Causes of Reactive Hypoglycemia and How to Prevent It

Reactive hypoglycemia is also referred to as postprandial hypoglycemia. This condition is characteristic of a person’s blood sugar (blood glucose) dropping following the consumption of certain foods. This is also called a "sugar crash," and typically happens four hours after a person eats. It is one of two kinds of hypoglycemia that are unconnected to diabetes. The second kind is called fasting hypoglycemia and this occurs when you haven’t eaten for an extended period, or you have particular medical conditions. Additionally, the specific cause of reactive hypoglycemia is oftentimes a mystery. However, there are a few medical conditions that are linked to it. And, if you are dealing with this condition, it may be possible to restore your blood glucose levels to a normal level with certain, tailored diets.

What Is Hypoglycemia?

Hypoglycemia refers to low blood sugar. The prefix "hypo-" means "low", and "glycemia" refers to the glucose (a primary source of energy the body needs) in the blood. When your body’s blood glucose levels dip below normal, hypoglycemia occurs. Also, when glucose levels fall under 60-70 mg/dl of blood, a person begins to experience symptoms of hypoglycemia.

Hypoglycemia is often found in people with diabetes, whose blood sugar may drop because they postpone or skip meals, take too much diabetes medication, or exercise without adjustments to their medication or food intake. However, a person may also experience hypoglycemia because of nondiabetic reasons.

Types of Hypoglycemia

There are two kinds of hypoglycemia, fasting hypoglycemia and reactive hypoglycemia

Fasting Hypoglycemia

This kind typically occurs when a person goes a long time without eating. Particular medications, alcohol, or ailments can also trigger low glucose levels. In addition, low levels of hormones may also be the culprit.

Reactive Hypoglycemia

This is a non-diabetic hypoglycemia that typically occurs specifically following food intake, particularly high-carbohydrate foods. It may not cause blood sugar levels to fall below 60-70 mg/dl.

In this case, it’s not the absolute blood sugar that’s the concern. Instead, it’s the sudden rise and fall of blood sugar levels that may occur after eating. As such, if you notice your blood sugar levels rising to the 100-120mg/dl range, and then quickly drop to around 70-80mg/dl, you may begin to have the symptoms of hypoglycemia, even while your blood sugar is within the normal range.

Still, reactive hypoglycemia may be an indication of pre-diabetes or suggest that a person may be at risk of developing diabetes. Furthermore, it may be due to a person having had stomach surgery in the past.

Symptoms of Reactive Hypoglycemia

Symptoms of reactive hypoglycemia typically vary from one person to the next depending on how quickly or severely their blood sugar levels fall. Consequently, symptoms may also differ from episode to episode in an individual as well.

Common Symptoms of Reactive Hypoglycemia

Common symptoms may include:

• Hunger
• Headache
• Shaking or tremors
• Anxiety
• Rapid heartbeat
• Tingling close to your mouth
• Sweating
• Fatigue
• Weakness
• Loss of muscle control

Severe Symptoms of Reactive Hypoglycemia

A severe drop in blood sugar can lead to significant or debilitating symptoms, especially in people who suffer from dehydration, and may require that the person receive immediate medical attention. These symptoms may include:

• Confusion
• Behavioral changes
• Blurry vision or double vision
• Slurred speech
• Clumsy movements
• Seizures
• Fainting
• Irritability
• Brain fog

While a single episode of reactive hypoglycemia doesn’t usually warrant cause for alarm, if the symptoms are severe, don't ignore the symptoms. Instead, address them quickly. Also, a recurrent fall in your blood sugar levels may indicate an undiagnosed health issue, like Addison’s disease.

Evaluation for Reactive Hypoglycemia

It can be difficult to identify reactive hypoglycemia. Lab test results, such as for blood glucose levels, are usually normal, which leaves sufferers frustrated and uncertain what to do. Some doctors may even tell their patients that everything is fine.

To check if a person has reactive hypoglycemia, the level of glucose in the person's blood needs to be checked as symptoms appear. A blood glucose reading below 70 mg/dL, may have your doctor make a recommendation for a mixed meal tolerance test (MMTT). This test involves feeding the individual a beverage rich in protein, carbohydrates, and fat. This can sometimes be Boost or Ensure. Following the beverage intake, the person’s blood glucose levels are retested at 30-minute intervals for a period of five hours. Furthermore, this test is also effective at monitoring the person’s insulin (a hormone that the pancreas produces that regulates blood sugar) levels in the blood.

It’s important to note that several health issues can mimic hypoglycemia because they may share some of the same symptoms, such as dizziness, sweating, weakness, and rapid heartbeat. Conditions that one can mistake for reactive hypoglycemia during an assessment include:

• Anxiety
• Heat exhaustion
• Menopause
• Migraine headaches
• Hyperthyroidism
• Syncope

However, to be sure that there is a link between your symptoms and hypoglycemia, your doctor will likely check for signs of the "Whipple Triad." Your doctor will look for three things:

• Symptoms of hypoglycemia
• Low plasma glucose reading accompanying your symptoms
• A lack of symptoms when your glucose increases to normal levels

Subsequently, if you lack these three symptoms, your doctor will likely evaluate for other health issues that share similar symptoms to reactive hypoglycemia.

Causes of Reactive Hypoglycemia

Based on an article in the Journal of Personalized Medicine, reactive hypoglycemia is not linked to any metabolic disturbance, but is related to individual factors that contribute to the severity of symptoms.

There are several possible causes of reactive hypoglycemia. A common trigger is a person consuming foods or drinks that are high in carbohydrates.

According to studies, reactive hypoglycemia appears to occur when, after you eat carbohydrate foods with a high glycemic index, your body produces higher levels of insulin to counter hyperglycemia and move the glucose into cells. However, the body doesn’t produce enough glucagon, which can counteract the action of insulin. Consequently, at the point that your blood sugar drops, your body does not increase glucose through gluconeogenesis or glycogenolysis. These are critical processes that play an active role in the production of blood glucose from stored nutrients in your body.

Still, other conditions may cause non-diabetic hypoglycemia. These include:

Deficiency of Certain Digestive Enzymes

This can disrupt the body's capacity to break down food. As such, there are problems with the level of glucose that is available for absorption in the intestines. This deficiency can be the result of health issues like cystic fibrosis, chronic pancreatitis, and pancreatic cancer.

Late Dumping Syndrome

This condition can lead to symptoms that are similar to reactive hypoglycemia following gastric bypass surgery. According to an article in Nature Reviews Endocrinology, “late dumping syndrome can be attributed to the development of hyperinsulinemia, or reactive hypoglycemia.” This complication is characterized by an inadequate amount of glucose from food because of the food's quick movement through the digestive tract. Specifically, the food moves too fast from the stomach into the duodenum. Furthermore, it has no link to blood sugar levels.

Insulinomas

This condition features rare, non-cancerous tumors in the pancreas that trigger the overproduction of insulin. As a result, a drop in blood sugar occurs. However, insulinoma typically results in more pronounced, fasting hypoglycemia instead of in-between-meal hypoglycemia.

Non-Insulinoma Pancreatogenesis Hypoglycemia Syndrome (NIPHS)

This rare condition causes changes in the pancreas that lead to the production of too much insulin. Extra insulin can lead to lower levels of glucose in the blood.

Addison's Disease and Adrenal Problems

This condition causes a deficiency of hormones that the adrenal glands are responsible for producing. As a result, this leads to an increase in a person's sensitivity to insulin. Another common condition that can lead to inadequate adrenal hormones is Adrenal Fatigue.

Reactive Hypoglycemia Symptoms and Adrenal Fatigue

Adrenal Fatigue (AF) is the non-Addison's form of adrenal dysfunction, where the body's stress response cannot keep up with life's chronic stressors. Caused by adrenal dysregulation due to chronic stress, Adrenal Fatigue disrupts the proper functioning of different systems in the body, including the bioenergetic circuit that impacts your metabolism.

A link has long been established between adrenal fatigue and blood sugar imbalances (most often reactive hypoglycemia). Sufferers of adrenal fatigue frequently have the urge to eat to eliminate the feeling of anxiousness or fatigue. However, not long after eating, brain fog sets in and the feeling of hunger reemerges in a couple of hours. The result is feeling what can be characterized as “hangry”, which is a mix of constantly being hungry and angry. Also, sometimes it’s called postprandial reactive hypoglycemia, which is hypoglycemia that happens after eating.

Adrenal fatigue causes difficulty producing normal levels of stress hormones, like cortisol and adrenaline. The stress hormone cortisol stimulates the liver to release stored glucose into the bloodstream for the cells to use as energy. Additionally, it helps convert fats and proteins into glucose. Compromised adrenal glands that are functioning at less than optimal levels struggle to produce the hormones to produce additional glucose when it is needed, such as during a hypoglycemic episode, leading to reactive hypoglycemia. This situation worsens in late-stage adrenal fatigue.

This connection can also be described by the bioenergetics circuit of the NeuroEndoMetabolic (NEM) Stress Response System, which is comprised of the pancreas, thyroid, and liver. Hypoglycemia can occur due to blood sugar imbalances due to problems with insulin, which is produced by the pancreas. In addition, your metabolism may burn off energy faster due to high levels of stress hormones, triggering the production of glucagon to balance insulin by gluconeogenesis via the liver.

Alleviating Reactive Hypoglycemia

You will need to address the cause to address reactive hypoglycemia. When it’s caused by an underlying health issue, the focus should be on managing the medical condition that is the root of the problem. For someone who has insulinomas, the surgical removal of an insulinoma would be the route to go, or the partial removal of the pancreas in the case of someone with NIPHS.

For many people, adopting certain dietary changes may also help prevent future episodes. According to Matthew and Thoppil in Hypoglycemia in StatPearls, a lack of adherence to diet is the most common reason therapy fails.

Diet Changes to Prevent Reactive Hypoglycemia

Sugar and simple carbohydrates in your diet tend to cause a big spike in insulin production in your pancreas. As a result, a significant amount of the glucose goes from your blood into your cells. This then lowers blood sugar and tricks your mind into thinking that you are hungry again. This causes you to eat more and more food, with may start the cycle all over again.

In contrast, eating complex carbohydrates and foods that are high in fiber, protein, and healthy fats, don't cause a big spike in insulin, but instead, a small gradual peak over a longer period. This gives your GI system a longer time to digest the foods, which allows you to remain satiated for longer.

Getting good nutrition from small, frequent meals can also help. You can help prevent drops in blood sugar by having good nutrition every 2 to 3 hours. Ensure that these meals contain high-quality complex carbohydrates, protein, and healthy fats, and keep sugar and caffeine limited. Also, avoid eating sugars/carbs first.

If symptoms do not disappear, you may want to eat smaller meals and snacks more often. In addition, because the metabolic profile of people varies, the exact type of food and frequency should best be personalized to meet your body's needs.

Furthermore, adding supplements like Dr Lam's Chromaster, which contains the essential trace mineral chromium, may help. This supplement boosts insulin to support healthy blood glucose levels already within the normal range, and it also plays a crucial role in the proper utilization of protein, fat, and carbohydrates.

The Takeaway

Reactive hypoglycemia symptoms can have you feeling tired, angry, and always hungry. Both your eating patterns and mood may fluctuate because of it.  It's not a condition that is easy to identify, and it could also be the result of specific underlying health conditions. You should not ignore the symptoms because they're an indication that something is wrong.  However, avoiding sugar and simple carbohydrates in your diet, along with eating smaller but more frequent meals high in protein, fiber, and healthy fats could help you avoid blood sugar spikes and crashes.

If you need help determining what could be causing your symptoms and safe dietary changes that work for your body, the team at Dr. Lam Coaching can help. We offer a free, no-obligation phone consultation at +1 (626) 571-1234 where we will privately discuss your symptoms and various options. You can also send us a question through our Ask The Doctor system by clicking here.