Could Reta be causing low blood sugar?

[Hichewgoddess]

I'm only on week 4 of Reta, taking 1mg each week. Roughly 24 hours in, my blood sugar seems to fall. I feel dizzy and nauseous, and I get faint. I'm guessing that's the cause, since a bit of candy or something sugary plus water appears to sort it out. I do eat carbs, I keep up with my water, and I take electrolytes too (1 packet of liquid IV daily), yet I still feel like I have to be extremely cautious. Is this hypoglycemia? Or could it be low blood pressure from not getting enough water/electrolytes?

 

[woundcarping]

Do you already have any glucose problems?

I don't have any, but from what I've seen, reta can push blood sugar lower more aggressively. For me, carbs in general help.

 

[Hichewgoddess]

woundcarping said:

Do you already have any glucose problems?

I don't have any, but from what I've seen, reta can push blood sugar lower more aggressively. For me, carbs in general help.

Before starting, I already had some insulin resistance, which is why my usual intake was just 60-100 carbs per day. Could that be why I’m going too low?

 

[krsct]

Hichewgoddess said:

I'm only on week 4 of Reta, taking 1mg each week. Roughly 24 hours in, my blood sugar seems to fall. I feel dizzy and nauseous, and I get faint. I'm guessing that's the cause, since a bit of candy or something sugary plus water appears to sort it out. I do eat carbs, I keep up with my water, and I take electrolytes too (1 packet of liquid IV daily), yet I still feel like I have to be extremely cautious. Is this hypoglycemia? Or could it be low blood pressure from not getting enough water/electrolytes?

For the most part, low blood sugar isn't something GLP-1's bring on, despite the fact that they lower blood sugar in people with diabetes. That said, exceptions can exist.

 

[woundcarping]

Hichewgoddess said:

woundcarping said:

Do you already have any glucose problems?

I don't have any, but from what I've seen, reta can push blood sugar lower more aggressively. For me, carbs in general help.

Before starting, I already had some insulin resistance, which is why my usual intake was just 60-100 carbs per day. Could that be why I’m going too low?

My own experience is that timing plays a role, though I can only really talk about broad patterns.

Physical activity can bring glucose down. I don’t stress about loading up on carbs before I work out, but I do check in with myself before starting.

Over the past 2 weeks, I’ve been taking in about 130g daily. Only 1 time did I notice the early signs of low blood sugar, and some carbs took care of it.

From what I’ve seen, others mention that carbs matter a lot when using Reta, and my own observations line up with that.

I’ve considered picking up a CGM so I could pair actual numbers with what I notice, but I haven’t gone ahead with it yet.

 

[Jfrick11]

Hichewgoddess said:

I'm only on week 4 of Reta, taking 1mg each week. Roughly 24 hours in, my blood sugar seems to fall. I feel dizzy and nauseous, and I get faint. I'm guessing that's the cause, since a bit of candy or something sugary plus water appears to sort it out. I do eat carbs, I keep up with my water, and I take electrolytes too (1 packet of liquid IV daily), yet I still feel like I have to be extremely cautious. Is this hypoglycemia? Or could it be low blood pressure from not getting enough water/electrolytes?

Both are possible, or it may be a mix of the two. Since candy or sugar fixes it, that points toward hypoglycemia, which Reta can trigger, particularly in the beginning. Low blood pressure and dehydration can also produce a very similar sensation. If you can, test your blood sugar while it's happening. Eating more often with protein + complex carbs, increasing fluids/sodium, and titrating more slowly may all be helpful. Should it continue, talking to a provider is definitely worthwhile.

 

[woundcarping]

That's a fair observation — if this kept happening to me, I'd be far more inclined to pick up a CGM. In the 3 weeks since I started bridging to Reta, there was just one occasion when I felt a mild early symptom; it was simple to handle and I carried on with my day.

 

[tubby]

Hichewgoddess said:

I'm only on week 4 of Reta, taking 1mg each week. Roughly 24 hours in, my blood sugar seems to fall. I feel dizzy and nauseous, and I get faint. I'm guessing that's the cause, since a bit of candy or something sugary plus water appears to sort it out. I do eat carbs, I keep up with my water, and I take electrolytes too (1 packet of liquid IV daily), yet I still feel like I have to be extremely cautious. Is this hypoglycemia? Or could it be low blood pressure from not getting enough water/electrolytes?

What you're feeling is a really common reaction when starting retatrutide, and for most people it fades with time.

On top of that, GLPs — retatrutide included — do a very good job of bringing blood sugar back into a normal range for people with diabetes. In some of those cases the change happens quickly, showing up within just the first few days.

Hypoglycemia wouldn't be the first thing I'd suspect, but it can't be ruled out, particularly if low blood sugar has been an issue for you before. Whatever the reason, while those symptoms are happening I'd steer clear of anything that depends on fast reflexes, like driving. And if you'd like to treat it as a reason to have some candy, no one's going to fault you for that — though in general it works against you, unless you're injecting insulin or taking certain medications that push your pancreas to make more insulin than it normally would (GLPs aren't in that group).

 

[lessthanhalf]

Based on what the companies marketing GLPs say, along with chatgpt 5 in scholar/academic mode, GLP medications do not produce hypoglycaemia in people without diabetes. (When it does happen, it stems from combining them with other drugs that lower glucose.)

People frequently label symptoms like these as hypoglycaemia on their own, yet when blood sugar is actually measured in those complaining of such symptoms, genuine hypoglycaemia turns out to be quite uncommon.

One might expect reta in particular, at least early on, to be the least likely culprit given its glucagon agonism.

Genuine hypoglycaemia is a rather serious condition. It can lead to losing consciousness and is not good for brain cells. Among people who feel tired, shaky and dizzy after going without food for a stretch, which happens all the time, attaching the label hypoglycaemia to these symptoms, when measurement usually shows it is not, matters mainly because it blurs the line between something medically quite serious and something fairly harmless. Take driving: if these episodes were genuine hypoglycaemia, you should not be behind the wheel whenever there is any chance one could occur.

Every GLP medication directly lowers blood pressure, and many cut fluid intake through a direct effect on the brain's thirst centers. Add to that the fluid and electrolyte losses from early weight loss, and postural hypotension becomes more likely, which is the more probable source of these symptoms. Should it resolve when you sit or lie down, that would confirm it. What you are already doing, having a drink and something to eat, works fine as a way to handle it. Still, I would recommend putting more focus on fluid and salt/electrolyte intake, since that matters for keeping it from happening again.

 

[meeklady]

Reta has caused me issues with hypoglycemia. When my PCP ran a non fasting blood test, the result came back in the 60's. Her advice was to carry high sugar snacks and consume some whenever symptoms appear.

For me, I believe the main culprit isn't really the Reta—it's that I don't eat enough or at consistent times while using it. Be sure to have something to eat regularly.

 

[Gohengrin]

On reta, my blood sugar won't go past 75, so I keep dextro energy nearby at all times — a really low reading nearly made me pass out. Back before I started reta, my numbers were usually 100 or 110 or higher. I've also increased how many carbs I eat.

 

[Purplepansy]

Hichewgoddess said:

I'm only on week 4 of Reta, taking 1mg each week. Roughly 24 hours in, my blood sugar seems to fall. I feel dizzy and nauseous, and I get faint. I'm guessing that's the cause, since a bit of candy or something sugary plus water appears to sort it out. I do eat carbs, I keep up with my water, and I take electrolytes too (1 packet of liquid IV daily), yet I still feel like I have to be extremely cautious. Is this hypoglycemia? Or could it be low blood pressure from not getting enough water/electrolytes?

Get your blood pressure checked, particularly if you're taking any medication right now. In my case, my dose had to be reduced since it kept falling too low.

 

[CNCCurrency]

Purplepansy said:

Hichewgoddess said:

I'm only on week 4 of Reta, taking 1mg each week. Roughly 24 hours in, my blood sugar seems to fall. I feel dizzy and nauseous, and I get faint. I'm guessing that's the cause, since a bit of candy or something sugary plus water appears to sort it out. I do eat carbs, I keep up with my water, and I take electrolytes too (1 packet of liquid IV daily), yet I still feel like I have to be extremely cautious. Is this hypoglycemia? Or could it be low blood pressure from not getting enough water/electrolytes?

Get your blood pressure checked, particularly if you're taking any medication right now. In my case, my dose had to be reduced since it kept falling too low.

Did the glp1 cause it, or was it from weight loss?

 

[Hambocommando]

tubby said:


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).

Click to expand...

Alternatively, candied ginger could give you a sugar lift while also potentially easing nausea.

 

[Purplepansy]

CNCCurrency said:

Purplepansy said:

Hichewgoddess said:

I'm only on week 4 of Reta, taking 1mg each week. Roughly 24 hours in, my blood sugar seems to fall. I feel dizzy and nauseous, and I get faint. I'm guessing that's the cause, since a bit of candy or something sugary plus water appears to sort it out. I do eat carbs, I keep up with my water, and I take electrolytes too (1 packet of liquid IV daily), yet I still feel like I have to be extremely cautious. Is this hypoglycemia? Or could it be low blood pressure from not getting enough water/electrolytes?

Get your blood pressure checked, particularly if you're taking any medication right now. In my case, my dose had to be reduced since it kept falling too low.

Did the glp1 cause it, or was it from weight loss?

The 2 episodes I had were probably caused by a mix of things: losing weight, being away on vacation with no job stress, a Reta dose that was too high, and not being able to eat much. A few weeks before that, my doctor said I still had to keep taking the blood pressure medicine despite the weight loss. When I felt dizzy and had to sit down, my first assumption was low blood sugar. My blood sugar came back normal, so I took my blood pressure and for me it was low at 85/69. I'm still taking the medication, just at a reduced dose.

 

[lessthanhalf]

Replying to Purplepansy.

You mentioned your doctor told you to keep taking blood pressure meds but at a reduced dose — however, if that advice came after a reading of 85/69, I'd find it hard to believe. Treatment for high blood pressure, even when quite intensive, generally targets 120/80. Going below that isn't linked to any known advantage, and there are clear risks when pressure falls too far — the most evident being a collapse from postural hypotension. I'm not suggesting that's your situation, but excessive reductions in bp and in renal blood flow can potentially harm the kidneys.

My recommendation: take a decent number of readings across several days — perhaps 10-20 — so you get a reliable average. Should you notice symptoms when getting up, such as dizziness or vision briefly dimming or blacking out, then postural hypotension is certain. If those don't occur, simply check your pressure while seated and then while standing, and note the gap. Record everything for your doctor.

Since I don't have your full medical background, I won't tell you to quit the medication. Still, with a reading like that, I believe taking a few more measurements and speaking with your doctor again would be wise — particularly if standing brings on any symptoms.

 

[BNLFL]

At my annual check-up last Wednesday, they went over my bloodwork. I'd spent a month at 2mg of Reta, then moved up to 4mg the Friday right before. My blood pressure came in at 128/70, heart rate at 76, and every test result was exactly where it should be. Honestly, I couldn't believe it. Twice a day I take Metoprolol 50mg along with Lisinopril 10mg.

 

[GLP1Pharmacist]

My RS subject has had trouble with hypoglycemia and makes sure to have something sugary within reach at all times. Alcohol is what reliably sets off the severe drops — 2 drinks will do it to some degree, while 3 without question bring on big, frightening crashes. The upside is that there is little to no genuine craving, yet even 3 drinks stretched across several hours trigger serious problems. The liver prioritizes processing alcohol, which throws blood sugar into disarray.

 

[Purplepansy]

lessthanhalf said:

Replying to Purplepansy.

You mentioned your doctor told you to keep taking blood pressure meds but at a reduced dose — however, if that advice came after a reading of 85/69, I'd find it hard to believe. Treatment for high blood pressure, even when quite intensive, generally targets 120/80. Going below that isn't linked to any known advantage, and there are clear risks when pressure falls too far — the most evident being a collapse from postural hypotension. I'm not suggesting that's your situation, but excessive reductions in bp and in renal blood flow can potentially harm the kidneys.

My recommendation: take a decent number of readings across several days — perhaps 10-20 — so you get a reliable average. Should you notice symptoms when getting up, such as dizziness or vision briefly dimming or blacking out, then postural hypotension is certain. If those don't occur, simply check your pressure while seated and then while standing, and note the gap. Record everything for your doctor.

Since I don't have your full medical background, I won't tell you to quit the medication. Still, with a reading like that, I believe taking a few more measurements and speaking with your doctor again would be wise — particularly if standing brings on any symptoms.

My blood pressure didn't keep dropping like that. Throughout the day I checked it multiple times. This was all before I started any medication. On both occasions when my blood pressure fell and I felt dizzy, I was standing and active. That took place during a trip in September. I'm still tracking it and taking my prescription exactly as my doctor instructed. Stress at my job can be significant, and I've noticed that both my blood pressure and blood sugar go up because of it. For a period I used a CGM to observe my blood sugar patterns. During the first week, while I was on vacation, my readings were low, but once I returned to work they increased. I hadn't known that stress could also push your levels higher. I don't have diabetes; I simply wanted to understand how my body responded to various foods. After having surgical menopause in my 30's, plus Hashimotos, I spent many years trying to shed weight. For a long time I've eaten a gluten free low carb diet. Thanks to Reta, I'm now near my goal weight,

 

[Lear00]

I don't have diabetes, but my job gives me access to what is essentially an endless stock of continuous glucose monitors (CGMs), and I used them in the past to follow my BGLs while off retatrutide. My readings usually sat in the 6-8mmol (108-144 mg/dl) range.

I've been raising my Reta dose over several weeks and have now been steady at 4mg for the last 3.

This week I put a CGM back on, and here's what I found.

- Roughly 12 hours after my weekly retatrutide injection, I had a notable low of around 3mmol/L. No symptoms.

- These days I generally sit near 4mmol/L, though I also spend a large amount of time in the 3.2-3.7 range. That pattern shows up most reliably during working hours, when I might go 8-10 hours without actually having a chance to eat.

- I haven't had symptoms from a low yet, but at these lower levels I do feel at minimum somewhat tired and foggy, plus hungry

A few things I take from this personally

- For my glycemic control, Reta is VERY GOOD — that's an average drop of 2mmol compared with before

- Even so, I believe hypoglycaemia risk on a GLP1 doesn't get discussed enough

- There's probably a group of people like me whose BGL is already 'borderline' without any medication, and they could be at risk of hypoglycaemia on a GLP1 without realising it. It matters that every trial so far selected people who are pre-disposed to insulin resistance (I.e BMI >31). By contrast, anyone can obtain it on the grey market, and that group isn't well represented in trials.

- Given the chance of a genuine symptomatic hypoglycaemic event, I definitely don't feel safe going above 4mg. For comparison, where I live T1 diabetics are legally required to test their BGL before driving and can't drive unless it's >5mmol/L.

- While on this medication it's important to eat at least small meals across the day; I'm not convinced that prolonged intermittent fasting is very safe on it.

- I do question whether some retatrutide side effects people report could be accounted for entirely by ongoing hypoglycaemia

Photo below is my trend from yesterday while working a busy shift with no time to snack!