Blood sugar drop on Reta?

[Hichewgoddess]

I’ve just started Reta 1mg per week and currently on week 4. After about 24 hours I get a blood sugar drop. I get dizzy, nauseous, and feel feint. At least I’m assuming that’s what it is as it seems to be fixed by water and a small piece of candy/sugary food. I am eating carbs, drinking my water, and drinking my electrolytes (1 packet of liquid IV per day), and still feel like I have to really be careful. Is this hypoglycemia? Low blood pressure due to not enough water/electrolytes?

 

[woundcarping]

Do you have any preexisting glucose issues?

I don’t, but I’ve seen reta can be tougher on blood sugar in the lower direction. Carbs in general help with mine.

 

[Hichewgoddess]

Do you have any preexisting glucose issues?

I don’t, but I’ve seen reta can be tougher on blood sugar in the lower direction. Carbs in general help with mine.

I just had some insulin resistance going in, so I’m used to eating only 60-100 carbs a day. Maybe I’m too low?

 

[krsct]

I’ve just started Reta 1mg per week and currently on week 4. After about 24 hours I get a blood sugar drop. I get dizzy, nauseous, and feel feint. At least I’m assuming that’s what it is as it seems to be fixed by water and a small piece of candy/sugary food. I am eating carbs, drinking my water, and drinking my electrolytes (1 packet of liquid IV per day), and still feel like I have to really be careful. Is this hypoglycemia? Low blood pressure due to not enough water/electrolytes?

In general, GLP-1's do not cause low blood sugar, even thought they do reduce blood sugar in those who are diabetic. However, there may be exceptions.

 

[woundcarping]

I just had some insulin resistance going in, so I’m used to eating only 60-100 carbs a day. Maybe I’m too low?

I can speak to gross generalizations, but for me, timing matters a bit. Exertion can depress glucose levels, I don’t worry about carb loading before exercise, but I do evaluate how I feel before I start.

The last two weeks I’ve averaged 130g per day. There’s only been once I had the starting symptoms of low blood sugar that eating some carbs fixed.

Anecdotally, people talk about carbs being important on Reta, which I tend to agree based on my own observations.

I’ve thought about getting a CGM to track my levels in combination with my observations, but haven’t done so yet.

 

[Jfrick11]

I’ve just started Reta 1mg per week and currently on week 4. After about 24 hours I get a blood sugar drop. I get dizzy, nauseous, and feel feint. At least I’m assuming that’s what it is as it seems to be fixed by water and a small piece of candy/sugary food. I am eating carbs, drinking my water, and drinking my electrolytes (1 packet of liquid IV per day), and still feel like I have to really be careful. Is this hypoglycemia? Low blood pressure due to not enough water/electrolytes?

It could be either (or both). The fact that it resolves with candy/sugar makes hypoglycemia likely, which can happen with Reta especially early on. Low blood pressure and dehydration can feel very similar too. You might try checking your blood sugar during an episode if possible. More frequent meals with protein + complex carbs, extra fluids/sodium, and slowing titration can help. If it keeps happening, definitely worth talking to a provider.

 

[woundcarping]

That’s a good point, if I had reoccurring issues I’d be much more likely to get a GCM. Only once in the 3 weeks I’ve been bridging to Reta did I notice a light starting symptom which was easily addressed and I moved on with my day.

 

[tubby]

I’ve just started Reta 1mg per week and currently on week 4. After about 24 hours I get a blood sugar drop. I get dizzy, nauseous, and feel feint. At least I’m assuming that’s what it is as it seems to be fixed by water and a small piece of candy/sugary food. I am eating carbs, drinking my water, and drinking my electrolytes (1 packet of liquid IV per day), and still feel like I have to really be careful. Is this hypoglycemia? Low blood pressure due to not enough water/electrolytes?

The feelings you described are a very common initial side effects with retatrutide that often pass over time.

In addition, GLPs (including retatrutide) are also highly effective at normalizing blood sugar levels in diabetics. For some diabetics this effect is very rapid and starts to happen in the first few days.

It wouldn't be my first guess, but it's certainly possible that you are experiencing symptoms of hypoglycemia, especially if you historically have a problem with that. Regardless of cause, I'd avoid putting myself in situations where rapid reflexes (e.g. driving) are important during periods when I experienced those symptoms. If you want to use this as an excuse to eat candy, nobody is going to judge you for doing that either, although that's generally going to be counterproductive unless you inject insulin or are on certain drugs that force your pancreas to produce more insulin than it otherwise would (not GLPs).

 

[lessthanhalf]

According to the companies that sell glp's and chatgpt 5 in scholar/academic mode , none of the GLP medications cause hypoglycaemia in non diabetics.( and then it is caused by an interaction with other glucose lowering medications )

Non medical diagnoses of hypoglycaemia with symptoms like that are very common and when blood sugar is tested in people complaining of those symptoms true hypoglycaemia is very rare.

You would think that reta especially initially, having glucagon agonism would be the least likely to cause it.

True hypoglycaemia is a fairly serious problem, it can cause loss of consciousness and is not great for brain cells. In people who feel tired, shaky and dizzy after not eating for a while, which is very common, calling these symptoms hypoglycaemia, when usually it is not when measured, is really only a problem as it confuses a problem that is quite serious medically with one that is fairly harmless. For example if these episodes were true hypoglycaemia then you should not be driving if there is any risk of one occurring.

All GLP medications lower blood pressure directly, and in many reduce fluid intake by direct action on brain thirst centers. Plus the loss of fluid and electrolytes from initial weight loss, all make postural hypotension more likely, which is the more likely cause of the symptoms. If it goes away sitting or lying down , that would confirm it . Doing what you are doing - having a drink and something to eat is fine as a way to deal with it . But I would suggest paying more attention to fluid and salt/electrolyte intake as important to prevent it from continuing to happen.

 

[meeklady]

I have had problems with low blood sugar on Reta. My PCP did a non fasting blood test and my blood sugar was in the 60's. She told me to keep high sugar snacks on me and eat some when I get symptoms.

In my case I don't think it's primarily the Reta just that I don't eat enough, regularly, on it. Make sure you are eating something on a regular basis.

 

[Gohengrin]

Can't get over 75 blood sugar with reta and always have some dextro energy on hand, because I almost fainted because of very low blood sugar. Before reta I was almost always above 100 or 110. Also i upped my carbs.

 

[Purplepansy 26202]

I’ve just started Reta 1mg per week and currently on week 4. After about 24 hours I get a blood sugar drop. I get dizzy, nauseous, and feel feint. At least I’m assuming that’s what it is as it seems to be fixed by water and a small piece of candy/sugary food. I am eating carbs, drinking my water, and drinking my electrolytes (1 packet of liquid IV per day), and still feel like I have to really be careful. Is this hypoglycemia? Low blood pressure due to not enough water/electrolytes?

Check your blood pressure. Especially if you are currently on medication. I had to lower my dose because I was dropping to low.

 

[CNCCurrency]

Check your blood pressure. Especially if you are currently on medication. I had to lower my dose because I was dropping to low.

Was it due to the glp1 or a result of losing weight?

 

[Hambocommando]

The feelings you described are a very common initial side effects with retatrutide that often pass over time.

In addition, GLPs (including retatrutide) are also highly effective at normalizing blood sugar levels in diabetics. For some diabetics this effect is very rapid and starts to happen in the first few days.

It wouldn't be my first guess, but it's certainly possible that you are experiencing symptoms of hypoglycemia, especially if you historically have a problem with that. Regardless of cause, I'd avoid putting myself in situations where rapid reflexes (e.g. driving) are important during periods when I experienced those symptoms. If you want to use this as an excuse to eat candy, nobody is going to judge you for doing that either, although that's generally going to be counterproductive unless you inject insulin or are on certain drugs that force your pancreas to produce more insulin than it otherwise would (not GLPs).

Or, go for some candied ginger for both the sugar boost and the possible help with any nausea.

 

[Purplepansy 26202]

Was it due to the glp1 or a result of losing weight?

I am guessing the two episodes I experienced were a combination of weight loss, being on vacation (no work stress) and dose of Reta was too high and I wasn't able to eat much. I saw the doctor a couple of weeks prior and he told me I still needed the blood pressure medicine even with the weight loss. My first thought went to blood sugar was low when I got dizzy and had to sit down. Blood sugar was normal so I checked my blood pressure and it was low for me 85/69. I am still on medication but at a lower dose.

 

[lessthanhalf]

In response to Purplepansy.

I realise you said your doctor asked you to continue blood pressure medications at a lower dose, but I would be surprised if he said that after seeing a bp reading of 85/69. Even fairly aggressive bp lowering is only aiming for 120/80, and there is no known benefit from dropping it further and there are definite downsides to dropping it too much, the most obvious one being falling over from postural hypotension. I am not saying this is happening to you but it is possible to cause kidney damage by dropping bp too much and dropping kidney blood flow too much.

I would suggest do a fair few different blood pressure readings over a few days to get a good average say 10-20. If you have symptoms on standing like dizzyness or things going grey or black for a few seconds then you definitely have postural hypotension. If not you can just measure it sitting then standing and see what the difference is. And write them all down for your Dr.

Without knowing all your medical history I am not going to say you should stop the medication, but I think given that reading , checking it a few times and checking in again with your Dr might be a good idea, especially if you have any symptoms on standing.

 

[BNLFL]

I just had my yearly appointment last Wednesday regarding my blood tests. I had been on 2mg Reta for a month, and had just started 4mg the previous Friday. BP was 128/70, HR 76 and all my tests were spot on. I was actually shocked. I take Metoprolol 50mg and Lisinopril 10mg twice daily.

 

[GLP1Pharmacist]

My RS subject has struggled with low blood sugar and keep some kind of sugary product around at all times. The automatic trigger for big drops is alcohol intake , 2 drinks somewhat and 3 definitely cause big, scary drops. Good news is little to no real desire but even three drinks spread out over hours causes major issues. Liver focuses on alcohol metabolism wrecking blood sugar.

 

[Purplepansy 26202]

In response to Purplepansy.

I realise you said your doctor asked you to continue blood pressure medications at a lower dose, but I would be surprised if he said that after seeing a bp reading of 85/69. Even fairly aggressive bp lowering is only aiming for 120/80, and there is no known benefit from dropping it further and there are definite downsides to dropping it too much, the most obvious one being falling over from postural hypotension. I am not saying this is happening to you but it is possible to cause kidney damage by dropping bp too much and dropping kidney blood flow too much.

I would suggest do a fair few different blood pressure readings over a few days to get a good average say 10-20. If you have symptoms on standing like dizzyness or things going grey or black for a few seconds then you definitely have postural hypotension. If not you can just measure it sitting then standing and see what the difference is. And write them all down for your Dr.

Without knowing all your medical history I am not going to say you should stop the medication, but I think given that reading , checking it a few times and checking in again with your Dr might be a good idea, especially if you have any symptoms on standing.

My blood pressure did not stay this low. I continued to monitor several times during the day. before taking any medication. I was upright and moving both times my blood pressure dropped and I got dizzy. This happened in September while traveling. I do continue to monitor and take my medication as directed by my doctor. My job can be stressful and I have found both my blood pressure and blood sugar will rise. I wore a CGM for awhile to see what my blood sugar was doing. I was on vacation the first week I had it on and my numbers were low but when I went back to work they climbed. I didn't realize that stress can also raise your levels. I am not diabetic and was just looking for more information on how I reacted to different foods. I have been trying to lose weight for many years after surgical menopause in my 30's along with Hashimotos. I have followed a gluten free low carb diet for many years. Reta has finally gotten me close to my goal weight,

 

[Lear00]

I am not a diabetic, but through work I have an almost unlimited supply of continuous glucose monitors (CGMs) and have them previously to track my BGLs whilst not on retatrutide. I typically hovered between 6-8mmol (108-144 mg/dl).

Have been uptitrating Reta for a few weeks and now stable at a dose of 4mg for the past 3.

Decided to chuck on a CGM again this week with the below findings.

- I had a significant low episode of about 3mmol/L ~12 hours after my weekly dose of retatrutide. Non-symptomatic.

- I typically now hover around 4mmol/L, but I am also spending a lot of time between 3.2-3.7. This is especially consistent during work hours where I may not actually get time to eat for 8-10 hours.

- I’m yet to be symptomatic from a low, but during these lower levels I do feel at the very least a tad bit fatigued and spaced out + hungry

Some of my personal take aways from this

- Reta is VERY GOOD for my glycemic control, that’s a 2mmol drop on average compared to prior

- That said, I think the risk of hypoglycaemia on a GLP1 is not talked about enough

- There is likely a subset of the population like me which already have a ‘borderline’ BGL on no medication, who would be at risk of hypoglycaemia whilst on a GLP1 and not know about it. It’s important to remember the population selected in all the trial so far are pre-disposed to insulin resistance (I.e BMI >31). On the other hand anyone can use it on the grey market and that population isn’t reflected well in trials.

- I certainly don’t think I feel safe uptitrating any higher than 4mg given the risk of a proper symptomatic hypoglycaemic event. As an example, in my state T1 diabetics are legally required to check their BGL before driving and aren’t allowed to drive unless it’s >5mmol/L.

- It’s important to have at least small meals throughout the day whilst on this medication, i’m not sure prolonged intermittent fasting is very safe on this medication.

- I do wonder if some of the side effects people experience from retatrutide can be explained exclusively by persistent hypoglycaemia

Photo attached below of my trend whilst working yesterday on a busy shift with no snacking time!