About Reactive Hypoglycemia

Ah….reactive hypoglycemia (aka RH). The above pictured blood sugar level was obtained by eating a handful of jelly beans. As you can see I did NOT finish eating handful number 2 which contained about 20 or so jelly beans. My sugary enjoyment was cut short when the sweating, blurry vision, heart palpitations and shakes suddenly kicked in. In the short time it took to hit me I had reached 46 and could have dropped lower before my emergency blood sugar raising procedure had kicked in.

So what exactly is reactive hypoglycemia?

It’s basically episodes of low blood sugars that occur somewhere within 4 hours after eating a high carbohydrate meal. While hypoglycemia reactions are generally thought of happening to those who are diabetics, reactive hypoglycemia occurs in those who are not diabetic.

What causes reactive hypoglycemia?

While the causes for every case isn’t written in stone some general reasons might include that some people are more sensitive to the hormones that play a role in controlling blood sugar levels (glucagon, insulin, epinephrine, etc). Others might over secrete these hormones when it’s not necessary. While people have metabolic issues (both genetic and surgery related) that can cause these hormonal reactions. No matter what the cause the body is basically over reacting to the presence of carbohydrates causing blood sugar levels to drop to abnormally low levels. In some cases symptoms are also felt when blood sugar levels drop quickly in an extremely short period of time but they don’t go below normal. Huge drops happening in 10 or 15 minutes feel just as horrible as low blood sugar levels. Trust me on this one.

How is reactive hypoglycemia diagnosed?

Your doctor can have your HbA1c level tested. It tests the average blood sugar level you’ve had over the last 2 or 3 months. The only problem with this test is how often your experiencing these drops. If they happen once in a while your HbA1c will most likely come back normal. This is because it’s an AVERAGE. If your blood sugar levels are normally within a range of 70 to 100 mg/dl but you have 3 or 4 drops into the 40’s then your average over several months will still show up normal.

Another method to test for RH is to have a 3 or 6 hour glucose tolerance test. For this test you fast before drinking a drink that contains glucose. Your blood is then drawn over the test time so they can watch how you react and what your blood sugar levels are doing.

Of course, if you suspect RH, testing your blood sugar levels during any episodes you might experience can help your doctor to diagnose you as well. Keep a log with what you ate before the symptoms occurred, what your symptoms are and your blood sugar level if you tested.

Types of reactive hypoglycemia:

– Congenital enzyme deficiencies: these are genetically caused and include conditions such as hereditary fructose intolerance and galactosemia.

– Hormonal hypoglycemia: sometimes experienced by those with hypothyroidism

– Late hypoglycemia: occurs when there is a delay in early insulin release from pancreatic beta cells. This results in a high spike in blood sugar followed by a late drop in blood sugar levels (4 to 5 hours later instead of the usual 2 to 3) when the glucose tolerance test is performed.

– Postgastrectomy Alimentary Hypoglycemia: this results from rapid emptying of the stomach contents after a meal. In surgical weight loss patients this is similar to “dumping” that occurs after eating a high carb meal. This does not just occur in weight loss surgery patients but in others who have had some type of stomach surgery (ex: surgery due to stomach cancer).

Symptoms of reactive hypoglycemia (usually occur within several hours of eating):

– flushing and sweating

– blurry vision, hazy vision

– heart palpitations or fluttering

– dizziness, lightheadedness

– tremors, shaky hands

– nervousness, irritability, panic attacks, depression

– trouble thinking, confusion

– headaches, nausea, vomiting

– fatigue

– sudden increased appetite, craving certain foods such as sweets/junk food

– extremely low blood sugars can result in seizures and even coma if not treated

Treatment for reactive hypoglycemia:

While some cases may require medication to control the release of glucagon, if that is the cause, most people control their RH through diet. The following is generally recommended:

– eat small meals and snacks every couple of hours to maintain blood sugar levels

– avoid eating meals that are mostly carb based

– limit your sugar intake (drinks such as specialty coffee drinks are especially sneaky sources of sugar)

– if eating carbs choose foods that are high in fiber to help delay the absorption of sugars by the body

– always include a bit of protein and fat when eating carbs, again, it helps to delay the body absorbing the sugars that make up the carbs

– when eating grains avoid highly processed ones – stick with whole grains (see the fiber note above)

– avoid rapidly absorbed sugary foods such as soft drinks, candy, cakes, cookies, etc

– limit alcohol – it can cause crashes too

– exercise on a regular basis

A few extra tips:

– ALWAYS carry some type of snack, glucose based candy (Smarties candies are glucose) or other commercially available product to eat in case you have a reaction while away from home. Always. Better safe than sorry.

– I’m sure this probably doesn’t need to be said but I’m going to mention it anyways. If you think you are experiencing symptoms while driving STOP! I know I’ve personally gone from fine and walking around to confused and unable to focus in minutes. Thankfully it’s been while I’m at home or some place where I can ride it out until my blood sugar levels return to normal. When your at the point that you can’t explain what is happening to people around you then driving, or continuing to drive, is a recipe for disaster.

Please remember, I’m not a doctor and don’t play one in real life. If you have RH or think you do please contact your doctor.


5 Responses to About Reactive Hypoglycemia

  1. Thank you for this post and all of your helpful advice 🙂

    I’m pretty sure that my body over secretes glucagon, epinephrine, and cortisol when my insulin spikes as my body sees any spike in insulin as a danger or a threat. I have recently developed insulin resistance at the age of 19, at a healthy weight, and very active so I know my weight or inactivity didn’t cause it. Do you know more about this condition?

  2. Thank you so much.
    I have struggled with problems exactly like you describe for years. I have asked various doctors for help to no avail. I actual asked one doctor if I had diabetes(my grandmother suffered with it) and he laughed at me saying I had described the exact opposite of diabetes and sent me on my way feeling like a fool! Tonight, in arestaurant I couldn’t believe it, I saw my son have exactly the same reaction that I have been describing to doctors for all my life (50 years). He had eaten a big lunch so did want a full meal instead opting for just the pudding. We were talking sensibly when the next minute his eyes were rolling, he was yawning and flopping about and he couldn’t string a sentence together. I was horrified it was everything I have tried to explain to doctors played out before my eyes. The previous day my son had all but crashed a large Cat (type of tractor) and couldn’t remember a thing about how it may have happened, waking up at the last minute and swinging the vehicle around so it only took out about twelve foot of hedge! Thank goodness there was no ditch.
    How do you actually get a doctor to take notice of this condition. I may also add that I suffer from low blood pressure as does my son, but in this country it is not recognised as a problem and yet I feel that the two conditions are related.

    Just had to let you know and thank you for writing in the first place. I now feel a little more confident to approach the medical profession again and seek help, more for my son now than myself.

    • Hi there,

      Sadly it seems that reactive hypoglycemia is not something that doctors think of right away. The symptoms can usually be blamed on so many other things. One of the easiest ways to gather some information to help your doctor out is to purchase a cheap glucometer to measure blood sugar levels. When you or your son starts having a reaction check the blood sugar levels. When my issues first began I started doing this. Doctors can’t ignore having blood sugar levels down in the 40’s. Good luck and I hope you are able to find a solution to the problems you are both having.

      • I’m confused. You say to avoid simple carbs, then say to carry glucose tabs in case of an emergency. Wouldn’t these just make things worse and continue the cycle of severe blood sugar issues?

        Thanks in advance.


        • Hi Kelly, I have had issues with reactive hypoglycemia for a few years now. I have to also carry glucose tabs with me for those unexpected drops. When you drop, it is important to get your sugar up immediately. It is life threatening for your sugar to go to low. These glucose tabs are ONLY meant to get your sugar up quickly, then you are supposed to consume something that will sustain your blood glucose at a healthy number. Milk is great at keeping a nice stable level. So in an emergency drop, consume a couple glucose tabs, then follow that up with a glass of milk…or a lean protein, healthy fat, and a complex carb. This will get you up and keep you up. FYI, reactive hypoglycemia triggers are not the same for everyone. Many complex carbs that they say don’t drop your blood sugar, drop mine into the 40’s in a heartbeat. I find it best to stay away from all grains and stick to just lean protein, healthy fats, and low glycemic veg and fruits. But that’s how my body works.

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