Reactive hypoglycemia: what it is and how to deal with it

Fighting both high and low blood sugar is actually an expected part of living with diabetes.

But reactive hypoglycemia is different from the usual low blood sugar that people with diabetes face because it has different causes.

In this article, you’ll learn everything you need to know about reactive hypoglycemia: what it is, how to manage it, and how to better prevent it.

Symptoms of low blood sugar

It’s important to recognize the symptoms of low blood sugar before it becomes an emergency.

Low blood sugar is usually defined as a blood sugar level below 70 mg/dL. Even people without diabetes can experience low blood sugar!

Signs to watch out for include:

Shakins
Dizziness
Bow
Difficulty concentrating
Exploitation
Confusion
Fast heartbeat
Weakness and extreme fatigue
Feeling weak
Hunger
In severe cases, loss of consciousness, coma and death

If you suffer from frequent low blood sugar levels and are not diabetic, you should talk to your doctor.


What is reactive hypoglycemia? 
Reactive hypoglycemia (also called postprandial hypoglycemia) is a type of low blood sugar that occurs after meals, usually between 2 and 5 hours after eating. 
This is different from fasting low blood sugar because it is caused by the release of too much insulin relative to the food consumed. 
There are three different types of reactive hypoglycemia:
Food reactive hypoglycemia – This is a form of reactive hypoglycemia that occurs about 2 hours after the end of a meal. 
Idiopathic reactive hypoglycemia – This is a form of reactive hypoglycemia that occurs about 3 hours after the end of a meal. 
Late reactive hypoglycemia – This form of reactive hypoglycemia occurs 4 to 5 hours after the end of a meal. 

What are the causes of reactive hypoglycemia? 
Scientists aren’t sure about the exact causes of reactive hypoglycemia.  However, people who often suffer from reactive hypoglycemia usually have pre-diabetes or have diabetes and suffer from gastrointestinal dysfunctions such as gastroparesis. 
In addition, people who do not have diabetes but are hormone deficient sometimes also have reactive hypoglycemia. 
Reactive hypoglycemia can also be caused by a cancerous tumor, excessive alcohol consumption, or recovery from surgery, especially gastric bypass or ulcer surgery. 
Reactive hypoglycemia tends to be more common in people who are overweight and obese.  In fact, suffering from reactive hypoglycemia, especially late-onset reactive hypoglycemia, can increase the risk of developing diabetes. 

How to deal with reactive hypoglycemia? 
If you suspect you have reactive hypoglycemia and you don’t have diabetes, ask your doctor for a mixed meal tolerance test or MMTT. 
Here they will serve you a sugary drink that raises your blood sugar, causing your body to produce more insulin.  After that, your doctor will keep a close eye on your blood sugar over the next few hours to see if you have a spike followed by a crash. 
A drop too low (less than 70 mg/dL) a few hours after drinking a fluid may be a sign of reactive hypoglycemia. 
If you currently have insulin-dependent diabetes, you may want to talk to your doctor about lowering your insulin to carb ratio, or taking less long-acting insulin, or maybe both.
If you suffer from low blood sugar after meals, are diabetic but not taking insulin, talk to your doctor about possibly lowering your diabetes medication.
However, if you’ve tried all of this and are still failing to heal, below are some strategies you can implement to help manage reactive hypoglycemia. 
It should be noted that there is no clinical “cure” for reactive hypoglycemia, only ways to weaken the response of the pancreas to food, which may help prevent such low blood sugar levels after meals. 

First, treat low blood sugar
Treatment of reactive hypoglycemia is generally different from treatment of an acute episode of low blood sugar. 
Eat at least 15 grams of fast-acting carbohydrates, such as glucose tablets, juice, or something sweet like candy, and check your blood sugar again to make sure it’s rising. 
If you are dangerously low and your blood sugar is unresponsive to fast-acting glucose, call 911 right away and have someone give you glucagon. 
Eat smaller, more consistent meals 
Try to eat a meal or snack every 2-3 hours so you never go hungry.  When you eat, make sure it’s not a huge meal and a huge carb dump.  This will help prevent the pancreas from releasing too much insulin, which will cause low blood sugar. 
Skipping all day and then eating a heavy meal at dinner time can worsen reactive hypoglycemia attacks, causing your blood sugar to drop sharply as you prepare for bed. 

Focus on fats and protein 
When you eat a meal or snack, make sure it includes protein and healthy fats, not simple carbohydrates.
Meals and snacks with lots of processed and added sugars and carbohydrates require more insulin and are more likely to cause reactive hypoglycemic episodes. 
Healthy proteins and fats include foods like salmon, full-fat dairy products like Greek yogurt, peanut butter, seeds and nuts, extra virgin olive oil, coconut, avocados, and lean meats. 
You can easily build a meal around these foods by adding leafy greens and colorful vegetables that won’t spike your blood sugar and insulin levels. 
If you drink alcohol, don’t do it on an empty stomach
If you are prone to low blood sugar and reactive hypoglycemia and enjoy drinking alcohol, always drink it with food. 
Alcohol lowers blood sugar, and if you haven’t eaten for several hours, it can put people with diabetes (even those without!) at risk for low blood sugar. 
What’s more, pairing alcohol with a high-fat and protein snack can keep your blood sugar levels smoother throughout the evening.  Think cheese, olives and raw vegetables with hummus alongside a glass of wine. 

Exercise regularly 
It’s important to exercise regularly to keep your blood sugar levels steady throughout the day.  Try to exercise in the early morning or afternoon when insulin resistance is at its highest (and least likely to drop). 
If you’re struggling with reactive hypoglycemia after lunch, this is not the best time to exercise.  However, establishing an exercise routine at the same time each day will help your body learn to better respond to both carbohydrates and physical activity, thereby reducing the likelihood of severe low blood sugar. 
If you don’t know where to start, talk to your doctor about developing an exercise routine that works for you and your lifestyle. 
Application
Reactive hypoglycemia is a form of low blood sugar that occurs after meals. 
Both people with and without diabetes can suffer from this disease, but it is more common in people who are overweight or obese, pre-diabetic, with diabetes and gastrointestinal problems such as gastroparesis, and in people who are recovering after surgery, struggling with alcohol addiction, cancerous tumors or hormonal imbalance. 
There are several ways to manage reactive hypoglycemia: the first, if you have diabetes, is to lower your diabetes medications and/or insulin.  Talk to your doctor about how you can safely do this. 
Always treat low blood sugar below 70 mg/dL immediately and call 911 if you experience severe low blood sugar that does not respond to treatment. 
In the long term, you may choose to eat smaller, more consistent meals focused on healthy fats and proteins, exercise regularly in the morning, and only drink alcohol with food. 
By taking these strategic steps, you can help manage reactive hypos and prevent them from taking over your day.