Reactive Hypoglycemia
Summary
Reactive hypoglycemia (postprandial hypoglycemia) refers to low blood sugar levels that occur after a meal - usually within four hours of eating. This is different from low blood sugar (hypoglycemia) that occurs during fasting.
Reactive Hypoglycemia
A condition in which the pancreas reacts violently to ingested simple carbohydrates and sugars by releasing an excessive amount of insulin. Insulin is the hormone that ensures that sugar from the bloodstream can enter the cells, within cells sugar serves as the primary energy source.
This inappropriate increase in insulin causes blood sugar levels to drop and causes hypoglycaemic symptoms that are very similar to normal hypoglycaemia and can also lead to true hypoglycaemia. How low the blood sugar level falls varies greatly from person to person.
Reactive Hypoglycemia is very similar in symptoms to normal hypoglycemia, even when blood sugar measurements drop after meals but still show normal values and generally do not cause life-threatening comatose hypoglycemia, but it is not exclusive!
In case of serious drops below 50 mg/dl, a doctor can be consulted to prescribe a hypo kit (Glucagon).
Reactive hypoglycemia is very similar to the syndrome Idiopathic Postprandial Syndrome (IPS) which should not be confused.
However, any underlying medical condition that may be causing RH such as prediabetes, post-gastric bypass and POTS should be treated.
Symptoms
● Hungry easily
● Nausea
● Fast heart rate (tachycardia)
● Pale skin
● Feeling of weakness/fatigue
● Sweating/being hot
● Dizziness
● Fear
● Headache
● Often feeling very cold
● Tingling in the lip
● Confusion (brain fog)
● Mood swings
● Irritability
● Morning malaise
● Night sweats and hunger
“Glycemic index (GI)” and “Glycemic load” are terms with different meanings:
If something has a low glycemic index, it will be absorbed less quickly.
If it has a high glycemic index, it is absorbed faster.
“Glycemic load” means that you can ensure that the glycemic index has less effect by adjusting your portions or by combining it with other foods (food rich in proteins and fats).
Diet
Dietary changes will help reduce your symptoms and stabilize RH.
It is important to make the following changes to the diet and timing, including the composition of the meals, such as:
●Eating a balanced diet, including lean and non-meat sources of protein, and fiber-rich foods, including whole grains, fruits, and vegetables
● Avoid sugary foods and processed simple carbohydrates, such as white bread or white pasta, especially on an empty stomach
● Pay attention to foods with a high glycemic index and load
● Eating several small meals and snacks throughout the day, approximately 2-3 hours apart during waking hours
● Potatoes have a high GI.
The GI increases when potatoes are baked or fried and decreases when you let the potatoes cool and therefore eat them cold.
This is because potatoes contain a lot of starch (i.e. carbohydrates), which is temperature sensitive
When cooled, this starch becomes more resistant, so it is not as easily absorbed.
Unpeeled potatoes have an even lower GI.
● Sweet potatoes have an average GI.
The GI is lower than the potato, but still not very low.
It contains 'inulin', which is a type of dietary fiber that lowers the GI. Here again a lower GI if unpeeled.
These do not have as strong an effect as regular potatoes when you let them cool.
Some patients also respond to fruit sugars or (natural) sugar substitutes such as Stevia and slow carbohydrates such as oats.
Once blood sugar levels have stabilized after some time with the diet, you can carefully try adding certain fruits and vegetables to the diet.
Also, each person's diet is different and it is important to keep a food diary to identify any triggers so that they can be eliminated.
Keeping a 'safe and trigger' food list can help with this.
Try to find out how many grams of carbohydrates per day you need and how much you can tolerate without harming your blood sugar level.
It is recommended that you contact a dietitian for more information and support when starting this diet.
Wearing a CGM (continuous glucose monitoring) can also help determine RH, it is also very valuable to discover which foods cause hypoglycemia and when to eat, how the blood sugar level is or is not at certain parts of the day. can keep stable etc.
Unfortunately, the CGM is not reimbursed by the health insurance fund in Belgium because it does not fall under the diabetic convention.
Hypoglycemia
Reactive hypoglycemia causes a sharp drop in blood sugar levels when sugars are consumed, which can lead to hypoglycemia that can differ per person. A sudden drop in blood sugar levels can occur within half an hour and up to 3-4 hours after a meal.
The first phase of hypoglycemia occurs when the blood sugar level falls below 70 mg/dl, the second phase occurs when the blood sugar level falls further below 60 mg/dl, and the third (less common) phase occurs when the blood sugar level falls below 40 mg/dl and is considered a severe hypoglycemia that also requires medical attention.
When a patient experiences symptoms of hypoglycemia, this can vary greatly individually. Patients may first experience symptoms of hypoglycemia with a blood sugar level lower than 80 mg/dl.
Recognize the symptoms of hypoglycemia in time and eat on time to prevent hypoglycemia!
Sugar is the primary cause of hypoglycemia, fast carbohydrates the second.
Some patients cannot sense (incipient) hypoglycemia coming in time, the body does not send a signal when blood sugar levels are falling and this is also called hypoglycemia unawareness.
The cause of hypoglycemia unawareness may be that the body has often experienced hypos or because nerves have been damaged (autonomic neuropathy).
Wearing a medical ID jewelry around the neck or wrist may be necessary for medical assistance in the event of severe hypoglycemia.
For most people with reactive hypoglycemia, the actual cause of its origin is not clear.
But the symptoms of this condition may be related to what food was eaten or variations in the timing of the food moving through the digestive system.
Possible causes of reactive hypoglycemia include alcohol, certain surgical procedures (gastric bypass or peptic ulcer surgery), hereditary metabolic disorders and some tumors or enzyme deficiencies.
Not much is yet known about this condition and it may also be related to prediabetes and the autonomic nervous system, further scientific research is needed.
Generally, a medical evaluation is performed to find out if the symptoms are caused by low blood sugar and if so, whether the symptoms improve when blood sugar levels return to normal.
If you have more severe symptoms, additional tests may need to be done.
There are various tests that can be done to determine reactive hypoglycemia, such as a sugar tolerance test and fasting glucose test (admission to hospital where the patient is kept fasting for a number of hours or days and the blood sugar is regularly checked).
Measuring the HBA1C value in the blood can also be done, but it is not conclusive, provided this represents an average value of the blood sugar level over the past three months.
However, any underlying medical condition that may be causing RH such as prediabetes should be treated.
Anti diabetics
Reactive hypoglycemia usually does not require medical treatment.
Some antidiabetic agents can help stabilize blood glucose levels, such as Metformin, even if the doctor suspects that these patients may have prediabetes.
Metformin works by reducing the amount of sugar the liver releases into the blood.
It also ensures that your body responds better to insulin.
However, these medications and their positive effect have not yet been fully proven and do not have a beneficial effect on every patient.
Side effects can also occur when taking medication that can no longer be taken in the long term.
Environmental factors
Environmental factors can also play a major role in regulating blood sugar levels, physical, emotional and environmental.
Intensive sports or efforts also have an influence on blood sugar levels, sugar is the main energy source of our body that provides us with energy in the body and brain.
During exercise, the body obtains glucose from the muscles as an energy source, so ensure there is sufficient glucose in the body before exercising or performing a certain sport and recognize the first signs of possible hypoglycemia in a timely manner.
Exercise and exertion can also cause blood sugar levels to rise because the liver releases glucose into the body that is stored as a reserve to keep blood sugar levels stable, this also happens at night. Blood sugar levels can drop and rise again without having to eat, this is called a rebound.
The liver can store and use up to 100-120 g of glycogen when needed, which is up to 10% of the liver.
The muscles can store 300-600 g of glycogen.
It is recommended to take action and eat something when the blood sugar level drops to 80mg/dl.
→ Study on a possible link between reactive hypoglycemia and dysfunction of the autonomic nervous system can be read here.
→Here you will also find a video of a lecture given by Dr Shibao (Dysautonomia Center of the Vanderbilt University) about the autonomic regulation of glucose in POTS patients.