Reactive Hypoglycemia: What is it?

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?

Click to skip to the page section:
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
  • 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.

    Back to Top

    What is Reactive Hypoglycemia?

    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.

    Back to Top

    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.

    Back to top

    Top Five Common Misconceptions About Reactive Hypoglycemia.

    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:

    • nutritionally balanced meals, frequent meals and snacks
    • Regular exercise
    • Smoking cessation
    • Weight management
    • Medical supervision, if indicated
    • Regular blood sugar checks, if advised

    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.

    Back to Top
    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:

    • 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
    • shaking
    • lightheadedness
    • dizziness
    • nausea
    • an upset stomach

    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.

    Back to Top

    Endocrine Society Guidelines for Evaluating Reactive Hypoglycemia.

    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:

    • Drugs
      – insulin or insulin secretagogue
      – alcohol
      – 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
      – sepsis
      – inanition
    • • Hormone deficiency
      – cortisol
    • • Nonislet cell tumor
    • 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!

      Back to Top

      Privacy Policy

50 thoughts on “Reactive Hypoglycemia: What is it?

  1. scott witoff

    I’ve just been diagnosed and things are VERY difficult. I’m a 23 year old male who is starting graduate school in September. I’ve seen an endocrinologist and am seeing a nutritionist next week. Dietary changes have helped somewhat but not nearly enough to make me feel normal. Any information would be appreciated. Thanks.

  2. Bernard

    Hi Stéphanie

    i have symptoms that are very close to reactive hypoglycemia: post-prandial somnolence, headache, depression (temporary), palpitations; but that is caused mostly by fats, not by carbs…

    Do you know what this could be ?

    1. Steph


      It could be related to the digestive process (fatty meals make me tired, so I avoid them). As for the exact link or cause — I don’t know.


  3. Anna

    I had gastric bypass in Sept 2004 and since late 2005, I have had times where my blood sugar would drop after eating. And I mean within 20 minutes of eating, sometimes even sooner if it was sugary. I know the sugar causes dumping syndrome, but when that happens and I chew up a couple of glucose tablets, it helps my sugar come back up and my symptoms go away. I have had 5 seizures associated with this and none of them were after eating something with sugar. Mostly just cheese, crackers, pizza, sandwich or other stuff you might have for lunch. I usually stay away from sugar because of this and I drink diet soda also and have for many many years. For some reason, I can go for a period of time where I don’t have this happen and then when it does happen, it tends to happen over and over for weeks. Then goes away for months. My doctor called it Hyper Insulin Sensitivity but from what I am reading here, it sounds like Reactive Hypoglycemia. I have never had my blood sugar go too high and stay there for very long at all. I can feel when my blood sugar gets into the 80’s and I start feeling weak and light headed. I have had all of the symptoms of Hypoglycemia except coma, but grand mal seizures are horrible. When this happens, I have to sleep for hours before I feel halfway normal again. It’s very tiring when my blood sugar gets low like that, but I always try to eat something with protein and not sugar, which seems to work just as well. Has anyone else had problems similar to this? Thanks!

  4. Lara

    It may be a form of dysautonomia, also known as autonomic dysfunction, which can cause reactive hypoglycemia as well as its own similar symptoms. To check for this, you would need an autonomic specialist. While not easy to find doctors because many do not know about or treat autonomic dysfunction,it is worth it if you are consistently bothered. and maintain lists of physicians who can disagnose this.

    Good luck!

  5. maddi

    I am really worried because I have always had this thing where I shake and go pale and stop thinking clearly and become very anxious and clumsy when I dont eat but recently, it has been happening a lot more often and now it seems like I cant even go more than about 4 hours without eating. Today I shook and became anxious plus my palms were pouring with sweat a total 3 times and this was only with gaps of 3 hours before my meals. When I eat again then I feel fine and my mood lifts massively. I feel like a different person. Im terrified to be honest. I know something is wrong. Could it be reactive hypoglycemia??

  6. Sandra

    as I stated, Im learning..teeny tiny steps..for breakfast this morning I had 1/2 cup cooked oatmeal..i dont do milk due to my chronic lung issues so I added a tblsp of cream ch eese for creaminess and a half pack of Splenda along with sliced banana..i had also a slice of raisin bread toast with butter and peanut butter..was that an ok breakfast ? if not what would have been better ? thanks..

    1. Steph


      My breakfasts are usually:
      Skillet veggies (peppers, onions, tomatoes, potato) with egg whites and salsa
      Piece of fruit (usually an apple) and some nuts

      Sometimes (rarely) I’ll have a bowl of organic, unsweetened cereal and milk.

      A sliced banana is high in sugar, and raisin toast is processed food also high in carbs. Oatmeal is a good choice…I would consider adding the cream cheese and some berries to it to sweeten it up (crushed blackberries or strawberries) and a teaspoon or less of organic, raw, unprocessed agave or Stevia (both natural sweeteners, unlike Splenda).


  7. Kim

    Wow! just wow! After seeing “Sugar Blues” on my mom’s book shelf since I can remember (the original 1975 version she probably bought as soon as it was published) you would think I would understand all this. I could not be like all the other kids and eat pancakes for breakfast without getting crazy sick. My parents let me have pancakes (a small serving) if we were out at a restaurant but I HAD to have bacon and eggs and milk with it. It was the only way I didn’t get sick. My mom ate an almost exclusively grain free diet. Beans and tomatoes were virtually her only carbs as I look back.

    Fast foward almost 40 years and I spoke briefly with someone last weekend about my blood sugar after meals and how it dropped low. She said it caused the release of extra insulin/cortisol and then the storage of stomach fat. I looked up hypoglycemia and found your page and others. After thinking my mom was in early dementia I realized that she was actually not taking care of herself post COPD dx and hospitalization. I called her at 4 in the afternoon, about 4 hours after a meal and she was shaking, on the verge of tears, and dispondent. (typical conversation with her since April) She has had memory loss, falling, got lost driving between 2 locations that she has driven 18 years, severe anxiety and depression. A few days of getting back to regular small meals and low carb she is feeling much better.

    I have experienced severe anxiety, felt like my heart would jump out of my chest, and exhaustion. I also have symptoms of lupus or FMS. About 6 months ago I started craving carbs or any food after 10 pm. I wrote it off to not eating enough during the day.

    Long story short, I had gotten a BG monitor at a health fair (I talked them into giving it to me because I wanted to teach my children about their rxn to food) and started monitoring on Tuesday. My first test was after a 7:15 breakfast sandwhich (muffin/egg/cheese/sausage) and dental work – vegetarian brocolli soup. I didn’t test pre-meal but 1.5 hours post meal (first test of the monitoring period) was 98, 3 hr=86, 4hr=72, 5hr=81 when I had a raging headache, very irritable, heart palpitations, yet hyperactive, and finally had a meal. 1 hour after meal of veggie sandwhich with avocado and cheese =136, 2 hr post meal=84, 3hr post meal=86 – needless to say I went to bed with a headache.

    This was a normal day… long times between meals (4 years ago I was told no more eating in my office), not eating high protein because I had gone largely vegetarian (I hate cooking meat at home), and exhausted ALL. THE. TIME.

    I’ve been monitoring for 4 days and the swings in BG are outrageous. While I have not tested below 72, I am feeling RH symptoms at around 80 all the time.

    My son (and daughter) are high IQ. Son matches the symptoms you mention – rages, emotional, loss of appetite, nauseous, headaches, tired but lean and athletic. He has SID and so is very picky about his foods and could live on salads… except for the fact that it isn’t enough calories.

    I can’t wait to read your book! THANK YOU THANK YOU THANK YOU… I hope to feel better soon with a more appropriate diet for my body.

  8. Netty

    I have had problems with reactive hypoglycemia for years and I have problems losing weight ? I read on another site that even eating whole grain beads the body recognizes it as carbs and suggested the South Beach Diet … Am I on the right track ?

    1. Steph


      None of my endocrinologists ever recommended a fad diet! Instead…lots of veggies, whole grains…

      Your inability to lose weight *could* have something to do with the fact that high cortisol makes it hard to lose weight, and people with RH often have high cortisol levels.

      I’d check with your doc…preferably a naturopathic physician…to find out what’s going on with cortisol and why you can’t lose weight.

      Good luck!


  9. Jennifer

    I’m 13 weeks pregnant and have been having lots of feelings of low blood sugar. I’ve always had them some, they’ve just increased during my pregnancy. I will get hungry a couple hours after eating and if I don’t eat, I can get shaky, nervous, etc. So I told my OB, who was concerned because I wasn’t tested for gestational diabetes when I was pregnant with my 4 year old son and he was 9lbs 12oz at birth.

    So last week I took the 1 hr. glucose test and failed with a blood sugar reading of 153. But 2/3 of women who fail the first one pass the second, so I tried not to stress too much.

    After fasting 12 hours (torture for a pregnant woman, haha), I went in for the 3 hr. test this morning. They drew blood and then gave me the orange goop to drink and were supposed to draw my blood every hour for 3 hours.

    About 10 minutes after drinking it, I started to feel funny. I know it makes some women nauseous, so I thought I could deal with. But by 15 minutes after drinking it, I felt really nauseous, cold, and shaky and got up to go to the restroom. On the way I knew I was going to faint and told the tech, who made me sit down.

    Well, I ended up vomiting in the trash can and had to lie down, drink orange juice, and use a cold compress. Since I still didn’t feel better after 20 minutes, they had me call my sister to come pick me up. On the way out the tech said to call my OB and see if he wants me to try again. HA! Like I’m going through that again.

    I’m so confused. All my symptoms were of a hypoglycemic attack. But the nurse I spoke to on the phone later acted like they might just want to start treating me for gestational diabetes. That doesn’t make any sense. If I had diabetes, wouldn’t the drink make my blood sugar turn out too high? The tech had to give me oj to RAISE my blood sugar.

    I feel like they’re not listening when I describe what happened. The nurse even suggested that maybe the sight of my blood during the first draw made me feel bad, which it didn’t. And it was A LOT worse than just light headedness. I still have a bad headache from it 12 hours later and am thinking about just getting a meter and testing my blood myself for a week. What do you think?

    1. Steph


      I wish I knew more about gestational diabetes to be able to advise you.

      That said, get a home glucose meter (an ambulatory meter) and test your blood sugar throughout the day. That way, you’ll have a clear picture of what your blood sugar is doing without having to go through the test from hell! Get a week’s worth of readings and let your doctor know what the results are. You certainly want to avoid being treated for diabetes if you don’t have it.

      A side note — my son’s blood sugar spiked at 160 mg/dL after a sugary drink. But he doesn’t have diabetes — just a sever form of RH.

      Best of luck,

  10. Melanie

    Glad to know I’m not the only one who thinks they are going nuts, because my doctor seems to think so. My symptoms can last for days with never feeling like I have eaten anything (when I really have). BS sometimes never get above 100. If I’m moving around, the sugars drop even faster. Eating used to help, but now it doesn’t unless I gorge on sugar. And of course, that just makes it worse. At least I know the cause of my panic attacks. QUESTION: Has anyone also had problems with adrenal glands or hypothyroidism??

  11. kay

    My son has adhd, bipolar, and reactive hypoglycemia. The blood sugar issues play a large roll in his mood swings, but they’re not the only factor. I feel like 80% of my day is somehow related to feeding him. He eats large amounts of food – huge quantities. He’s 12 and outeats all of the other kids combined (2 adult girls + 2 teenage boys). I’m not overly concerned with the quantity as he’s pretty thin (5’1″ 102#) but I do worry that its a symptom that I still don’t have his blood sugar issues under control. All simple carbs I’ve taken out of his diet, along with all processed food. Anything with corn syrup doesn’t get in the door. I restrict what he can have with actual sugar in it to less than 15g and only if he eats it with something else & only once a day with the exception of berries, apples, and a few other fruits that don’t throw him off- on average 1-2 times a month. He comes home from school for lunch and his teachers have all been told not to give him treats (each teacher he’s had has messed this up at least once. I think they thought I was being mean, but after they personally saw the results they did not do it a second time) My questions are mainly 1- about the hunger since he eats so much – granted he probably burns off more than most as he’s constantly in motion but am I missing something that he’s still that hungry? 2- if his blood sugar drops enough before I can get food into him again he’s in some other horrible world, paranoid, hysterical, everything tastes bad and the entire world us awful that it takes a long time to convince him to eat, sometimes hours during which time things just get progressively worse as his blood sugar drops more- any ideas on how to prevent this? I try to feed him every 3 hours (its a little longer in the afternoon because of the time between lunch and school being out) 3- unless he’s sneaking food, which is entirely possible -but I haven’t caught him since Easter when he got a hold of a pound sized reeses peanut butter egg and threw up for a week and a half afterwards because of it along with all his other symptoms , he’s becoming more and more sensitive – milk used to be ok as long as it was whole milk. Now I have to keep it to less than 6 ounces and balance it out with the rest of his meal just like I would if I gave him something semi sweet and it takes longer to get him back to being balanced out once he’s been thrown off than it used to oh the highest his blood sugar has been recorded was over 400 and the lowest around 50. Those readings both happened to have been taken by medical professionals and not at home so they’re a little more accurate than our home meter he’s not diabetic and his a1c is normal

    1. Steph


      Sorry to hear you are going through this. I went through the same thing with my son. I can tell you that he did sneak food — a lot. But now he is 13 going on 14 he’s finally realizing that sneaking food makes him unwell. His mood swings have finally disappeared to zero.

      Not much you can do to prevent those blood sugar drops :/ I wish I had some solid advice for you, but every kid is different. I do find it a little strange though that his sugar was up to 400. That’s very, very high. I would go to a pediatric endo (and pay out of pocket if you have to!).

      Best of luck,

  12. Christina

    Hi Stephanie,
    I’m a 22 year old grad student living in Washington DC. I have a strong family history of diabetes. (I am happy to know, after reading your article, that extra body weight around the hips decreases a woman’s likelihood of developing diabetes. [finally a reason to celebrate big hips 😉 ])
    Anyway after dealing with the symptoms of RH for a long time, and not knowing the cause (symptoms have become much more severe in the last 6 months) I finally made a Dr appt last week. I’m seeing a new Dr. as I just moved to DC. The place is primary and immediate care center, and I don’t have a lot of faith in their abilities.
    Anyway today I went in for my test results. The Dr. showed me the lab results and explained the dip in bs from 84 to 53 from the 2nd hour to the 3rd hour of the GTT means a diagnosis of RH and not diabetes as was previously thought ( my brother was diagnosed at 22 as well). He then handed me a 2 page print out from the Mayo clinic explaining RH and how to change your diet, told me to read it, he left the room and came back to ask if I had any questions. I asked about the likelihood of still developing diabetes, but I had barely wrapped my head around the idea of RH, much less what questions I wanted to ask. I feel like he completely left me hanging! I have no idea where to start. I’m in the process of reading some of your articles, and my brother is sending me an extra glucometer so that I can try to track my bs levels.
    My main concern is, should I seek a 2nd opinion? Should I be seeing an endocrinologist, or dietitian? I feel absolutely lost and I don’t know what to do 1st. I’m a grad student and I don’t have a job yet so I am really worried about being able to afford to eat healthy, not to mention the fact that I’ve never had a successful diet in my life. Furthermore, with two classes, an internship, and (hopefully soon) a job I cannot fathom the idea of eating every 3 hours.
    I’m pretty overwhelmed with all of this, I know it’s not the end of the world like I’m making it out to be, and I’m extremely happy that it is not diabetes but I really wish the dr gave me more information!

    1. Steph


      Welcome — I’m glad you found the site!

      If you already have the diagnosis, there’s really not much point in going to an endo. They can’t do anything for RH that your primary can’t do (give you information). So now that you have the diagnosis, I’d just say work on your diet — find out which foods work for you and which do not.

      Best of luck!

  13. Holly Foley

    I just wanted to say thank you soo much Stephanie for publishing this website. I was “diagnosed” by my symptoms alone by my Doctor a year ago last month and I felt lost and didn’t know what to do about my symptoms. My doctor told me I most likely had Reactive Hypoglycemia and that the only help would be a diet change. I told him I’d GOOGLE it and see what I could do! He rescheduled me for a month to check on me and off I went! I researched website after website with differing ideas on what you can and can not eat. It was confusing and frustrating. I finally settled on your website and you personally had the condition (as well as your son!) and you just laid everything out there and it just made sense. I thought on the diet change for maybe two days before I convinced myself (with help from family) that a diet change was in order to help myself after years of wondering what my symptoms were caused by. As a teenager I remember leaving the doctors frustrated with a prescription for allergy medicine and trying to figure out why they would ask if I was depressed, or taking drugs. Very disheartening when you have a real issue. As I got older I learned to discern when my symptoms would arise and what would help. Luckily my doctor caught on after I told him I needed to eat or I’d get sick/angry/dizzy/confused and he immedietly told me what it was. Fast forward one year later and I feel really good. Trying out different foods here and there for personal reasons but this diet you have here made it so simple and clear. It is hard to find food you can actually eat but it is so worth it with the way I feel. I found that I can eat the Evaporated Cane Sugar but only if it’s under 10g per serving. Otherwise I can’t hardly speak but it’s nice to know what my symptoms are, what causes them and adjust my diet accordingly. My Mom can’t believe how much different I sound and wishes she would have known about this when I was younger.

    Also My sons started school this year and are exhibiting signs of this condition and once again, I’m thankful for your website and that you have shared your trials with your son. It has been very benifitial to me with my twins. We are in the process of cutting back on their sugar and it seems as though even this slight cut back is climbing a mountain. It is hard to get everyone they come in contact with to “cut back” and to understand how important it is! Like after a big discussion with their teacher she gives them soda because she wasn’t sure if I’d be okay with it. Ahh! I didn’t think I’d have to decide that in school, but we are working toward a better diet and hopefully they can do better in school and focus! I will be glad to end the mood swings!

    But Thank you sooo much for putting this information out there, I don’t know what I would have done without it!

  14. Kathy

    I am so glad I found this site. Very informative and comforting to see others who have issues like mine. I have been having problems with dizziness and lightheadedness for years (onset in 1999). I would get these spells where I just did not feel good for weeks. I had urinary issues as well. They only thing the doctors could come up with was hyploglycemia (54 on a 3 hour OGTT). Things settled down and I went on to have my third child in 2002 at the age of 40. In 2006, my spells returned, but this time with episodes of near syncope. I went to the hospital by ambulance twice in one day for this. Oddly, the EMT on both occasions tested my blood sugar at 135. Maybe my liver compensated for the low, I don’t know. I thought maybe I was having a heart attack or a stroke. I had many tests done – nothing. Then, in 2007 at the request of my rheumatologist (I do occasionally get an elevated ANA, as high as 640) I had a tilt table test which was positive. Finally another answer. However, I do not believe these episodes are totally neurcardiogenic syncope. I wore a monitor for a month and nothing showed up on the test, even when I was symptomatic. The doctors told me my problem was dysautonomia or an anxiety disorder. I have always believed there is something more to this. After another spell in 2008, I did relatively well for 4 years. When I am doing well, I am very active. I run, swim, etc. Nothing too excessive, just good, moderate exercise. Well, last month, this problem reared it’s ugly head again. I was sitting in a movie theater and had this sensation go through the left side of my head, like I was going to pass out. Then I felt a little electrical shock in my chest. My vision got bad, my neck and jaw got real tight and I had trouble speaking. I had my husband take me to the emergency room. The EKG was normal. I talked to the doctor who thought this was a neuromuscular disorder. I decided to go home and sleep it off and went to my doctor that following Monday. She had me get an MRI/MRA of the brain, which was normal. My mom gave me a meter. One night laying on the couch, I felt it again – same sensation. Wanted to go back to the hospital, because it is so scary. I checked my glucose – it was 42. Checked it again – in the 60’s. A few minutes later, it got back up into the 80’s. I did not eat anything to get it back up – came back on it’s own. Something in my body is reconciling this for me. I got some sleep, tried to eat better and did some moderate exercise. Once again, I am feeling good, actually really good. I am following a reactive hypoglycemic diet as best as I can (I love to eat and I love to eat carbs). At the suggestion of my Rheumatologist, she ordered a 5 hour OGTT. I took a meter with me to the test. I don’t have the official results, but here is what I got with the meter. 12 hour fasting, before 1st draw – 77. I drank the orange stuff. I wish I had known to test at 30 minutes, but did not. At 1 hour, my glucose actually went down to 72 (odd). At 2 hours, it went up to 100. At 3 hours, it was back down to 77. At 4 hours it was 61 and at 5 hours it was 62. From what I have read online, this low curve could be a sign of an inuslinoma (could it all be this simple – I almost hope it is). Anyway, sorry this is so long, but I wondered if you have ever experienced the near syncope thing, with your RH and what is your interpretations of my own results on the OGTT. Thanks so much! Kathy

    1. Steph


      I did experience syncope for many years before fixing my RH. I wish I could be more helful, but I’m not a doc. I wish you the best of luck :)


  15. karen

    I’ve been diagnosed with reactive hypoglycemia and am becoming obsessed with food, i’m constantly hungry about an hour after eating no matter what it is. i desperately need to lose weight but snacking on fruit just makes me feel like i’m starving. Not to mention my boss gets angry and thinks i’m being greedy when he sees me snacking. He doesn’t understand how fed up i am with eating but feel so ill if i dont. I’ve even been told its all in my mind. I really need some help with this condition.

  16. Shelley

    Hello. I am so confused :( I was diagnosed with N.I.P.H.S. (Non Insulinoma Pancreatagenous Hypoglycemic Syndrome) I have had Gastric bypass surgery. My confusion is, is this also reactive hypo? just with a fancier name? I haven’t found anything on any of the hypoglycemia sights about this. I am really struggling, I seem to drop at anything that I eat :( My food is so very limited to only about 4 things. It has completely consumed my world. Any comments or suggestions would be very helpful. I have spoken to many Nutritionists and they just don’t seem to “get it”, when I tell them, ” I can’t eat that”, ” no, tried that too, can’t eat it” etc……
    Medicines didn’t help, nothing has helped. Please help me. Thanks :)

    1. Steph


      Yes, it’s essentially the same thing.

      Everything I know is on this site — take a look around. I wish you the best of luck :)


  17. Kathy

    Hi Stephanie,
    I recently checked out your cookbook – 2nd edition. I am a bit disappointed at the errors in the book. For example – the list of foods in bold everyone should be able to eat – nothing is bolded. Then there are a few recipes where the ingredients in the list, are not the same ingredients in the directions below the list. The only recipe I tried so far is the Pasta Bake. – and it was very good! And I did not have any reaction.
    I am confused though as some of the recipes show a load of carbs – like 55 – 100 and I don’t understand that. What is the secret in those recipes with the high carbs that allows them to be accepted by our body? Thanks, Kathy

    1. Steph


      Could you let me know which recipes you found which have different ingredients? I’d be happy to fix those errors and send you a new copy of the book.

      Plant based carbs are easier for blood sugar than, say, carbs that come from processed foods like white sugar. I found that eating a vegetarian diet that is low on processed foods, I can tolerate higher levels of carbs. Of course, this is all individual — but it’s easy to up the protein intake by eating a piece of cheese or a few nuts (even a glass of wine before dinner has been shown to have positive effects on blood sugar levels :) ).


  18. Christine

    So I am happy to have found this website but am not really sure yet if I have RH. So basically I thought I was hypoglycemic my entire adult life. I did the blood glucose tolerance test – 5 hour and all I remember was in the 5th hour my bs dropped down to 27. Fast forward 12 years or so and three kids later I recently had an episode where my bs was dropping drastically. I was scared to death, felt I was dying etc. etc. My sugars were in the 50’s or so and I would eat glucose pills, oj, protein bars to try to bring it back up. What I didn’t know I was doing was taking too much and then my bs would spike and then drop again. This literally went on 24/7 for 3 months. It got so bad they thought I had an insulinoma. I was sent to Stanford University and put in the ICU for three days while they ran the appropriate tests. The funny thing is, is my bs dropped to 46 on the third day of fasting which would indicate an insulinoma but the other numbers didn’t match up so they ruled it out. I sometimes wonder if I still have one. The good news is, after fasting for three days, it seemed to get my body back to some sort of norm. A few months later I noticed that I am struggling with my bs again. Every time I eat, especially after breakfast, my sugars drop. I’ve been trying to figure out what is causing all of this at such random times. Ironically enough, they presscribed me the dexcom 400 which is a continuous glucose monitoring system which I inject a wire into my stomach once a week and it takes my bs every five minutes. It tells me if it’s dropping too fast, too low, etc. Since wearing this, I’ve noticed my bs drops after only 30 minutes of cardio. I’m to the point where I can hardly even workout as I end up needing glucose pills afterwards. Also noticed when I’m stressed, it drops fast. Yesterday I went from 150 to 46 in less than an hour. Then of course I experience the anxiety that comes along with low bs. I am overwhelmed. I need answers. I am willing to do diet change if it works. I’ve been eating complex carbs, have to have lots of protein or it drops quickly but lately none of this seems to matter as it drops anyway. Mostly in the morning. Usually by afternoon it’s easier to manage. Does this sound like RH to you?

  19. SJG

    Last Saturday I played tennis when I wasn’t feeling well. I pushed myself like I was 20 years younger, and came home with my blood sugar dropped. I didn’t measure, but I am familiar with the symptoms. It was the worst I ever experienced. I live a very healthy lifestyle. My diet is high vegetables, fruits, EFA, etc. I’ve never had a problem until Saturday. I did notice a feeling that I MIGHT be dealing with a cold as well, but I am not sure if its from the hypoglycemia or actually my body fighting something. Today I find myself eating, but not being able to keep my blood sugars stable. I am eating the same diet, but I seem to be going a lot less time between meals before I need to eat again, or begin experiencing symptoms of weakness or shakiness.

    Is it normal to be “out of balance” almost a week later?

    1. Steph

      I don’t know if anything to do with RH is “normal.” :/

      All I have is my personal experience, which is when my blood sugar does get out of whack, I feel the effects for at least a week later.

      Good luck!


  20. Sally

    I was diagnosed with RH just over a year ago. I have quite an extreme form of it and everything I do, the weather effects it. I am beginning to settle more with it now and have less hypo’s than I did. I have been lucky that I work for an Emergency Service and have special instructions in place as when I have a hypo the only way to reverse me is to have IV glucose and I also find I need fluid replacement as I get very thirsty. This has been the only informative site that I have found and have not had much support with this at all.

    1. Steph_anie

      Hi, Sally,
      I started this site when I was in the same boat as you. I hope you figure out what’s causing your hypo episodes. Mine is a faulty gene, but a good diet has seen then end of the really bad crashes. Best of luck!

  21. Sally

    Hi Stephanie,

    Thank yiou so much for the response!!, They seem to have put it purely down to RH with no cause. I have actually learnt a lot overnight from reading the info on this site. I am not sure where this site originates from eg USA but I live in England and have had very little help in dealing with this disease and keeping myself healthy, being a single mother as well this is even more important.

  22. Steph_anie

    I’m in the U.S., although I was raised in the UK, so I guess the site might have the feel of both :)

    RH *always* has an underlying condition. It’s a symptom of something, although when doctors can’t find the cause they call it “idiopathic.”

  23. Tracy

    Hi Stephanie, I just want to thank you as your book really was a lifesaver for me!
    I have a serious problem, that I am very concerned about. I have to have a colonoscopy in two days time and the day before I have to have a liquid diet? What do you suggest? I feel sick as it is with my colon and I dont know how I will cope …. feeling desperate and any help will be greatly appriciated

    1. Steph_anie

      I am approaching 50 and I too am wondering the same thing. If you find the answer, please let me know. And I hope it went well for you.

  24. Diane

    I would like to comment on a lifetime of living with reactive hypoglycemia. I am 60 years old and started to have symptoms in my 30’s. I went through 4 doctors, until I finally found one you told me it was food related and did a 5 hour glucose tolerance. He told me to not eat any sugar, in any form, honey and other natural sugars including fruit and especially dried fruit. No white or processed flour or white or pre-processed rice products. As you can imagine 30 years ago the were not natural foods available like today, but I managed to find whole wheat flour. The first week on the diet I felt 90% better and the mood swings, shakes, weakness etc. were much better. I then started eliminating the “hidden” sugars from my diet. Ketchup, mayo, all processed foods containing, sugar, glucose, dextrose, maltodextrin, etc. I carried peanuts or almonds with me at all times, especially when not at home in case I felt shaky. I also ate 5-6 meals per day making sure they contained complex carbos and protein. It took a few years to completely be symptom free, but I can’t remember the last time I have had any episodes. I still do not eat fruit, except I mash up a banana to put in a muffin recipe I have, using WW flour and oatmeal. I have other recipes for pizza crust, pancakes, etc if any one is interested. I also eat Eziekel bread now, but didn’t have 30 years ago. My family has a history of diabetes and my Doctor then told me if I continued to eat the sugar I would wear out my Pancreas and be diabetic. At 60 I do not have diabetes, my cholesterol is low, my triglyserides are low and high, the right ones, and my blood pressure is good. I am over weight, because I eat too much of the right foods, but I also walk at least 30 mins a day and am working on the weight. This is not a quick fix, stay on the diet for a few months or years and then I can eat what I want. This is a life style, a the rest of your life thing, if you want to feel good. I don’t know what would happen if I ate sugar now, I don’t want to find out, I still remember how sick I was, and I don’t want to go back there. No cookie or ice cream is worth that. Hope this helps someone else.

    1. Lynn Manheim


      Your description of your experience is almost identical to mine, except that for about 40 years I was always able to eat as much fruit as I wanted. That is until about 1-1/2 months ago when, having my regular breakfast of two oranges and oatmeal, I crashed, barely able to keep my eyes open. A few days later, armed with a glucose monitor, I repeated the same meal and had the same reaction. My blood sugar climbed to 158, then plunged to 95 in just 13 minutes. Possibly it went lower, but I’d run out of test strips.

      Now most days I eat no fruit at all, but it’s still hard to avoid those very uncomfortable and debilitating blood glucose reactions after meals.

      Chia seeds seem to help, since they slow down digestion. I’ve just bulk-ordered 36 pounds online because I intend to have them with every meal and to bake with them as well. I put about 1/2 teaspoon of the seeds in my mouth before a meal and just suck on them, then chew and swallow. Another teaspoon or so goes into whatever I eat.

      I’m a vegan for ethical reasons (animal rights), so my diet is even more restricted than most. Trying to look on the bright side, I recently learned that my favorite fruit, tangerines, are loaded with pesticides if they’re not organic. So maybe this awful reactive hypoglycemia is helping me to dodge an even worse bullet?

      I’ve asked elsewhere on this site, but can anyone recommend a doctor, preferably an endocrinologist, who is willing to work on the cause of an individual’s reactive hypoglycemia? It probably doesn’t matter where the doctor is, because s/he may know of others in other areas. I saw a nasty SOB of an endocrinologist a couple of weeks ago. He said he couldn’t help me and grudgingly agreed to do a battery of tests, but said I had to fast for 16 hours. Truthfully, I don’t think I can do that without getting very ill.


      1. Steph_anie

        The only doctor who I managed to find who even has a clue about causes of non-diabetic RH is Dr. Frederic Brun, and he is in Europe :/.
        I think the main reason may be that it doesn’t matter what the cause is, there are no drugs to treat it. The treatment is the same (diet/exercise). IF you do find someone, please let me know.

  25. KR


    The childhood night terrors, the fainting, the clumsiness and absent-mindedness, the frequent yet unexplainable upset stomach, the racing heart, the panic disorder (which always seemed to me to be odd for a person that generally had lower-than-average anxiety levels)… I have long sensed that these had to be related somehow, and now I have a way of making sense of it. Thank you so much for helping me interpret my experience and move forward toward better health!

  26. Sally

    I just saying hi again on this site as it is the only place that I can find any info. I have changed my foods about and havent had a hypo for nearly 4 mths now apart from when I had a migraine and was very unwell with it and taken into hospital. I just wanted to say to those that are struggling, or newly diagnosed is dont give in!. My only problem that I suffer from is I feel tired all the time.


  27. Audrey

    It’s difficult to find well-informed people about this subject, but you seem like you know what you’re talking about!

  28. Ashley

    Can someone explain to me what idiopathic postprandial syndrome is? Unfortunately, medical professionals don’t recognize it as a condition that can occur in non-diabetics. I asked my endocrinologist about this syndrome and she said that it is impossible to have if it is not accompanying diabetes. So can someone fill me in on this? I’m almost 100% sure that I have it.

    Thank you

    1. Steph_anie

      Idiopathic means “no known cause.”
      I’d find a different endocrinologst — someone in a teaching hospital should be more up to date on current thinking.

  29. Beth McDonald

    I hope that this post reaches all who have left a comment on this site so that you too can heal your hypoglycemia. I became hypoglycemic in 2006. Like others, I scoured the internet and library for a cure, only to find that there is no cure, and I must manage it through my diet. Which I have, for the past 9 years, until NOW. I am no longer hypoglycemic. A few months ago I tried URINE THERAPY, and it has healed my hypoglycemia. I feel better than I have in many years. Do yourself a favor and research urine therapy on the internet, buy a book from Amazon, read about it! Yes, it involves drinking your urine, but after researching it, you will hopefully be willing to try it. I was, and I will continue it for the rest of my life because I NEVER want to be hypoglycemic again. Urine is sterile, 95% water, and is known to treat and prevent many diseases. A few unexpected benefits from urine therapy have affected my eyes — I have always had “floaters” in my vision. The floaters have noticeably diminished. My eyesight has noticeably improved, and the whites of my eyes are brighter. After I became hypoglycemic, I steadily gained weight, particularly around my waist, which I understand is caused by excess insulin in the bloodstream. Now that I am no longer hypoglycemic, I have lost inches in my waist, which to me is another indication (aside from the disappearance of the more obvious symptoms of hypoglycemia) that my pancreas has stopped secreting too much insulin. From what I have learned about urine therapy, it also can aid in weight loss, so this is another factor that I believe has attributed to my weight loss. Another reason for my weight loss is that I no longer need to eat high protein/fat with every meal like I used to. I am eating fruits that I could never eat when I was hypoglycemic!
    I hope that you will consider urine therapy for hypoglycemia and your overall health!
    My email is if you want to contact me.
    Best wishes for your health.

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>