What Causes Reactive Hypoglycemia?

Reactive Hypoglycemia is a condition, not a disease. Often, the underlying disorder can’t be determined, but that’s not because a real cause doesn’t exist. According to F. John Service, M.D., reactive hypoglycemics fall into three categories, Alimentary Hypoglycemia (this is a consequence of dumping syndrome; it occurs in about 15% of people who have had stomach surgery), early diabetes mellitus or prediabetes (if you have risk factors for diabetes, this could be worth further consideration), and “Other,” sometimes referred to as “Idiopathic.”

If you are reading this article, you most likely fall into the “other” category, as I’m going to assume you know if you’ve had stomach surgery (and have spoken to your doctor about your symptoms), and you have already had a diabetes talk with your physician (always a good idea if you are at risk).

Tracking down why you might have reactive hypoglycemia could be a long process, because there are many different causes for reactive hypoglycemia. Some tests (like a breath test for Helicobacter Pylori Infection) are remarkably easy. Others, like testing for a hereditary fructose disorder are neither easy nor inexpensive.  Here are some causes which you may want to consider when trying to figure out what is causing your reactive hypoglycemia:

• Being Gifted

  Around six percent of highly gifted children have reactive hypoglycemia. This is usually seen in very active, lean children with IQs above 160. The thought is that these children use up the available glucose quickly, crashing mid-morning or mid-afternoon.* For more on this topic see my post Reactive Hypoglycemia in Highly Gifted Children.

• Helicobacter Pylori Infection

  A common stomach bacteria can lead to reactive hypoglycemia, according to current research. If you have other symptoms such as bloating or nausea, a breath test from your doctor can rule of the presence of this bacteria.

• Epinephrine Sensitivity and Insulinemia

  When a reactive hypoglycemic eats a meal high in carbs, the body responds by producing a large shot of insulin, resulting in insulinemia, an abnormal concentration of insulin in the blood. This high concentration of insulin results in the unpleasant side effects of hypoglycemia, and will often subside within a short time period until enough epinephrine is released to balance the insulin. The body’s natural reaction to this influx of insulin is to balance the insulin with compensatory epinephrine. This is where it gets complicated: individuals with a sensitivity to epinephrine will have symptoms of hypoglycemia–shakes, anxiety, sweats etc. Additionally, stress causes more epinephrine to be released, so being anxious about the pounding heart, palpitations and other unpleasant side effects of epinephrine in epinephrine sensitive individuals will lead to more epinephrine being released, and more anxiety. How to decide if epinephrine sensitivity or insulinemia might apply to you? I discovered I was sensitive to epinephrine in the dentist chair (some anesthetics contain epinephrine), but monitoring my blood sugar helped me to determine that epinephrine alone was not the culprit. As of time of writing, Leo and I are still searching for the cause of our reactive hypoglycemia, and we haven’t ruled out some type of hereditary insulinemia.

• Glucagen and Epinephrine Deficiency

  Glucagen works alongside epinephrine in regulating insulin levels.
  According to authors Ellenberg & Rifkin in the book Diabetes Mellitis, glucagen deficiency alone isn’t enough to cause hypoglycemia, although a epinephrine and glucagen deficiency working together will. The only way to determine whether you have an epinephrine and glucagen deficiency is to see a physician and undergo further testing (i.e. blood tests and a Glucose Tolerance Test).

• Hereditary fructose intolerance

  As suggested by the title, this condition is caused by the transmittal of a faulty gene, resulting in a fructose-1-phosphate aldolase. If you have this condition, you are likely to already know about it, but a dietary history can help with a diagnosis: if your symptoms occur after eating fructose or sucrose heavy foods instead of the usual culprit, carbohydrates, this may be worth a second look.

  

  A fructose tolerance test can help with the diagnosis.

• Galactosemia

  Hypoglycemia isn’t very common in this rare genetic disorder, but it can be a problem. Galactosemia affects how an individual processes galactose, a simple sugar found in many foods. Symptoms can range from severe (a failure to gain weight and grow in infants, jaundice, sepsis, and shock) to moderate (cataracts, delayed development). This is usually diagnosed at birth and is one of the rarer causes of reactive hypoglycemia.

• Pharmaceuticals / Drugs

  Many different pharmaceuticals and prescribed drugs can make hypoglycemia worse. If you are taking any of the drugs listed as “potentially causing hypoglycemia” in this document, you should suspect them as a possible cause for at least some of your symptoms.

• Leucine sensitivity

  This is also a rare disorder. Leucine sensitivity causes too much insulin to be released in the body (and thus causing the body to respond the same as in insulinemia, see above for explanation). An L-Leucine Sensitivity Test can diagnose this, but it is a rare disorder. This is usually only seen in adults with other factors (i.e. if you have had a partial pancreatectomy).

• Fibromyalgia

  Reactive hypoglycemia is a common occurrence in people afflicted with fibromyalgia. According to Dr. Devin Starlanyl, reactive hypoglycemia in people with fibromyalgia “is enhanced by dysfunctional neurotransmitter regulation and other systemic mechanisms.”

*Webb, James et. al. Misdiagnosis and Dual Diagnoses of Gifted Children and Adults: ADHD, bipolar, OCD, Asperger’s, depression, and other disorders. (2004) Scottsdale: Great Potential Press. Available from the publisher

Related posts:

1. Reactive Hypoglycemia in Highly Gifted Children

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