Blood sugar drop on Reta?

[Lear00]

I didn't use the word "can't." My point was that there's a reason why doctors will warn you about hypoglycemia when starting injectable insulin or a sulfonylurea, but they won't warn you about it when starting a GLP. It's because (symptomatic) hypoglycemia isn't a common risk factor associated with GLP use (unless that person is also taking injectable insulin or a sulfonylurea).

Now every once in a blue moon someone will have something deranged going on with their metabolism where adding a GLP into the mix could lead to symptomatic hypoglycemia, just as every once in a blue moon someone will go blind after starting a GLP. Both are rare conditions and in the case of hypos that person is usually aware that it's a problem for them before starting the GLP because it's historically been a problem.

What you're doing it reading into values on your CGM and even in the absence of feeling light headed, clammy, or losing consciousness you're convincing yourself that you're at risk of something. This is causing you to misapply type-1 diabetic thumb rules in regards to hypoglycemia and think 50-60 mg/dL is a dangerously low blood sugar, despite being a very common level one will achieve on an extended fast and a significant number of normal healthy people will see as a reactive level after a meal without experiencing those symptoms.

Here's what's tripping you up: A type 1 diabetic will sweat a 50-60 mg/dL level, not because that level itself is harmful, but because of the trend that it represents. If their blood sugar is trending downwards AND their body lacks the ability to course correct then by the time they see 50-60 mg/dL on their CGM it's likely their actual blood sugar level is already lower than that. Also, since their body lacks the ability to course correct on its own hormonally, it's important that they initiate action now, since if they wait until it has fallen to a harmful level, it will be too late for them to do so.

So again, everyone is free to wear a CGM and role-play being a type 1 diabetic, but the vast majority of the time it will be unnecessary.

I am a medical doctor, and I certainly don’t have 1/10th of the confidence you seem to have in making such sweeping and definitive statements about a relatively new research use only medication that we are still actively learning about. Internet armchair expertise is risky at the best of times, but particularly so when discussing medications like this.

All the best

 

[tubby]

I am a medical doctor, and I certainly don’t have 1/10th of the confidence you seem to have in making such sweeping and definitive statements about a relatively new research use only medication that we are still actively learning about. Internet armchair expertise is risky at the best of times, but particularly so when discussing medications like this.

All the best

This is interesting because most doctors I encounter fixate on clinical data from research studies and would be dismissive of anecdotal stories (like your CGM data) as "weak." You seem to take a strong interest in N=1 anecdotal stories, which is unique (and I honestly wish more of your peers did that and think you should be commended for that, but that's a gripe for another time).

Out of curiosity, have you tried to investigate what Lilly's response is to that in their phase 2 and 3 trials for retatrutide and if they've instituted any hypoglycemia mitigation measures (like CGM use)? We have published phase 2 trials and have information shared from participants in phase 3 trials. Presumably if this were at all a common issue it would have been caught in phase 2 trials and if not there, at least in the phase 3 trials.

If you do you'll discover that there is a trial where Lilly pairs retatrutide with CGM use and.... (drumroll).... it's in their 3rd TRANSCEND-T2D trial, which is specifically involving type 2 diabetics that are ON INSULIN.

Now this doesn't prove that there is no hypoglycemia risk (and as stressed in my last reply I'm not saying no risk exists). But it does strongly support the idea that if it exists, it exists as an edge case rather than a common side effect.

 

[Lear00]

- 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.

This is a good website to learn how to critically appraise studies and evaluate them for applicability/generalisability.

https://www.cebm.ox.ac.uk/resources/ebm-tools/making-a-decision

External validity refers to the extent to which we can generalize the results of a trial to the population

Look for the main characteristics of the study population. You should be asking how much this population matches the patients you see or how much do they differ. If they differ too much then no matter how good the results are they it will be difficult to justify applying the treatment to your patient from a given paper.

 

[tubby]

This is a good website to learn how to critically appraise studies and evaluate them for applicability/generalisability.

https://www.cebm.ox.ac.uk/resources/ebm-tools/making-a-decision

But I'm not treating patients. I'm offering commentary on pharma products.

The conceptual error that you're making is you're mistakenly thinking blood sugar is as simple as "lower is bad" once anyone get under 70 mg/dL. Lower is only bad when it leads to SYMPTOMS. And that's why my original critique of your FUD was that you weren't experiencing hypoglycemic SYMPTOMS. It's easy to tell the difference (when wearing a CGM such as you did) since you can gauge whether the symptoms accompany periods where blood sugar dips and go away the rest of the time. In fact, you don't even need a CGM to do that.

If you have consistent fatigue or tiredness, that's not going to be hypoglycemia. That's going to be GLP side effects. If you have variable symptoms that come and go minute to minute, hour to hour, that at least could plausibly be related to hypoglycemia. Until a person starts getting those, it's all a moot point.