Updated: Aug 1
Reactive hypoglycemia is a condition characterized by low blood sugar levels that occur after eating a meal. This guide will provide you with information on how to manage your blood sugar levels, prevent crashes, and make dietary and lifestyle changes to effectively manage reactive hypoglycemia.
Understand the Causes and Symptoms of Reactive Hypoglycemia
Reactive Hypoglycemia”, is also called “postprandial hypoglycemia”. (The word postprandial means “after a meal”). Reactive hypoglycemia is a condition that occurs when blood glucose, or blood sugar, rises rapidly after a carbohydrate meal. The meal may include simple carbohydrates (sugars) or complex carbohydrates like bread, potatoes, or other starchy foods. These foods cause blood sugar to rise rapidly.
This rapid rise is then followed by a significant drop in blood sugar and the associated symptoms of low energy and fatigue.
The blood glucose does not need to be at a markedly low level to experience these symptoms. “Relative hypoglycemia” can also cause the feeling of low energy. True hypoglycemia is generally considered a blood glucose below 70 mg/dl.
However, “relative hypoglycemia” occurs whenever a significant and/or rapid drop in blood sugar occurs, even if the blood glucose does not drop to be technically in the “low” range. A spike in blood glucose from a baseline of 120mg/dl up to 160mg/dl, followed by a “reactive” drop to 85 mg/dl produces similar symptoms. The result of this relative reactive hypoglycemia is the same – low energy and fatigue.
When we eat a high carbohydrate meal, the carbohydrates are digested by our intestines and then released as blood glucose into the bloodstream. The pancreas then releases insulin. Insulin is the hormone that allows our tissues and organs (for example our muscles) to absorb blood glucose to use as an energy source. This allows the organs and tissues to function properly. However, often the amount of insulin released overshoots the mark, resulting in an excessive amount of blood glucose being absorbed by the tissues. When this occurs, the amount of blood glucose in the blood rapidly drops, causing hypoglycemia.
The below image demonstrates this process:
Follow a Balanced Diet with Regular Meal Times
The American diet averages over 300 grams of carbohydrates per day. A hundred years ago that number was less than a third of that amount. The explosion in carbohydrate intake has led to an epidemic of obesity and diabetes (and their complications) . . . but it is also likely the reason for another common condition: the excessive fatigue and low energy many people experience on almost a daily basis.
Reactive hypoglycemia usually occurs within an hour or two after a meal and can last for four hours or more. However, if you are eating carbohydrate-rich meals or snacks often, this process can repeat itself over and over during the course of a day, resulting in recurrence periods of hypoglycemia and fatigue. It may seem to the person ingesting these high carbohydrate meals and snacks that they always have low energy.
Reactive hypoglycemia is compounded by a couple of other physiological processes that prevent the hypoglycemia from reverting rapidly:
The presence of “insulin resistance” - Adults who have been ingesting high carbohydrate meals for years, often have a condition called “insulin resistance”. Insulin resistance is the process that eventually leads to prediabetes and diabetes. (Many American adults are already prediabetic and do not know it. Just because your fasting blood glucose is below 100 mg/dl or your A1C is below 5.7% does not mean that a person is not prediabetic, or that insulin resistance is not present. Most people have some degree of insulin resistance present for more than five years before they are diagnosed as prediabetic or diabetic.) When insulin resistance is present, it means that the body’s organs don’t absorb inulin as readily. This results in higher inulin levels, and more rapid and enhanced spikes and drops in blood sugar.
Here are some key ways to prevent blood sugar crashes and manage reactive hypoglycemia:
Follow a balanced diet with regular meal times. This means including a combination of carbohydrates, proteins, and fats in each meal to help stabilize blood sugar levels.
Avoiding sugary and processed foods as they can cause a rapid spike in blood sugar followed by a crash.
Sticking to a consistent eating schedule can help regulate insulin production and prevent sudden drops in blood sugar.
Consulting with a healthcare professional or registered dietitian can provide personalized guidance on creating a balanced meal plan for managing reactive hypoglycemia.
How can reactive hypoglycemia, low energy and chronic fatigue be reversed with Continuous Glucose Monitoring?
First and foremost, a person needs to have an understanding of their blood glucose levels over the course of a typical day. This can be achieved by a physician prescribing a Continuous Glucose Monitor, or CGM.
A CGM is a temporary wearable device with a tiny probe that measures blood glucose continuously. The device’s sensor transmits blood glucose levels to a smartphone (and remotely to the prescribing physician). A CGM (after being prescribed by the physician) is placed at home by the patient in a 5-minute painless procedure. It is then worn for a two-week period and replaced. With a CGM a person can see how their diet affects blood glucose on a continuous basis, including spikes and drops. A person can if they have episodes of hypoglycemia or relative hypoglycemia after a meal. It can be determined if the reason for low energy is reactive hypoglycemia of relative reactive hypoglycemia.
CGMs also provide constant reminders to those wearing them of how their dietary habits affect their blood sugar. This is why CGMs are also remarkable tools in assisting people in losing weight. Eating behavior is significantly changed when a person is reminded in real-time of the impact of their diet on their blood sugar. When eating behavior is altered with these constant reminders, most people lose weight in addition to improving energy levels.
To reverse the symptoms of low energy and chronic fatigue, a properly constructed low carbohydrate diet is often the answer. This diet may involve both limiting overall carbohydrates and eating the right types of carbohydrates. (In particular “low glycemic” carbohydrates can help avoid blood glucose spikes and plunges.)
The improvement in sense of well-being can be dramatic for many patients. Energy is improved, fatigue is reduced or eliminated, and often weight loss is also achieved. With a CGM and the right diet patients often feel more energized and vibrant than they have in many years.
To learn more about the benefits of using a Continuous Glucose Monitor, check out my book, The Continuous Glucose Monitor Revolution.
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