. If I could be asymptomatically hypoglycaemic long term I’d be over the moon given we know there’s a direct correlation between elevated HbA1c and atherosclerotic burden.tubby said:
It is certainly brave to be so confident that someone can’t have hypoglycaemia related symptoms whilst commencing retatrutide and that everything is just explained by ‘normal initial symptoms’. Once again, GLP1 medications were literally designed initially to lower blood glucose levels in T2DM.
You do not have to have T1DM to experience hypoglycaemia symptoms. There is significant variation in what levels people experience hypoglycaemic symptoms - otherwise known as hypoglycaemia awareness.
Glad you felt fine at 50–60 mg/dL, but your personal experience probably shouldn’t be presented as though it’s universally safe or normal for everyone else.
I didn't use the word "can't." My point was that there's a reason why doctors will warn you about hypoglycemia when starting injectable insulin or a sulfonylurea, but they won't warn you about it when starting a GLP. It's because (symptomatic) hypoglycemia isn't a common risk factor associated with GLP use (unless that person is also taking injectable insulin or a sulfonylurea).Lear00 said:
Now every once in a blue moon someone will have something deranged going on with their metabolism where adding a GLP into the mix could lead to symptomatic hypoglycemia, just as every once in a blue moon someone will go blind after starting a GLP. Both are rare conditions and in the case of hypos that person is usually aware that it's a problem for them before starting the GLP because it's historically been a problem.
What you're doing it reading into values on your CGM and even in the absence of feeling light headed, clammy, or losing consciousness you're convincing yourself that you're at risk of something. This is causing you to misapply type-1 diabetic thumb rules in regards to hypoglycemia and think 50-60 mg/dL is a dangerously low blood sugar, despite being a very common level one will achieve on an extended fast and a significant number of normal healthy people will see as a reactive level after a meal without experiencing those symptoms.
Here's what's tripping you up: A type 1 diabetic will sweat a 50-60 mg/dL level, not because that level itself is harmful, but because of the trend that it represents. If their blood sugar is trending downwards AND their body lacks the ability to course correct then by the time they see 50-60 mg/dL on their CGM it's likely their actual blood sugar level is already lower than that. Also, since their body lacks the ability to course correct on its own hormonally, it's important that they initiate action now, since if they wait until it has fallen to a harmful level, it will be too late for them to do so.
So again, everyone is free to wear a CGM and role-play being a type 1 diabetic, but the vast majority of the time it will be unnecessary.
tubby said:
I am a medical doctor, and I certainly don’t have 1/10th of the confidence you seem to have in making such sweeping and definitive statements about a relatively new research use only medication that we are still actively learning about. Internet armchair expertise is risky at the best of times, but particularly so when discussing medications like this.
All the best
Lear00 said:
This is interesting because most doctors I encounter fixate on clinical data from research studies and would be dismissive of anecdotal stories (like your CGM data) as "weak." You seem to take a strong interest in N=1 anecdotal stories, which is unique (and I honestly wish more of your peers did that and think you should be commended for that, but that's a gripe for another time).
Out of curiosity, have you tried to investigate what Lilly's response is to that in their phase 2 and 3 trials for retatrutide and if they've instituted any hypoglycemia mitigation measures (like CGM use)? We have published phase 2 trials and have information shared from participants in phase 3 trials. Presumably if this were at all a common issue it would have been caught in phase 2 trials and if not there, at least in the phase 3 trials.
If you do you'll discover that there is a trial where Lilly pairs retatrutide with CGM use and.... (drumroll).... it's in their 3rd TRANSCEND-T2D trial, which is specifically involving type 2 diabetics that are ON INSULIN.
Now this doesn't prove that there is no hypoglycemia risk (and as stressed in my last reply I'm not saying no risk exists). But it does strongly support the idea that if it exists, it exists as an edge case rather than a common side effect.
Lear00 said:
This is a good website to learn how to critically appraise studies and evaluate them for applicability/generalisability.
https://www.cebm.ox.ac.uk/resources/ebm-tools/making-a-decision
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But I'm not treating patients. I'm offering commentary on pharma products.Lear00 said:
The conceptual error that you're making is you're mistakenly thinking blood sugar is as simple as "lower is bad" once anyone get under 70 mg/dL. Lower is only bad when it leads to SYMPTOMS. And that's why my original critique of your FUD was that you weren't experiencing hypoglycemic SYMPTOMS. It's easy to tell the difference (when wearing a CGM such as you did) since you can gauge whether the symptoms accompany periods where blood sugar dips and go away the rest of the time. In fact, you don't even need a CGM to do that.
If you have consistent fatigue or tiredness, that's not going to be hypoglycemia. That's going to be GLP side effects. If you have variable symptoms that come and go minute to minute, hour to hour, that at least could plausibly be related to hypoglycemia. Until a person starts getting those, it's all a moot point.
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