The hypoglycaemic side of hypothyroidism.

[arTistapple]

Firstly apologies, I still don’t know how to cite the paper so it shows up in blue for you guys to read.

Indian Journal of Endocrinology and Metabolism. doi:10.4103/2230-8210.126517

Several times on the Forum I have come across forumites reporting that their HbA1c scoring actually increases when on thyroid medication. I think this is mostly reported when they start T3. This certainly happened to me. The reverse also happened when I stopped T3.

So I have been pretty rigorous in attempting to get my HbA1c lower. I did Intermittent Fasting and really watched my diet (I thought). This involved no late day eating.

Anyway the upshot of all this is twofold. My HbA1c is now at 43 so I have been doing right!

Or have I?

Symptom wise I am worse than I have been since before diagnosis. Why? Well I think this is because of my ‘re-established’ sensitivity to insulin. It’s a double edged sword. You want your body to be sensitive to insulin so you don’t go into full diabetes. So this is a good thing? Yes but in some patients this brings about hypoglycaemia and all its awful batch of symptoms. I see people on the Forum write about these symptoms and they (like me) may not recognise what is going on. The symptoms can just feel like geared up hypo symptoms. Whilst adrenal insufficiency can still be a cause of being unable to safely introduce T3, so can this process.

The symptoms are dramatic and need attention. Even in someone without hypothyroidism the symptoms can be dramatic. However with hypothyroidism it’s even trickier. According to Paul Robinson (his CT3M book) in certain patients this needs handling before successful use of T3 can happen. It brings about the same difficulties in attempting T3 as adrenal issues.

My hypothyroidism has exposed me to a full list of co-morbidities associated: Type 2Diabetes, apparently now resolved, HBP, High Cholesterol, Muscle pain since taking statins 20 years ago, obesity, memory problems/depression, CKD and my main original issue, for which I was told 25+ years ago “there is nothing wrong with your heart” three months before a heart attack.

We are dreadfully familiar on this Forum with this ‘outcome’ from the medical profession.

This paper makes a clear but thought rare connection to hypoglycaemia. Reading people’s stories on the Forum, I don’t think it’s so rare. Again it’s my experience that doctors don’t have a clue. I have recounted my tale of woe to many and never once has hypoglycaemia been mentioned to me.

This problem was particularly highlighted to myself when I started T3. I recognised the old symptoms: tachycardia, sweating, visits to the loo, thick head, nausea - just my ‘general picture of unwellness’, plus in my case chest pain. I did not truly make the connection myself until reading this paper. “Physician heal thyself comes to mind”. I mean since I am the only one bothering about myself, I am my physician and all the difficulties that entails! How many times I have come across this information in different formats (a constant problem for me) and not fully understood?

Well in my defence when we see endocrinologists in the U.K. - so many of them alleged diabetes specialists and even they don’t recognise the description of hypoglycaemia from a non diabetic patient. What hope is there for us mere mortals to recognise it?

[TiggerMe Ambassador]

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[arTistapple in reply to TiggerMe]

Thank you again TiggerMe.

[Judithdalston]

Had nfact sent you a query on another post today where you had mentioned hypothyroidism and blood glucose…I had infact seen the Indian research as about the only one that covered the two diseases. My Gp reduced my levo 3 weeks ago from 100 to 50 ( tho I kept the 5x3 mcg T3), so I am expecting a change in blood levels ( frees rather than TSH) . As I said I was querying why my BG has gone up ( and might still be rising) as fasting BG about 2 units higher…upped my background insulin (Toujeo) by two last 4 days and still bit high this morning.

I am now a type 3c diabetic ( had been type 2 but a bile duct ‘op’ going wrong gave me septic shock and acute pancreatitis), and been intermittent fasting for nearly 17 months ( 11pm-3 pm), and also swim 5 days a week for 50 mins. My HbA1c is 40-41. I have had health problems for decades across the endocrine system…yet never seen an NHS endo! I had a cortisol blood draw this morning. It’s difficult to unpick all my symptoms and perhaps 4 1/2 years of Long Covid has just made everything worse, but postural hypotension, high resting BP, high HR seem unique to LC as I seemed to be reasonable ( not ok) on the T4 /T3 combo before this. When originally diagnosed as likely to be type 2 I was not told that my TSH was high ( found out 20 years later, nearly 6 then tho Gp waited till 10 ) and think well if they treated me for hypothyroidism first perhaps I wouldn’t have BG, bile/ gallbladder problems !

[humanbean]

Just a few suggestions...

Intermittent fasting has been implicated in reduced conversion of T4 to T3.

Tachycardia can be caused by low iron/ferritin and also high blood sugar.

[arTistapple in reply to humanbean]

I knew the ‘dangers’ of Intermittent Fasting but I was trying to get something out of the way - the diabetes diagnosis. However it seems once you have actually tipped the numbers, medics don’t let it go. Seems daft but they don’t acknowledge when you manage this. For all this ‘work’, apparently my eyesight is damaged. No empathy at all for what goes on for patients. They are not working with you on any level. It’s a lousy relationship all round it seems to me. Or at least it’s not what I expect of medicine.

My conversion has not been happening (apparently) since the 50 mcg of Levo dose. T3 level has dropped consistently for three years. Last I looked T3 was 5.41%. This was due to information from my new endo. He said my conversion would be better if my T4 level was lowered. Well I did have a day when I felt ‘brand new’ when I started reducing my Levo in preparation for my new prescription, which never arrived. He wrote explaining he would not be treating me. He won’t touch me because of heart issues and I can’t have the stents cardio wants because of ‘folding’ arteries. The whole argument is circular. Cardio is ruthless and endocrinology timid.

My vits etc are good. Selenium too over quite a long period (virtually since discovering this Forum) has made no difference, as far as I am aware.

Being ‘unable’ to take T3 without some sort of drama has been a real setback.

My ferritin has ‘reduced’ over the whole time of thyroid treatment. It’s still very high though. I think down to the amount of inflammation in my body. Hashi numbers are always high. Otherwise I seem to have no indication of blood issues - but who knows?

Just trying everything and trying to be timely about everything (scientific) something my medics are failing to do. This is so I can have the best idea about what is happening.

I am fed up of going between terror to despair.

[Bertwills]

If you want to self medicate, I have had great success with Berberine for controlling blood sugar. I use one from Time Health available online. I also take their adaptogens capsules.

I know Berberine works as I, following instructions from Sarah Myhill, went on a keto diet, less than 20 to 30 grams of carb a day. I stoppped taking my Berberine as I thought reducing my carbs by so much would do the same job. It didn’t.

My Hba1c test rose five points & made me very nearly diabetic. I didn’t feel well either.

I try to take combination treatment of T4 & T3 but always return to T3 only as I feel better but it does raise my blood sugar readings so I rely on Berberine to improve things. In the past I have definitely had hypoglycaemia episodes, I think they wake me in the night.

You’re fasting for a long time in every 24. I couldn’t do that. Have you tried the five/ two approach, ie eat normally for 5 days a week but have 2 days, not consecutively of only eating 500 calories. It’s been found to be very effective & maybe easier to maintain.

You mention high ferritin too. I also have that. It has recently been found to be damaging at well below the NHS haemachromatosis level of 1000. It lodges in organs including the eyes & pancreas. I have eye damage & possibly a damaged pancreas.

Dropping red & processed meat, eating green leafy veg & blueberries every day reduced mine to normal. But the easiest way to reduce it, which you should, is to donate blood. I can’t as I’m banned due to having a blood transfusion in 1988. Mad cow disease possibilities stop me.

The article is very interesting. I saw the diabetic nurse when I had the big jump in my Hba1c test. I was told as I was leaving that I could have NHS Metformin as a preventative treatment but I was already late for another appointment so didn’t wait to discuss it. I’m keeping it in mind. It’s considered to be one of the longevity drugs so might be worth considering.

Are you still taking statins? Generally they’re not recommended for hypos. I think they have serious long term impacts increasing risks of dementia for example.

[arTistapple in reply to Bertwills]

Bertwills. You have supplied a lot of info and it will take a little bit of sorting out. I appreciate you picking up my post. I am off to do battle with the NHS right now, so a bit out of sorts!

[Wua13262348]

Hi . I've been deep diving into my genetic mutations in the last couple of days and have found that I have a double mutation for HMGCL , which 90.4% of the population might have, but is marked as benign.HMGCL is for 3-Hydroxy-3-Methylglutaric Aciduria. It is autosomal recessive, from both parents. The mutation means that the body can't process the amino acid, Leucine. Leucine is commonly in lots of food, and I discovered today that Thorne Basic B supplement , which I take, has Leucine listed as an ingredient. You also cannot make ketones, an important source of energy when fasting. I have a feeling that Sarah Myhill, whom I think you recently turned to for help, is a big fan of getting you into ketogenesis? If you have this mutation ,organic acids can build up and cause metabolic acidosis and the shortage of ketones can cause HYPOGLYCEMIA. Both can damage cells, especially in the brain. When leucine not processed normally, chemical byproducts (organic acids), can build up and make blood too acidic. A shortage of ketones can cause blood glucose levels to be dangerously low (hypoglycemia). I used to be addicted to glucose in Lucozade and drank 1 litre a day. For those with the disease , when not considered a benign mutation, intravenous glucose is administered when in crisis, funnily enough. HMGCL protein plays an essential role in breaking down dietary fats and protein for energy. A deficiency, thus, causes lethargy. Most mutations change a single amino acid. A low leucine and high carbohydrate diet is recommended and L- Carnitine supplementation recommended for detoxification . Izabella Wentz is a great fan of L-Carnitine. Fasting should be avoided if you have HMCGL mutations.

I also have supposedly benign double mutations for AUH ( 3 Methylglutaconic Aciduria) though this one is 8.7% of the population. The disease can cause an enlarged , weak heart and impairs body's ability to make energy in the mitochondria. Low protein and low LEUCINE diet recommended. Carnitine deficiency often found.

I also have supposedly benign mutations , which need only come from one parent, but I have a mixture of double and single mutations. It is also for an Aciduria, and involves the 4th step in the LEUCINE catabolic pathway, and is biotin dependent. It can cause metabolic acidosis , HYPOGLYCEMIA, muscle pain and weakness, hyperammonemia, among other things. The mutation is MCCC1 and MCCC2. I have 2 of both.

I do not know if you have your genetics to check for these and other cardiovascular related mutations. I had thyroid blood results in November 2022 which looked ideal and , I think, were almost identical , or very similar to your results at this time. Despite the blood results looking good, we both felt no better, and felt awful.

I believe Ancestry .com can provide results to run through a data base to get your genetics. If you don't already have your genetics, this might provide some insight .

[arTistapple in reply to Wua13262348]

Oh dear Wua. I will need to digest this. It’s a cracker. I have been taking L-Carnitine for a while and over a number of years. As with many supplements it’s blooming difficult to tell whether they are doing you any good at all! It’s probably as good a potential money maker for supplement businesses as big Pharma.

Thanks for that though. I have not done any genetic testing.

[Wua13262348 in reply to arTistapple]

Interesting you are taking carnitine. On the face of it , looks as if it is probably a keeper. What would you recommend as a particularly clean carnitine without nasties? And what dose do you take? My citric acid /krebs cycle an absolute car crash for double mutations, too. A cheap way of finding out your levels of about 26 amino acids is a blood spot test from Cerascreen. It takes 6 weeks to come back and is about £60 ish. Less , with discounts. My Leucine was 25.88% in Nov.22. Leucine is one of 3 branched chain amino acids. The others are Isoleucine and Valine. Mine were 29.57% and 17.3% respectively. So quite low.

[arTistapple in reply to Wua13262348]

The carnitine I take is Pharma Nord. It’s a Danish company, very efficient. But here are the list of contents. L-Carnitine-L-Tartrate. Bulking agent: Microcrysataline cellulose. Capsule shell: Hydroxylpropyl methyl cellulose. Anti-Caking agents: Magnesium salts of fatty acids. Silicon dioxide. This all sorts of probably nasties. As they don’t upset me I have a policy of “Let sleeping dogs lie.” Not very careful of me I suppose. I did take another one from the USA many years ago, my gym ‘prescribed’ that.

It’s the first time I have read the contents of this and I was very interested by the Silicon oxide. Oddly enough (again a good few years ago) I was prescribed Silica as a homeopathic remedy. It actually did very well indeed for me. Got me thinking again! Always things to learn. I just wish I was obviously benefiting from this knowledge!!

[Wua13262348 in reply to arTistapple]

Still looks like a keeper for you then. Thanks for that. Would rather try something that comes recommended and doesn't upset someone. Some time in the future this is the one I will try.

[radd]

arTistapple,

I think you are correct in every corner.

I experienced the same when starting T3 meds but luckily was being closely monitored by a functional endo and a nutritionist who both came to the same conclusion and suggested the necessary protocols (diet & supplements) to bring elevated blood sugar levels under control. Stabilised results have remained a consistent level ever since.

It is commonly known that excess levels of T3 enhance blood glucose levels (as in hyperthyroidism), yet many still fail to see a connection to evaluated glucose levels after the recent introduction of T3 meds in a deficient body 🤷‍♀️.

[TiggerMe Ambassador in reply to radd]

Just looking back and mine did the same when starting T3 bobbed up to 40 for a few weeks and then settled back to 36-38

[arTistapple in reply to TiggerMe]

This is great, especially with your story having considerable success. As I say I have seen it come up more than a few times and it’s vital we all know this is a recognised issue for those of us floundering about in often, fear and adding to our anxieties.

[arTistapple in reply to radd]

Radd thanks for your info and experience here. Yes that issue of trying to separate hyper and hypo symptoms is just so irrelevant - for hypos anyway. We see this every day on the Forum. It’s a huge blank in medics knowledge - even (but unsurprising to us) endocrinologists miss this very important issue.

Hope for me yet. Thank you.