Following are the most commonly asked questions. Just click on the topic for the answer.

Some questions and answers are excerpted from The Do’s and Don’ts of Hypoglycemia: An Everyday Guide to Low Blood Sugar. Return frequently since we will be adding more Q & A’s. Please understand that the opinions expressed by the experts should not be construed as a specific diagnosis or treatment recommendations. These answers are offered to provide a framework of information pertaining to commonly asked questions. Remember that nothing takes the place of a medical diagnosis and treatment plan. If your symptoms persist or are severe, seek medical attention!


What is Hypoglycemia?

Hypoglycemia – hy-po-gly-ce-mi-a (n.)
An abnormally low level of sugar in the blood.

What does this mean?
In simple layman’s language, hypoglycemia is the body’s inability to properly handle the large amounts of sugar that the average American consumes today. It’s an overload of sugar, alcohol, caffeine, tobacco and stress.

In medical terms, hypoglycemia is defined in relation to its cause. Functional hypoglycemia, the kind we are addressing here, is the over secretion of insulin by the pancreas in response to a rapid rise in blood sugar or “glucose”.

All carbohydrates (vegetables, fruits and grains, as well as simple table sugar), are broken down into simple sugars by the process of digestion. This sugar enters the blood stream as glucose and our level of blood sugar rises. The pancreas then secretes a hormone known as insulin into the blood in order to bring the glucose down to normal levels.

In hypoglycemia, the pancreas sends out too much insulin and the blood sugar plummets below the level necessary to maintain well-being.

Since all the cells of the body, especially the brain cells, use glucose for fuel, a blood glucose level that is too low starves the cells of needed fuel, causing both physical and emotional symptoms.

-an excerpt from The Do’s and Don’ts of Hypoglycemia: An Everyday Guide to Low Blood Sugar by Roberta Ruggiero

Nutrition Education for Doctors

Most types of (reactive/functional) hypoglycemia are preventable and diet-related. Sadly, nutrition education is sorely lacking for doctors and healthcare professionals and has actually been declining over the last four decades. This is one reason why many healthcare professionals do not properly understand hypoglycemia and how to treat it.

The Hypoglycemia Support Foundation is working to change this, by developing high quality Continuing Medical Education (CME) for health care professionals. This is one reason we have designed the first comprehensive infographic on hypoglycemia for patients and their healthcare providers.

What are some of the symptoms of hypoglycemia?

  • fatigue
  • a craving for sweets
  • cold hands and feet
  • forgetfulness
  • dizziness
  • blurred vision
  • inner trembling
  • outbursts of temper
  • sudden hunger
  • allergies
  • crying spells
  • insomnia
  • mental confusion
  • nervousness
  • mood swings
  • faintness
  • headaches
  • depression
  • phobias
  • heart palpitations
  • Whether you are hypoglycemic or think you are hypoglycemic, the first requirement is to EDUCATE yourself. As a knowledgeable patient, you will then be able to wisely choose a health-care professional who can assist you with your diagnosis and treatment.

    What is the difference between functional and reactive hypoglycemia?

    Functional hypoglycemia refers to decreases in blood sugar that cannot be explained by any known pathology or disease. It’s a nice way of saying, “Your glucose regulating mechanisms aren’t functioning normally, and we don’t know why.” Reactive hypoglycemia refers to hypoglycemia resulting from the body’s abnormal response to rapid rises in blood glucose levels caused by diet or stress. The terms are now frequently interchangeable. – Dr. Douglas M. Baird

    What is the Glucose Tolerance Test (GTT)?

    I’ve read so much about the Glucose Tolerance Test (GTT). I’m more confused than ever. Should I take it to confirm I have hypoglycemia?

    Doctors who have significant experience with blood sugar management disorders such as hypoglycemia are able to identify probable candidates for this diagnosis through symptoms, history and examination alone. Subjecting a patient to a glucose tolerance test can be very stressful and many doctors opt not to do these tests for that reason.

    Additionally, the GTT may not provide enough information to establish the diagnosis that could further confuse and complicate the situation. A single finger prick seldom tells us enough to be of significant value. It is both the absolute level of blood sugar, as well as the change in levels, that assist us in making a diagnosis.

    Also, the standard glucose tolerance test, due to its lack of flexibility, is prone to error and can easily miss some of the low blood sugar readings and precipitous drops in glucose levels as the patient responds to a heavy glucose load.

    If a patient’s symptoms warrant it, I use a different protocol for the GTT. This enhanced design remedies the shortcomings of the standard test and has in practice identified a higher percentage of patients with blood sugar management disorders. For the purposes of this test, the patient is instructed to eat a diet high in carbohydrates for three days prior to the test. On the day of the test the patient is to fast from midnight on. Water is permissible.

    The first (venous blood, not finger stick) serves as a baseline for both blood glucose and serum C-peptide insulin. Insulin levels are monitored along with blood glucose measurements. The test proceeds according to the standard protocol until the patient begins to become symptomatic. With the onset of symptoms of falling or low blood sugar, blood samples are drawn every fifteen minutes and recorded until stabilizing around baseline level. At this time, the test can be terminated. The patient should eat something appropriate at this point and should not be released from the examination center until they are perceived to be in control of their faculties. Any examination facility performing this testing should be equipped to manage hypoglycemia convulsions. If the fasting blood sugar level is in excess of 300mg/dl, the test should not be performed.

    This test is considered positive for hypoglycemia if the rate of glucose drop is greater than 100 mg/dl/hr or an absolute blood sugar level less than 60 mg/dl at any time during the test. Whether or not you should have a glucose tolerance test should be determined by you and your physician. — Dr. Douglas M. Baird

    Is it possible to be diabetic AND hypoglycemic?

    A diet high in refined carbohydrates can cause the pancreas to overproduce insulin resulting in hypoglycemia.  If this taxing of the pancreas goes on long enough, the pancreas begins to tire and fails to respond with insulin when needed.  A temporary high glucose level is produced. When that same tired pancreas finally does respond, it does so with too much insulin causing hypoglycemia again.  This is a hypoglycemic/pre-diabetic response.  If the process continues the pancreas finally becomes exhausted and full-blown diabetes can be the final outcome.  The dietary treatment for both conditions is the same.–Dr. Lorna Walker

    Help! I have to have a colonoscopy. However, I have hypoglycemia and need suggestions fast.

    I can only share with you what has helped me and so many others.

    Preferably make a pot of homemade chicken soup the day before you have to fast. Remove all the solids from the soup leaving just the broth. If you can’t, purchase it fresh locally. As a last resort, get it from your local super market in a box, not a can. On the day of the fast, sip the chicken broth throughout the day. Rest as much as possible, sleep if you can and stay calm and positive. Do what works for you…read a book, watch TV and meditate…anything that doesn’t add stress. The day of the test, bring a snack with you, such as peanuts or whole grain crackers with cheese, that you can eat immediately after the procedure. –Roberta Ruggiero

    Tips on Choosing a Physician

    Excerpted & condensed from The Do’s and Don’ts of Hypoglycemia: An Everyday Guide to Low Blood Sugar.

  • Do choose a physician carefully – and preferably not during an emergency situation.
  • Ask for physician referral from friends, neighbors, family and business associates, hospitals and organizations. (Check out the link page on this website, it has an extensive list of foundations/organizations with referral listings.)
  • If you have a physician’s name you are considering, first call the office and ask if this doctor tests and treats hypoglycemia? Do they provide nutritional counseling? If the answer is no, can they refer you to someone else? What is their fee and do they accept insurance?
  • Once you’ve made your appointment, prepare a written list of your symptoms, as well as past medical records and bring that with you to your first visit.
  • It is wise to also bring a diet/symptom diary, which should include a list of everything you’ve eaten, or medication you’ve taken in the past 5 to 7 days, as well as the times you ate and any symptoms or reactions afterwards.
  • Do prepare a list of questions, and don’t hesitate to ask them.
  • Write down any instructions you receive.
  • Discuss a complete prevention program.
  • Discuss your concerns.
  • Be specific and to the point.
  • Get a second opinion, especially if you’re not satisfied with your first physician.
  • Remember that there are many caring, sensitive, trustworthy physicians out there who test and treat hypoglycemia. If at first you don’t succeed in finding one, try again!
  • Can stress trigger hypoglycemia?

    I am 29 years old and have just been diagnosed as having hypoglycemia. I have been under a lot of stress and was wondering if this could have triggered the condition?

    To understand how stress can adversely affect this condition, a little physiology lesson might be in order. You cannot separate the psychological from the physical.

    When you suffer from stress (real or imagined), your physical body reacts with what is known as the “fight or flight” response. The adrenal glands secrete the catecholamines, epinephrine and norepinephrine (adrenaline), which raise the blood glucose levels to prepare the body to fight or flee. Once that occurs, the pancreas begins to over-secrete insulin, and the blood glucose yo-yo begins. The drop in blood glucose is real! So, you need to be even more diligent with your diet during times of stress. I also believe that once you understand how stress, like poor diet, can set off hypoglycemia, you will understand the need to control both. Also, the more overanxious you become about this condition, the more difficult it will be to get it under control. – Dr. Lorna Walker.


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