If you’re here for information on Reactive Hypoglycemia (or Postprandial Hypoglycemia, as it’s sometimes called), you’re in the right place!
What is Reactive Hypoglycemia?
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Types of Hypoglycemia.
What is Reactive Hypoglycemia?
What is Idiopathic Reactive Hypoglycemia?
Top Five Common Misconceptions About Reactive Hypoglycemia.
Signs and Symptoms of Reactive Hypoglycemia.
Endocrine Society Guidelines for Evaluating Reactive Hypoglycemia.
Causes of Reactive Hypoglycemia.
What is Hypoglycemia?
Hypoglycemia is a condition where your blood glucose drops below normal levels. Glucose is a source of energy for your body that comes from food. When you eat, your body digests the food and absorbs glucose into the bloodstream. Insulin, which is released from the pancreas, helps your cells create energy from the glucose. When your levels of glucose fall, your pancreas releases another hormone called glucagon to break down glycogen (which is extra glucose stored in your liver), returning your glucose levels to normal. Hypoglycemia occurs when this process becomes impaired, either because the body uses glucose too quickly or the glucagon-response is impaired.
What are the Different Types of Hypoglycemia?
Hypoglycemia can be broken down into several categories:
- Diabetic hypoglycemia. This is usually caused by diabetic medications such as chloropropamide or nateglinde
- Reactive hypoglycemia (sometimes called postprandial hypoglycemia). Hypoglycemia that is caused or exacerbated by the food you eat (particularly carbs and sugary food/drinks). It’s usually treated with dietary changes.
- Pre-diabetic reactive hypoglycemia
- nutritionally balanced meals, frequent meals and snacks
- Regular exercise
- Smoking cessation
- Weight management
- Medical supervision, if indicated
- Regular blood sugar checks, if advised
- Cold extremities and nose
- a state of confusion or panic
- a craving for high sugar or high carb foods
- varying mood swings and personality changes
- an upset stomach
– insulin or insulin secretagogue
– other drugs
- • Accidental, surreptitious, or malicious
- • Endogenous hyperinsulinism
- – insulinoma
- – functional beta cell disorders(nesidioblastosis)
- – noninsulinoma pancreatogenous hypoglycemia
- – postgastric bypass hypoglycaemia
- – insulin autoimmune hypoglycaemia
- – anti-insulin antibody
- – anti-insulin receptor antibody
- • Idiopathic postprandial hypoglycemia
- • Critical illnesses
– hepatic, renal, or cardiac failure
- • Hormone deficiency
- • Nonislet cell tumor
If you’re pre-diabetic, you’ll experience the same symptoms as someone with reactive hypoglycemia. The difference is that the reaction is caused by insulin resistance, as opposed to insulin sensitivity. A hyperglucidic breakfast test can differentiate between the two conditions.
With the exception of diabetic hypoglycemia, which may require emergency administration of a glucose source, the treatment for all other types of hypoglycemia is the same: change the diet to include small, frequent meals rich in complex carbs and eliminate most sources of sugar from your diet.
Simply put, reactive hypoglycemia is a blood sugar disorder; it’s a symptom of an underlying condition. If you have reactive hypoglycemia, your body’s gluco-regulatory system (the part of your body that turns food into fuel) does not operate normally. You will experience blood sugar highs that you probably won’t notice, and blood sugar lows that you most probably will (ranging from mild shakes and feeling ill, to severe nausea, fainting and even seizures).
If you have reactive hypoglycemia you’re going to notice a host of strange and alarming symptoms an hour or two after eating a meal. Shakes, sweats, nausea, mood swings, blurred vision, confusion and lethargy are all common symptoms for the condition. In severe cases, you may faint or even have seizures (which can be a medical emergency).
Is reactive hypoglycemia a real disorder?
However, research from the last couple of decades and the advent of the 5-hour glucose tolerance test and particularly the hyperglucidic breakfast test has proved that reactive hypoglycemia (hypoglycemia that occurs because of something in the diet) is a real disorder.
What is idiopathic Reactive Hypoglycemia?
The term “idiopathic” is a word that means from an obscure or unknown cause. In the case of reactive hypoglycemia, it used to be that reactive hypoglycemia was a “false” hypoglycemia, because the low blood sugar could not be reproduced in the lab. It was researcher MA Charles, who coined the term “postprandial idiopathic syndrome” for the people who didn’t “really” have hypoglycemia.
Idiopathic reactive hypoglycemia
Here’s where the tricky phrasing of idiopathic reactive hypoglycemia comes in. What the term “idiopathic” is supposed to mean is that you have reactive hypoglycemia, but that it isn’t caused by any known disease or underlying issue (like you’re missing a piece of genetic material). But what often happens is that a doctor will test you for pre-diabetes (perhaps with a glucose tolerance test) and then he’ll tell you that you have “idiopathic reactive hypoglycemia” because you don’t have pre-diabetes.
In fact, what should be happening is that you get a battery of tests for known causes for RH (celiac, insufficient growth hormone, yeast infection, helicobacter pylori infections, epinephrine sensitivity and more). Only then, when the doctor has ruled out all causes for your reactive hypoglycemia should he be telling you it’s idiopathic.
Of course, you can’t always blame the doctor. Some doctors (like one I went to a few years back) are plainly incompetent (He wrongly diagnosed me with prediabetes when in fact I had celiac disease and a systemic yeast infection) but others have to work within the confines of an insurance system that won’t pay for that battery of tests.
The good news is, if you’ve been diagnosed with Idiopathic Reactive Hypoglycemia, you probably don’t have a life-threatening disorder — just a very real and uncomfortable one. The solution to nearly all reactive hypoglycemia (idiopathic or not) is to change your diet to a reactive hypoglycemic diet.
Charles MA, Hofeldt F, Shackelford A. Comparison of oral glucose
tolerance tests and mixed meals in patients with apparent idiopathic
post-absorptive hypoglycemia. Diabetes, 1981, 30, 465-470.
1. Reactive Hypoglycemia is the same thing as Hypoglycemia.
They are not, and this distinction is extremely important because they are treated differently. According to the McKinley Health Center at the University of Illinois, reactive hypoglycemia can be managed with:
Perhaps most importantly, reactive hypoglycemia does not generally lead to a more severe condition. On the other hand, hypoglycemia (without the “reactive,” is often a sign of more severe disease such as diabetes). Hypoglycemia is often treated by eating a low carb diet, but three meals a day instead of the six meals recommended for reactive hypoglycemics. That’s why it’s important to get a proper diagnosis…you will not feel better if you are reactive hypoglycemic and you follow a diet for hypoglycemics!
2. Reactive hypoglycemics cannot eat carrots or potatoes.
If you’ve read my article on How to Get Diagnosed for Reactive Hypoglycemia, you’ll have read that my doctor told me to avoid eating carrots. The misconception that carrots are a high glycemic index food and therefore should be avoided is simply untrue. I quote here from Yale-New Haven hospital:
“carrots have a glycemic index of 92 which is high. But, in a typical serving size of one-half cup, there is only 4.2 grams of carbohydrate. So, the calculated GL is only 3.9 which is low (GL = 92/100 X 4.2), showing that this food is unlikely to cause a disturbance in blood sugar or insulin response”
In plain English, don’t eat four cups of carrots in one sitting. The decision to eat, or not eat a food does bring up an interesting point. I’ve found that I can eat most foods in small quantities, if I balance those foods with something else. For example, I will eat potatoes in a vegetable soup…just not a whole baked potato on its own with butter.
3. If you have reactive hypoglycemia, avoid all soups–they’re too high in sugar.
Totally untrue. The key here is to read your labels. Compare Campbells’ Tomato Bisque with Amy’s Kitchen Chunky Tomato Bisque. They both have a similar sugar content: one serving of Amy’s soup has 14g of sugar obtained from High Fructose Corn Syrup, while one serving of Campbells’ has 15g of sugar obtained from High Fructose Corn Syrup. The difference is the type of sugar being used. High Fructose Corn Syrup (HFCS) has a High Glycemic Index, meaning that it has a big effect on your blood sugar level (this is bad because the aim here is to keep your blood sugar stable, not raise it to the kind of level that will necessitate a large crash). Evaporated Cane Sugar is an unrefined sugar which is quickly burned off as energy and has a negligible effect on blood sugar. The moral here is you can eat soup, but avoid soups that are sweetened with high fructose corn syrup or other refined sugars.
4. You can never eat bread again.
Pure rubbish. You just need to eat nutrient dense bread like Ezekiel’s 4:9 (available in the freezer section of my local Publix) or whole grain breads (check for no sugar or high fructose corn syrup). Pumpernickel and Sourdough tend to have a lower GI, but like any other food you consume as a reactive hypoglycemic, you should check your labels and avoid anything sweetened with sugar or high fructose corn syrup. Don’t be fooled by the label “whole grain” either. I made the mistake of purchasing a loaf from my local store thinking it was healthy, only to find it has HFCS. I stick almost exclusively to Ezekiel’s now…they have a great cinammon raisin variety and also make hamburger buns and English muffins. I never have a blood sugar spike after consuming these products.
5. Reactive Hypoglycemia can lead to diabetes, coma, and/or death.
See item #2: reactive hypoglycemia can make you feel like you need to be hospitalized, but it isn’t usually indicative of a serious health problem. There are extremely rare cases of coma and death in patients with other ailments such as Grave’s Disease, but unless you are one of these extremely rare individuals, you body will eventually recover and raid food stores to raise glucose levels back to normal, even if you don’t eat. Get your yearly blood work, and if all looks good, don’t worry about slipping into a coma…you have a better change of being killed by a cataclysmic storm (about 1 in 4,000 lifetime risk) than you do dying by anything vaguely related to your reactive hypoglycemia.
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Signs and Symptoms of Reactive Hypoglycemia.
There are many signs of hypoglycemia, but postprandial hypoglycemia has a bit of a twist. Instead of a diabetic hypoglycemia state where the person can eat a sugary item or drink and bounce up, nondiabetic reactive hypoglycemics must eat protein, as sugar tends to drive them lower. The signs for the condition are the same whether it is diabetic hypoglycemia or postprandial:
If you are having these type of symptoms and you aren’t getting answers whenever you tell your doctor, start a home monitoring system and check your blood sugar numbers (blood sugar monitors can be purchased for around $50 from pharmacies — you can often find free offers). If you seem to get these signs after an hour or two after a meal, you could be postprandial. If you notice that this seems to be the case, start altering your meal pattern to include smaller meals more often throughout the day. I’ve noticed that this tends to keep a more level blood sugar reading and doesn’t have the highs and lows of three meals a day.
If you are struggling with getting a diagnosis for reactive hypoglycemia,
you aren’t alone. Countless people research the disorder on the internet, only to be dismissed by doctors who say “You shouldn’t believe everything you read on the internet.” I was one of those people. If you are having trouble finding a sympathetic doctor, you might find the guidelines issued by the Australian Endocrine Society to be helpful (print them out and give them to your doctor!).
If you have documented Whipple’s triad (symptoms of hypoglycemia, low plasma glucose and alleviation of symptoms when your blood sugar returns to normal), it’s recommended by the Endocrine Society that your doctor begin to evaluate you to find the cause of your hypoglycemia.
Second, if you are experiencing symptoms that you believe are due to reactive hypoglycemia (perhaps through ambulatory testing) and your doctor has not observed an episode, it’s recommended you undergo a mixed meal test.
Causes of Reactive Hypoglycemia.
There are dozens of causes of reactive hypoglycemia in non-diabetics. Most are laid out in the guidelines. They include:
Has your doctor ruled out all of these diseases? If so, you’ll probably get a diagnosis of idiopathic reactive hypoglycemia, which is treatable. If your doctor hasn’t ruled out these disorders, and you have a definite blood glucose issue (shown through mixed meal test or ambulatory blood tests), then find a more sympathetic endocrinologist. Your health could depend on it!