Hypoglycemia (Low Blood Sugar)
Users on Reddit report varied experiences with hypoglycemia (low blood sugar) while on GLP-1 medications. Some experience it as a new side effect, while others with pre-existing hypoglycemia find the medication either helps, worsens, or has no effect on their condition. The perception of whether GLP-1s directly cause hypoglycemia is mixed, with some users and medical information suggesting they are glucose-dependent and shouldn't cause lows unless combined with other sugar-lowering drugs or due to insufficient food intake.
Experiences with Hypoglycemia:
Symptoms reported include lightheadedness, dizziness, weakness, feeling faint, and disorientation. A user described, "I actually completely wiped out walking into work a few weeks ago. Didn't trip or anything - just was so lightheaded I went tumbling down the sidewalk in the middle of a monsoon. "[3] Another on Mounjaro said, "After the shot, I feel dizzy and lightheaded, sometimes disoriented. "[11]
One user on Saxenda (liraglutide) found it "made my hypo much worse. "[4]
Impact on Pre-existing Hypoglycemia (especially Reactive Hypoglycemia):
Experiences vary. Some find GLP-1s beneficial. A user who developed reactive hypoglycemia after RNY surgery said their GLP-1 medication "absolutely does help. My sugars only range about 20 points now instead of a teeter totter of imbalance. "[16] Another with childhood hypoglycemia stated Mounjaro "has stabilized, for the most part, my episodes. "[10]
Others see no improvement or worsening. One user with reactive hypoglycemia on Ozempic for 5 months reported, "I don't notice any difference at all, it's not made my RHG any better or any worse". [2]
There's interest in whether certain GLP-1s like tirzepatide (Zepbound/Mounjaro) might be better for reactive hypoglycemia due to the GIP component, with one user hearing it "helps with reactive hypoglycemia due to the GIP factor. "[5]
Mechanism and Contributing Factors:
Many users and some medical explanations suggest GLP-1s are glucose-dependent, meaning they lower blood sugar primarily when it's elevated and shouldn't cause hypoglycemia on their own. [3, 9, 12, 13] One user shared, "The glucose-lowering action of semaglutide is dependent on the glucose level... The medication itself does not cause hypoglycemia. "[3]
Combination with other medications: The risk of hypoglycemia is widely acknowledged to increase when GLP-1s are taken with other diabetes medications like insulin, sulfonylureas, or metformin. [8, 9, 11, 12, 13] A user on Mounjaro and Metformin experienced blood sugar in the 60s and lightheadedness, which resolved after stopping Metformin and reducing the Mounjaro dose. [9] Another stated, "The only time I ever had hypoglycemia while on a GLP-1 is when I was taking metformin while taking the med. once I stopped the metformin I had no issues. "[11]
Insufficient Caloric Intake: Reduced appetite leading to not eating enough is a common reason cited for feeling hypoglycemic symptoms. [3, 12] One user mused, "Maybe it isn’t the drug directly but an indirect cause by virtue of not eating enough because of the drug. "[3]
Alcohol: Consuming alcohol, particularly on an empty stomach, is noted to increase hypoglycemia risk on GLP-1s. [14]
Type 1 Diabetes: For individuals with Type 1 Diabetes (T1D), GLP-1s can complicate hypoglycemia management. The delayed gastric emptying caused by these drugs can slow the absorption of carbohydrates used to treat lows. [6] An endocrinologist reportedly told a T1D patient that with GLP-1s, "it’s harder to treat lows... For a T1 approaching or experiencing low blood sugar, this food that’s parked in the stomach can also slow the absorption of glucose tablets or other treatment so the way you would normally treat a low may not be sufficient. "[6] Another T1D user found, "Solid food is useless at raising my sugars now if low. I have to drink juice or some sugary liquid. Even the glucose tabs didnt seem very effective unless I chased them with water. "[20]
Remedies and Preventions Recommended:
Treating Lows (General): "What I’ve found helps is some orange juice, then a little protein like an egg or sliced turkey. Set a timer and wait 15 minutes. "[3]
Treating Lows (T1D with Delayed Gastric Emptying): Due to slowed digestion, liquids are often preferred. "I also find that treating hypos is harder because of the delayed gastric emptying. For me drinking juice boxes works much quicker than sweets like I used to treat with. "[20] Another T1D user said, "Solid food is useless at raising my sugars now if low. I have to drink juice or some sugary liquid. "[20] It was also mentioned that "You absorb fast acting glucose through your mouth also. "[7]
Eating Regularly and Balanced Meals: Some users find they "need to eat more regularly"[10] and that mild hypoglycemia "is easily resolved by eating, and eating properly balanced food". [10]
Managing Alcohol Intake: Recommendations include: "Keep careful track of your blood sugar levels when drinking alcohol Don’t drink alcohol if blood sugar levels are too low, or if your stomach is empty Eat a meal or snack that has carbohydrates when you drink Test your blood sugar before going to bed If your blood sugar is lower than 100–140 mg/dL, eat a snack to raise it. "[14]
Monitoring and Medication Adjustments:
Monitor Blood Sugar: Regularly checking blood sugar levels is advised, especially if experiencing symptoms or when combining with other medications. [9, 11, 13] "I start getting it after getting on Mounjaro , use a monitor constantly". [11]
Adjust Other Diabetes Medications: If taking insulin or oral hypoglycemic agents like metformin, a dose reduction may be needed in consultation with a doctor. [8, 9, 11] One user's doctor "took me off Metformin and reduced my Mounjaro to 5mg. No issues since. "[9]
Medical Consultation:
Users stress the importance of discussing symptoms with a doctor rather than self-diagnosing. [3, 9] "PLEASE don't diagnose yourself with hypoglycemia... tell your doctor! "[3]
One user advised, "I would encourage you to not be distracted by your semaglutide use and to chase down all possible causes of hypoglycemia, from hormonal issues to things like insulinomas. "[3]
Other Tips:
Some users mention electrolytes alongside sugar, for instance, "A couple of those [gummy candy] seem to do the trick! That mixed with some electrolytes should keep the sugars up!
Experiences with Hypoglycemia:
- New Onset or Worsening Hypoglycemia:
- Some users report experiencing hypoglycemia for the first time after starting GLP-1s.
Remedies and Preventions Recommended:
- Dietary Strategies:
- Carry Fast-Acting Sugar: Many users recommend carrying candy, glucose tablets, or sugary drinks.