5mg Tirz - hypoglycemia

[BrowsingAbout]

I started Tirz in October 2024. I’m just doing it for binge eating now, I’ve lost all the weight I need to lose.

I’ve been extremely exhausted (very unlike me). I’ve also always had lightheadedness when standing, but a few months into Tirz, I passed out and bonked my head pretty hard.

I had blood drawn yesterday and I came back amazing in all of my labs, with the exception of glucose, it was abnormally low. I have to have a repeat fasting test and A1C.

I’m not sure if Tirz is the root cause of it, but what I do know is I can’t come off of it. I’m a lifelong binge eater and I have been through every single medication for it, with no luck. Any advice on how to fix the glucose issue?

 

[Calm Logic]

That is unusual. Continuous glucose monitoring would seem ideal. It costs like $90+ a month. In the meantime , I would be using the cheap $10 or $20 blood glucose kit at Walmart. I like the $20 one that comes with a lot of everything:

https://www.walmart.com/ip/ReliOn-Platinum-Blood-Glucose-Monitoring-System/1047555019

I use it for prediabetes, but I have never been hypoglycemic, even on higher doses of tirz.

 

[Iamnew2this]

I started Tirz in October 2024. I’m just doing it for binge eating now, I’ve lost all the weight I need to lose.

I’ve been extremely exhausted (very unlike me). I’ve also always had lightheadedness when standing, but a few months into Tirz, I passed out and bonked my head pretty hard.

I had blood drawn yesterday and I came back amazing in all of my labs, with the exception of glucose, it was abnormally low. I have to have a repeat fasting test and A1C.

I’m not sure if Tirz is the root cause of it, but what I do know is I can’t come off of it. I’m a lifelong binge eater and I have been through every single medication for it, with no luck. Any advice on how to fix the glucose issue?

Blood glucose monitoring( get a blood glucose monitor), orange juice, sugar packets, or eat something sweet when sugar is low.

 

[Calm Logic]

Are you having breakfast and snacks? I would think that would help prevent another epidose. (For an in-law with type-1 diabetes, those are very important, including a bedtime snack.)

Blood glucose monitoring( get a blood glucose monitor), orange juice, sugar packets, or eat something sweet when sugar is low.

This could be a safety poster:

 

[nonyabizznez]

I’m not sure if Tirz is the root cause of it, but what I do know is I can’t come off of it. I’m a lifelong binge eater and I have been through every single medication for it, with no luck. Any advice on how to fix the glucose issue?

Maybe try lowering your dose or dosing less frequently and/or eating small bits more often. Intermittent fasting and glucose issues are not simpatico if that's how you eat. (I'm an intermittent faster by habit and have similar issues.)

 

[BrowsingAbout]

Are you having breakfast and snacks? I would think that would help prevent another epidose. (For an in-law with type-1 diabetes, those are very important, including a bedtime snack.)


This could be a safety poster:

View attachment 6946

I eat three meals and snacks every day! The sudden drop in glucose has me all confused. I haven’t eaten sugar in years and have been low carb for just as long.

 

[BrowsingAbout]

Maybe try lowering your dose or dosing less frequently and/or eating small bits more often. Intermittent fasting and glucose issues are not simpatico if that's how you eat. (I'm an intermittent faster by habit and have similar issues.)

I had just eaten about a half hour before my appointment, and I usually do really good at having something in my system. I can’t fast, i am not built for that.

 

[Calm Logic]

If you are also having GI side effects, those can also contribute to fatigue, in addition to hypoglycemia or eating less calories/carbs than before.

@StonePny just mentioned naltrexone in another thread. But you may have already tried it, so it may not help much if you lower your tirz dose. I have already added it for my next order from India to try with other things to augment my tirz.

Have you tried other GLPs? According to Google Gemini, tirz and sema may be the most likely to cause hypo:

Medication	Class	Mechanism of Action (Glucose & Appetite)	Likelihood of Hypoglycemia (as monotherapy)	Impact on Food Noise/Fullness/Binge Eating	Notes
Retatrutide	Investigational GLP-1/GIP/Glucagon RA	Agonist of GLP-1, GIP (satiety signals), and glucagon (potential counter to hypoglycemia)	Potentially Very Low	Significant potential for reduced food noise, increased fullness, and decreased binge eating due to GLP-1 and GIP agonism.	Glucagon receptor activity may help counter hypoglycemia. Still under investigation, more data needed on all effects.
Survodutide	Investigational GLP-1/Glucagon RA	Agonist of GLP-1 (satiety signals) and glucagon (potential counter to hypoglycemia)	Potentially Very Low	Likely to reduce food noise and increase fullness due to GLP-1 agonism, potentially aiding in preventing binge eating.	Glucagon receptor activity may help counter hypoglycemia. Still under investigation, more data needed on all effects.
Semaglutide	GLP-1 Receptor Agonist	Enhances glucose-dependent insulin secretion, suppresses postprandial glucagon secretion, slows gastric emptying (increasing fullness)	Low to Moderate	Known to reduce food noise, increase feelings of fullness, and can be effective in reducing binge eating tendencies for some individuals.	Risk of hypoglycemia is higher when used with insulin or sulfonylureas. Gastrointestinal side effects can occur.
Tirzepatide	GIP and GLP-1 Receptor Agonist	Enhances glucose-dependent insulin secretion, suppresses glucagon secretion, likely has significant effects on satiety pathways through GIP and GLP-1 agonism.	Low to Moderate	Demonstrates strong effects on reducing food noise, promoting fullness, and aiding in weight loss, suggesting a potential to reduce binge eating.	Risk of hypoglycemia is higher when used with insulin or sulfonylureas. Gastrointestinal side effects can occur.

Also from Gemini: "While GLP-1 is well-known for slowing gastric emptying and promoting satiety, GIP can complement these actions through its own pathways in the brain and potentially by influencing energy balance and fat metabolism. This combined action may lead to a more potent reduction in food noise compared to a GLP-1 agonist alone."

Instead of switching to reta, some of us will add survo to tirz.

 

[Calm Logic]

I haven’t eaten sugar in years and have been low carb for just as long.

Well, if you are having hypoglycemic side effects, maybe it's time for the Olive Garden? There are a lot of vegetarians who can graze on carbs all day without gaining weight since the corn, potatoes, etc. are filling (by volume) and give them energy (that's the theory anyway, at least if they avoid processed foods and exercise enough). In any case, adding some more carbs like a piece of fruit or some Triscuits may help.

 

[Rawlinsd]

Be certain you are eating an adequate amount of protein with each meal (shoot for around 30/40grams per meal). Protein will help to stabilize serum glucose levels by slowing down the absorption rate of carbohydrates. The carbohydrates are known to cause glucose spikes and subsequent decreases.

 

[AndyPanda]

Do you know your thyroid numbers? You could take some T3 or take Modafinal or Clenbuteral. I never have energy but mine is psychological.

 

[Calm Logic]

Be certain you are eating an adequate amount of protein with each meal (shoot for around 30/40grams per meal). Protein will help to stabilize serum glucose levels by slowing down the absorption rate of carbohydrates. The carbohydrates are known to cause glucose spikes and subsequent decreases.

But tirz is a diabetes medication, which is why it may cause hypoglycemia in some cases. So you don't need to worry about spikes (as much or at all).

Also, most Americans don't get enough fiber, which can also slow the release of glucose.

 

[Calm Logic]

I have to have a repeat fasting test and A1C.

If you haven't already, I would certainly mention to your doctor that you are taking "compounded" tirz:

Exploring Hypoglycemic Ketoacidosis in Nondiabetic Patients on Tirzepatide: Is Starvation the Culprit? - PMC

Case series Patients: Female, 29-year-old • Female, 34-year-old • Female, 17-year-old • Female, 26-year-old Final Diagnosis: Tirzepatide-induced hypoglycemic ketoacidosis for weight loss in four nondiabetic patients Symptoms: Diarrhea • vomiting ...

pmc.ncbi.nlm.nih.gov

"Tirzepatide can induce hypoglycemic ketoacidosis in nondiabetic patients with obesity when used for weight reduction. Measuring urine and serum ketone levels in patients with gastrointestinal symptoms who are taking dual GLP-1 and GIP receptor agonists is crucial. Medical supervision is recommended when this medication is prescribed."

"The main mechanism of euglycemic ketoacidosis is starvation due to vomiting, diarrhea, and poor caloric intake induced by dual-acting GLP-1 agonists. In addition, dual-acting GLP-1 agonists can suppress appetite, prolong gastric emptying, and decrease calorie intake [5]. The present case series featured hypoglycemia with ketoacidosis."

(Though there are at-home urine ketone tests, the blood test is more accurate.)