"This site changed my life...thanks for everything, Steph!" -Olivia, San Diego, CAHow To Get Diagnosed for Reactive Hypoglycemia
Filed under: Diagnosis | 28 Comments »If you think you might have the condition (click here for the top ten signs you may have reactive hypoglycemia), you should read this before you make an appointment with your doctor.
Let me first tell you that I knew my symptoms were reactive hypoglycemia before I went to the doctor. My ten-year-old son, Leo, has the condition, so it wasn’t difficult to figure out what might be causing my mental confusion, mood swings, heart palpitations, hand tremors, cold sweats and anxiety two hours after eating pizza. My doctor, however, had other ideas…
The Doctor’s Visit
I wouldn’t have made an appointment with my physician if I hadn’t been concerned that, considering both Leo and I had the same disorder, that we might have an underlying condition. A missing liver enzyme perhaps, or some other hereditary disorder.
My idea was that if the doctor could pinpoint a cause, he might be able to solve Leo and my problem with a simple supplement or the like, instead of a restrictive diet.
I specifically chose an Internal Medicine doctor from my health plan, thinking that an “expert” in puzzling, chronic problems would be my best choice (an internal medicine doctor is sometimes called “the doctor’s doctor” because of their expertise in pinpointing conditions with a myriad of symptoms).
It turns out that doctors–even internal medicine doctors– are only human.
An Odd Conversation
The doctor, I’ll call him Dr. Brown, listened as I explained that my son and I had the same symptoms, that I had monitored my blood sugar and it appeared I might have reactive hypoglycemia. I also told him about how my son had been diagnosed by his pediatrician. I asked him if I should be concerned about any hereditary disorders.
He did a quick physical examination and asked me if I felt stressed. Puzzled, I noticed that my hands were sweaty. “My hands sweat when my blood sugar dips” I said.
He nodded, left the room, and came back with a sheet of paper. He handed it to me. The top of the sheet said “Signs of Depression” and included questions like “Are you having difficulty sleeping?” “Do you have thoughts of worthlessness?” “I’m not depressed,” I said. “I feel fine, except after I eat certain foods like potatoes or lasagna…” He nodded thoughtfully, told me I needed to lose weight because I was at risk for diabetes (I’m 5 pounds overweight and have no history of diabetes in my family), and handed me a sheet on diabetes. “Hypoglycemia is one of the first symptoms of pre-diabetes,” he said. “Lose weight, and exercise more. Avoid carbs and root vegetables like potatoes and carrots. Come back for a check up in six months.”
Don’t Avoid Carrots
I was stunned about how a physician with so much training in internal medicine could be so wrong. Here are just a couple of reasons he didn’t have a clue:
- According to the Mayo Clinic, the cause of reactive hypoglycemia isn’t usually pre-diabetes. In fact, without a whole lot of expensive testing, it often isn’t clear what the cause is at all. Researchers think that it could be caused by a sensitivity to epinephrine, or a glucogen deficiency, to name just two.
- Hypoglycemia can be a symptom of pre-diabetes, but reactive hypoglycemia and hypoglycemia are two very different diseases, and need to be treated as such.
If you have reactive hypoglycemia, please don’t avoid carrots. I was floored by the amount of misinformation there is out there on what reactive hypoglycemic should and shouldn’t eat. I even found one website that said to “avoid soups and breads of all kinds.” Oh my, no wonder people have trouble managing this disorder! If you are interested in reading more on diet see my diet post, and you can also check out my article The Top Five Common Misconceptions About Hypoglycemia to find out exactly why you shouldn’t stop eating carrots. I’m working on a cookbook too, so other people won’t have to go through what my son and I did.
I’m not suggesting that you don’t go to the doctor. To the contrary–it’s a good idea to go for a checkup and a basic blood test to make sure you are otherwise in good health. But when you do go, go armed with the information, and if something sounds wrong or goes against your research, seek a second opinion: reactive hypoglycemia is an unusual condition and most doctors are simply not equipped to deal with it. Make sure your doctor knows that you want a hyperglucidic breakfast test (HBT), or better yet, buy a home glucose monitoring kit and tell him your results before asking for the HBT.
There are only two ways to diagnose reactive hypoglycemia: a Hyperglucidic Breakfast Test and a home blood glucose monitoring kit. Of the two, the home glucose monitoring kit is probably the easiest. See my article on Tests for Reactive Hypoglycemia for further info.
If only I knew what I knew now, I would have ordered a blood glucose monitoring device and saved Leo the uncomfortable experience (not to mention the expense…two copays at $35 each, and a $200 lab bill). A home blood glucose monitoring kit is the same kind of kit used by people with diabetes. They are small, inexpensive gadgets, and involve a tiny pin prick on the finger, smearing a tiny drop of blood on a test strip, and waiting for the machine to beep and tell you your blood glucose level. The entire process takes less than 5 minutes.
I used one like this excellent blood glucose monitoring device which cost less than a single visit to the doctor. Once I figured out how to work the device (about ten minutes), I monitored my blood sugar every hour or so for a full day. It was almost painless: after the initial hesitation (it took me a few breaths to summon up the courage to prick my finger), I discovered that it wasn’t as bad as I thought it would be.
My Results
A normal blood sugar reading is 70 to 140 milligrams per deciliter or mg/dL. This chart, will give you an idea of what blood glucose levels look like normally, and what they look like for reactive hypoglycemia.
You cannot tell by this chart alone who has reactive hypoglycemia and who has prediabetes (amongst other things, your insulin needs to be checked too, to see if you are insulin resistant or insulin sensitive).
Here are a few of my readings from the first day I tested with the home blood glucose monitoring device. Bear in mind that the home test kits are not as accurate as a lab, and I’ve read reports that they can vary by as much as 20 mg/dL. However, it gave me a good idea of what was going on with my blood glucose when symptoms occured:
- 9 a.m. After a “good” breakfast of kamut flakes, wholewheat toast, jelly and coffee: 150 mg/dL.
- 11 a.m. (feeling weak, dizzy, and panicky): 30 mg/dL.
- 11:10 a.m. After I ate two glucose tabs (available from any pharmacy) and drank a carton (8 oz) of fruit juice: 60 mg/dL. I still felt shaky, and a little anxious.
- 11:30 a.m. After one more carton of juice: 70 mg/dL.
- 12:30 p.m. After lunch: 115 mg/dL I felt great…no longer panicky. My glucose continued to rise immediately after eating.
I continued to monitor my blood glucose for long enough to pinpoint that my glucose was dropping about 2 1/2 hours after eating. Not everyone’s blood glucose will drop at that point…for my son, his plummets after 3 hours (and when I say plummet…I mean plummet. He convulsed and went to the emergency room more times than I’ve been to see a doctor my whole life. See my other blog article called Why My Son Had Nightmares to read more).
At time of writing, one company out there offers a FREE home glucose monitoring kit that comes with ten free test strips. They’re betting that you’re a diabetic, and that you will continue to use their very expensive (over $1 each) test strips. Reactive hypoglycemics do not need to monitor their blood glucose except to diagnose the illness, and perhaps for a little while after diagnosis to aid in symptom recognition (i.e. I know now when my hands get sweaty that this is the first sign my glucose level is dropping, and that I need to eat).
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Reactive Hypoglycemia
[...] Reactive Hypoglycemia Just another WordPress weblog « How To Get Diagnosed for Reactive Hypoglycemia [...]
[...] 7. Have you had panic attacks, or have you been diagnosed with a panic disorder?I have. I even went on medication (Buspar) for a year. But I never could shake the feeling of feeling frequently nervous and shaky. I’d have heart palpitations and stomach churning and trouble breathing…all symptoms of a low blood sugar crash. If you have had panic attacks and are an anxious person, think about when these attacks happen. If they tend to occur after meals (1-3 hours after), and you feel that perhaps the diagnosis doesn’t quite “fit, “you may want to read the article on How to Get Diagnosed With Reactive Hypoglycemia. [...]
[...] I could fill a book with the bizarre health incidents that have happened to my family over the last two generations (yes, my mother most probably had reactive hypoglycemia as well, we think). If you or your family members have had a list of strange ailments and disorders like us, my advice is to write everything down, and if you think reactive hypoglycemia is the cause, be insistent with your doctor! It is difficult to obtain a diagnosis, but the test is remarkably easy and cheap (if you haven’t already, see my article on How to Obtain a Diagnosis for Reactive Hypoglycemia). [...]
[...] a good idea to check your blood sugar using a home blood glucose monitoring device–see How to Get Diagnosed for Reactive Hypoglycemia for more info), but the two hour rule works for most people to avoid a crash. That equates for me to [...]
Hi,
Love your website – thanks for posting such useful info.
I have read elsewhere online that reactive hypo can not be measured by a glucose meter (which doesn’t make sense to me), but I am going to buy the one you recommend and give it a try. I’ve been fighting out of control hypo for at least 15 years. I’m certain it is reactive hypo. I have been diagnosed in the past with a pancreas that produces too much insulin. The hypo seems worse since having my gall bladder removed in September – do you know if there’s a link between gall bladder removal and hypoglycemia?
Kelly,
I’m not a doctor, so I can’t say for absolute certain. However, as gall bladder removal affects digestion of fats and essential fatty acids, it doesn’t seem too much of a stretch that it could cause hypoglycemia (Some studies indicate that a low fat, high carb diet contributes to reactive hypoglycemia). If I were you, I’d seek out a knowledgeable endocrinologist, someone who is willing to test your insulin/glucagon responses to try and determine the root cause of your hypoglycemia.
As for the home glucose test not being able to measure your RH, there is the possibility that you test your blood too late (i.e. after your body has responded to the excess insulin by releasing epinephrine and glucagon). That said though, nearly all the articles I’ve read state that the Ambulatory/Home test is often the preferred method. It worked for me!
I haven’t come across a link between gall bladder removal and hypoglycemia in my reading so far, but if I do, I’ll post it!
Thanks for the comment
Steph
[...] a good idea to check your blood sugar using a home blood glucose monitoring device–see How to Get Diagnosed for Reactive Hypoglycemia for more info), but the two hour rule works for most people to avoid a crash. That equates for me to [...]
[...] 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 [...]
[...] he passed out. After he was diagnosed with reactive hypoglycemia (for more on that see my post How to Get Diagnosed), the pieces of the puzzle fell into place. However, we wanted to know the cause. Wouldn’t [...]
[...] your doctor might recommend you take to diagnose reactive hypoglycemia. As discussed in my article How To Get Diagnosed for Reactive Hypoglycemia, there really are only two ways this can be done (Hyperglucidic Breakfast Test and at Home). There [...]
[...] I could fill a book with the bizarre health incidents that have happened to my family over the last two generations (yes, my mother most probably had reactive hypoglycemia as well, we think). If you or your family members have had a list of strange ailments and disorders like us, my advice is to write everything down, and if you think reactive hypoglycemia is the cause, be insistent with your doctor! It is difficult to obtain a diagnosis, but the test is remarkably easy and cheap (if you haven’t already, see my article on How to Obtain a Diagnosis for Reactive Hypoglycemia). [...]
[...] time and cash to be tested (actually, you can do it for free if you follow the advice in my article How to Get Diagnosed With Reactive Hypoglycemia, and send off for a “sample” blood glucose monitor). What do you have to [...]
Why do you recommend testing? This and most other sites about reactive hypoglycemia suggest that the diagnosis can be made, or at least suspected, on the basis of typical signs and symptoms, and then recommend testing by OGTT. Yet numerous studies have found no distinctive OGTT pattern shown by most people with reactive hypoglycemia, and all of the patterns said to be characteristic of reactive hypoglycemia are common in the general population without symptoms. So why advocate testing at all? Why not simply recommend that people who are tired, depressed, anxious, shaky, sweaty, irritable, and/or overweight should eat lower-carb, smaller meals with healthier foods, since this is the treatment that goes with the diagnostic label anyway? Why is it desirable to call it “hypoglycemia” and confuse it with more dangerous conditions that need more complicated testing, and treatment with hormones, drugs, or surgery?
John,
Testing (by the Hyperglucidic Breakfast Test) is the only way to diagnose RH. (The OGTT has been completely discredited for the detection of RH). Why do I advocate testing? In part, to avoid misdiagnoses and to assist other parents in my position; in my son’s case, his seizures were suspected of being caused by something neurological (i.e. epilepsy), and a diagnosis helps with avoiding drugs and unnecessary tests (i.e. CAT scans).
Additionally, knowing you have RH (as opposed to prediabetes or other forms of hypoglycemia) is important because they are treated differently as far as diet goes. People with RH should eat every 2 hours–this is unique to this condition.
Hope that helps explain my position,
Best,
Stephanie
Someone pointed your site to me on http://www.stevepavlina.com forum. I’m going nuts with all, often conflicting, information out there. This is the first time I realise there is a difference between reactive hypoglycemia and “just” hypoglycemia.
I’ve been panicking about going into a coma or something so this site already helped in that regard.
I was tested for glucose and insulin (we call it glucose and insulin curve over here). My insulin levels were extremely high 3 hours after I ingested the sugary drink.
Then the hospital’s nutritionist gave me a “personalised” diet and it included cereal and yogurt for breakfast. Thanks to the glucose monitoring device, which I also acquired, I realised my blood sugar went to 150 after half an hour of having breakfast and an hour later it was 62, and I was already feeling shaky.
I believe I’ve always had this and I always had trouble focusing at school. I’d have either excellent results or terrible results at school with no defined pattern. However I was always overweight and never had much energy.
Not sure if I have reactive or not… :s
I’m really enjoying your site and I’m going to keep coming back.
Susana,
That sounds exactly like me! I was terrified I was going to go into a coma when my blood sugar dipped. There’s a lot of bad info out there!
I’ve written a little about food and such in some of the articles, but as a starter, check the sugar/carbs in your cereal and yogurt. Most cereal has a ton of sugar, and yogurt is usually sweetened with sugar. Try switching to something like Kamut Flakes (find in a health food store) and yogurt that’s sweetened with fruit juice or evaporated can syrup–that’s part of what worked for me.
Glad you found the site!
Stephanie
The article is usefull for me. I’ll be coming back to your blog.
I spend 12 years on medication for Panic/Anxiety. I was always looking for a natural solution when I ran across a webpage from Australia stating that Panic/Anxiety was due to reactive hypoglycemia. 12 years on medication for absolutely no reason. I picked a blood glucose monitor too. My sugar was very low 2-3 hrs after eating. I’ve corrected this problem with strickly grassfed beef, free range poultry, salmon, organic vegetables and fruit, healthy snacks, pure water, sunshine and nutritional supplements. The drug companies are getting rich by the misleading diagnosis “Chemical Imbalance”. “Chemical Imbalance” is a theory only. Never proven. I’m fine now. If start to not feel well I eat a healthy snack with protien. Try this approach and see if it does not work. I was in bad shape before I made these changes.
Michael,
I absolutely agree–except for the meat that is (I am a vegetarian bordering on vegan). A natural diet without all the processed crud is a must for this disease,
Thanks for stopping by,
Stephanie
I had shakinesss,dizziness, mental confusion and feared i was going to fall or something many times for a few months. The Doc did a variety of tests and finally he said diagnosing with RH. However i was fearing its something seriously wrong with me. The more i was worried, the worse the symptoms used to become. Worst part is the mood really swings to depression and you feel its the end of the world.
Untill i read these articles and changed my diet. First 2 weeks i strictly followed the diet and i feel much better. In fact i am almost back to normal (for 2 months now) and have much better carb tolerance. The breakfast si the key. toast with peanut butter and some pecans working for me so far.
I am really glad i found this site
hi i was diagnosed with adrenal failure oh 10- 15 years ago..they simply put me on natural low dose of cortisol I did a saliva test
finally had to go off it because i ws plumped upp, so sick but no one ever suspected the hypoglycemia connection which I always got shaky as a kid when I forgot to eat..now Im having panic attacks since hubbies tragic sudden death they put me on meds but i wake up in panic at 4 or 5 am
Ive been eating bannansa when i get up or go to bed trying to eat more often had oatmeal this am, then had that bannana mid morning my stomach has hurt all day!
I did not know it was a bad fruit for adrenals & hypoglycemia Im sure I have & the extra stress.. causing panic
anyone knowof good naturpath or do I go to endocronologist to help me thru this I live in kansas city well olathe ks
Thnaks
I’m so sorry to hear about your husband 8(
Let’s see if I can help:
Panic attacks are common for people with RH. What I do to avoid nightmares and waking up in the middle of the night is eat a slice of Ezekiel toast with peanut butter. Ezekiel is a special brand of bread that’s not really “bread”, it’s a protein, but it looks and tastes a lot like bread. If your grocery store doesn’t carry it, then try 1/3 cup of mixed nuts. The idea is to get protein into your system before you go to bed. That should stabilize your blood sugar long enough for you to get a full night’s sleep.
Also, something that triggers hypoglycemic episodes for me is stress itself. Epinephrine is a hormone that’s released when you get stressed, along with Adrenaline. There are different causes for RH, but in my case, I’m very sensitive to Epinephrine (I get the shakes when I go to the dentist after they numb me, because Novocain contains pseudo-Epinephrine!), so when I get stressed, my blood sugar plummets. That might be happening to you. I suggest trying your best to take it easy, simplify your life as much as possible, go on vacation, whatever–for just a while, and see how that helps your anxiety.
Best of luck to you!
Just found your site and have been reading it with awe. Recently my son who is 37 had what he thought was a heart attack coming on at work. They brought him by ambulance to the hospital and after running an EKG and tests, found his heart to be fine. They did a full blood work up on him and his thyroid appeared to have a question and was told he should see his primary doctor soon, which he did. (His symptoms were feeling faint, heart palpatations, sweaty hands, numbness in his arms and hands.) He went to his primary doctor who ran more blood work and decided he should see an
endocrinologist, which he did. Again, they did more blood tests. They “suspect” thyroiditis but are not sure. They want to do an “uptake scan”. After all of this, he is experiencing the symptoms of anxiety, feeling faint, not sleeping well, shakey hands, etc.
Then when he was at work ( a new job, by the way!), he felt this panicy state coming on again, shakey legs, etc.
A few days ago, my son was explaining to me how he felt dizzy when he had been bending over on the floor and then rose up. I asked him if he had eaten anything and he said he had just ate a donut. (Not the best, I know!) After listening I suddenly thought of myself. I have hypoglycemia and definitely need to eat every 2-3 hrs…depending. My sister also has it. My other sister is a nurse and she is thinking that he may have it as well. I am just wondering if we should mention this to the endochrinologist before he puts my son through this uptake scan. I told him to eat healthy and every 2 to 3 hrs. – low carbs, high protein meals/snacks and see how it affects him. By the way, I have been with him at times when he has to eat “right now” – like when you KNOW your blood sugar has dropped and you have to get something right away.
Sounds like a pretty classic case of Reactive Hypoglycemia. I would definitely let the Endocrinologist know about your family history, and whether he has it or not, your diet advice to him seems sound. Let me know what happens!
Very interesting article. I fully agree with your statement about Doctors. I went for a ‘regular checkup’ (one is expected to take annually!) for the first time. I was tired and sleeping for most of the time for 2 days after the test. Just a week before, I told my wife when she went for the test, that the blood taken for the test is quite small in quantity and need not bother about it. She was feeling ok, and, I have been sleeping and tired for 2 days after the test. After browsing the net, I realised it is the cause of Glucose Tolerance Test, where I had taken 80gms of glucose on empty stomach. My fasting sugar was 98, and, 2 hours later (PP) it was 65. The doctors whom I have consulted, including a diabetologist, were not concerned about this at all. I intend changing my diet to include more proteins and fibre and reduced carbs as advised in these columns. Thanks a lot for all the tips and advise.
Thank you for this article! I was diagnosed with RH 3 months ago. I changed my diet and it made a huge difference in how I feel.
I also have hypothyroidism and maybe adrenal fatigue. I think my RH is somehow connected to a malfunctioning thyroid and adrenals.
Maggie,
You could certainly be correct. I *think* my RH is connected to epinephrine sensitivity, but with zero actual research in this area, even my doc is relying on educated guesses. Hopefully there will be more research in the future.
Glad you found the site!
Stephanie
I have been very concerned about my teenage daughter’s physical health for a while now and watched her closely on vacation. Up until recently, my daughter has been a happy, although low energy girl.
She put on 20 lbs. over the winter and has been really irritable and tired when she doesn’t eat. I have really good “instincts’ when it comes to my childrens health, and I am the total opposite to a hypochondriac, but my guts told me this is a physical, not psychological issue. I thought she might be hypoglycemic and I don’t know that much about it. Long story short, as soon as we got home I went on the internet and found your site. As it turns out, my daughter was diagnosed with anxiety disorder 4 years ago, and she also has been complaining about headaches, difficulty breathing and sometimes queasiness. Does
this ring a bell? As soon as she starts eating, her mood immediately lifts! She loves ice cream, desserts, bread and pasta more than anything, which also helps putting this puzzle together. Thanks for all
of the information. I feel that I am on the right path and intend to test her blood sugar levels. Thank you, thank you, thank you.
P.S. My daughter is also adopted and we have very little information about her genetic background, so I am working from
a real lack of knowledge.