Could Reta be causing low blood sugar?
- Thread starter Hichewgoddess
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Donstofikus
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There was one occasion when I felt somewhat lightheaded, so I used that moment as a reason to have something sweet. I continue to have sugary snacks, although I have reduced them a lot. My typical lunch is a light meal plus a snack, and for dinner I have a moist meal with a snack, and occasionally I'll have 2 snacks. Right when I began, I lowered my sugar intake considerably, so it was simple for me to connect the way I was feeling to a need for sugar—or at least, that was my assumption.
kobeanbry24
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Every day I go through 3-4 packets of electrolytes
BNLFL
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Watch out — each Liquid IV packet contains 500mg of sodium.kobeanbry24 said:
I'm drinking 3-4 packets of electrolytes per day
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kobeanbry24
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That's exactly right.
There's a lot of fear, uncertainty, and doubt in this thread:
"Asymptomatic hypoglycemia" is not something worth worrying about. In fact, this is partly why doctors tend to resist prescribing CGMs to people without diabetes (and even to many with type 2 diabetes), even though I think it would be a great thing. They know their patients will overinterpret the readings and begin acting as though they have type-1 diabetes (for example, eating sugar snacks whenever the number drops, and making other strange choices to flatten the figure displayed in their phone app). You're also mixing up the usual early GLP symptoms with hypoglycemia. I had those symptoms at the start too. I've used a CGM for years. On reta my blood sugar dropped. During dose escalation it often sat in the 50-60 mg/dL range. That's not unusual. Ordinarily I'd need to fast for 4-5 days before it would sit in that range.
If you inject insulin and take sulfonylureas, then you should monitor your blood sugar and do things like eat a sugar snack when you notice it dropping. Apart from that, unless something very unusual is going on with you, acting like a type-1 diabetic won't do you any good.
"Asymptomatic hypoglycemia" is not something worth worrying about. In fact, this is partly why doctors tend to resist prescribing CGMs to people without diabetes (and even to many with type 2 diabetes), even though I think it would be a great thing. They know their patients will overinterpret the readings and begin acting as though they have type-1 diabetes (for example, eating sugar snacks whenever the number drops, and making other strange choices to flatten the figure displayed in their phone app). You're also mixing up the usual early GLP symptoms with hypoglycemia. I had those symptoms at the start too. I've used a CGM for years. On reta my blood sugar dropped. During dose escalation it often sat in the 50-60 mg/dL range. That's not unusual. Ordinarily I'd need to fast for 4-5 days before it would sit in that range.
If you inject insulin and take sulfonylureas, then you should monitor your blood sugar and do things like eat a sugar snack when you notice it dropping. Apart from that, unless something very unusual is going on with you, acting like a type-1 diabetic won't do you any good.
No one here, as far as I can tell, is worried about hypoglycaemia without symptoms. Honestly, if I could walk around with asymptomatic low blood sugar for years, I'd be delighted, since the link between a raised HbA1c and atherosclerotic burden is well established.
Claiming with such certainty that hypoglycaemia symptoms cannot occur when someone starts retatrutide — and that every complaint is simply 'normal initial symptoms' — takes a fair amount of nerve. And remember, GLP1 drugs were originally developed with the explicit aim of bringing blood glucose down in T2DM.
Experiencing hypoglycaemia symptoms does not require a T1DM diagnosis. How low someone's glucose has to fall before they notice symptoms varies a great deal from person to person — this is what's called hypoglycaemia awareness.
I'm glad 50–60 mg/dL felt fine for you, but presenting your own experience as if it were universally safe or typical for everyone else is probably not the right move.
I never said "can't." What I meant is this: when someone begins injectable insulin or a sulfonylurea, doctors give a hypoglycemia warning for a reason, yet no such warning accompanies the start of a GLP. Why? Because symptomatic hypoglycemia is not a frequently seen risk tied to GLP therapy, unless the same individual is concurrently using injectable insulin or a sulfonylurea.
That said, once in a blue moon a person's metabolism is deranged enough that introducing a GLP tips them into symptomatic hypoglycemia, just as once in a blue moon someone loses their vision after starting a GLP. Both events are uncommon, and with hypos the individual typically already knows it is an issue for them before ever starting the GLP, since it has been a longstanding problem in their history.
What you are actually doing is over-interpreting the numbers on your CGM. Even without feeling light headed, clammy, or passing out, you have talked yourself into believing you are in danger. As a result, you misapply type-1 diabetic rules of thumb about hypoglycemia and treat 50-60 mg/dL as a dangerously low blood sugar, even though that level is commonly reached during an extended fast and a substantial number of normal healthy people will show it as a reactive reading after eating, all without those symptoms.
Here is the piece you are missing: a type 1 diabetic will sweat a 50-60 mg/dL reading not because the number itself causes harm, but because of the direction it signals. When their blood sugar is moving downward AND their body cannot self-correct, then by the time the CGM displays 50-60 mg/dL their true blood sugar is probably already beneath that. And because their body cannot hormonally self-correct, acting right away matters; waiting until it drops to a harmful level means it is already too late to respond.
So once more: anyone may wear a CGM and role-play being a type 1 diabetic, but in the overwhelming majority of cases it is not needed.
As a medical doctor, I can say that my confidence is nowhere near 1/10th of what you display when you make such broad, definitive claims about a relatively new research use only medication that is still being actively studied. Armchair expertise on the internet carries risk even in ordinary situations, and that risk is especially high when the subject is drugs of this kind.
All the best
What strikes me here is that the majority of physicians I run into zero in on trial-derived clinical evidence and would write off personal accounts (such as your CGM readings) as "weak." Your evident enthusiasm for N=1 anecdotal reports stands out as unusual (and frankly I wish a greater number of your colleagues shared that inclination, and I think you deserve praise for it, though that complaint belongs elsewhere).
Just wondering, have you looked into how Lilly addresses this matter across their phase 2 and 3 retatrutide trials, and whether any hypoglycemia prevention steps (such as CGM usage) were put in place? Phase 2 trial results are out there, and we also have accounts from people enrolled in phase 3 trials. The logic would be that if this were even somewhat frequent, phase 2 trials ought to have flagged it, and failing that, phase 3 trials would have.
Should you dig into it, you will find a trial in which Lilly combines retatrutide with CGM use and.... (drumroll).... it sits within their 3rd TRANSCEND-T2D trial, which centers specifically on type 2 diabetics who are ON INSULIN.
That said, this is not proof that no hypoglycemia risk exists (and as I emphasized in my previous reply, I am not claiming zero risk). What it does do is lend strong backing to the notion that any such risk would be an edge case rather than a frequent side effect.
If you want to get better at judging research and figuring out whether findings can be applied or generalised, this site is a solid resource.
https://www.cebm.ox.ac.uk/resources/ebm-tools/making-a-decision
However, giving patients treatment isn't what I do. What I do is share my take on pharma products.
Where your reasoning goes wrong is that you assume blood sugar works on a simple "lower is bad" rule the moment a person drops below 70 mg/dL. The only time lower is bad is when SYMPTOMS follow from it. That was the whole basis of my first critique of your FUD: you weren't having hypoglycemic SYMPTOMS. Distinguishing the two is straightforward (with a CGM on, like you had) because you can check whether the symptoms line up with the stretches when blood sugar falls and disappear the rest of the time. Actually, a CGM isn't even required for that.
Constant fatigue or tiredness isn't hypoglycemia. That points to GLP side effects. Symptoms that shift and fade minute to minute, hour to hour, at least could plausibly tie back to hypoglycemia. Before someone reaches that stage, the whole question is a moot point.