Frequently Asked Questions are addressed here. 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 about hypoglycemia and related metabolic health issues. 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.
What is reactive or functional 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
“The backbone of successful management of reactive hypoglycemia is the diet.”
– Fred D. Hofeldt, (1975). Reactive hypoglycemia. Metabolism, 24(10), 1193–1208. doi:10.1016/0026-0495(75)90156-0
What are the signs and symptoms of hypoglycemia?
Because all the cells in the body require glucose for energy, the symptoms of hypoglycemia are as varied as there are people who have the condition. Symptoms can be mental, such as depression, anxiety, confusion, insomnia, irritability, and even thoughts of suicide. Physical symptoms include fatigue, headaches, dizziness, fainting, convulsions, irregular heartbeat, sweating, and cold hands or feet. Food addictions, food sensitivities, or food cravings are also common in hypoglycemia. Feeling hungry, in spite of having recently eaten, is also a sign of hypoglycemia.
What are the main causes hypoglycemia?
Medical conditions, such as tumors of the pancreas or adrenals can cause hypoglycemia. Type I and II diabetes can result in hypoglycemia when insulin or other glucose lowering medications are not followed by food intake. Gastric Bypass surgery can result in post-prandial (after eating) hypoglycemia due to “Dumping Syndrome.” Functional or reactive hypoglycemia, which is the kind we are addressing here, is caused by poor diet, stress, and lifestyle. A diet high in refined sugars and carbohydrates is a common theme among diagnosed hypoglycemics.
Stress is another common cause of reactive hypoglycemia. Poor diet and stress usually go hand-in-hand. Persons who suffer from a lot of stress often reach for those high sugar, high starch comfort foods to help them deal with the stresses in their lives. This is a perfect breeding ground for the development of reactive hypoglycemia. People whose lifestyles gives them little time for sleep, relaxation, or play, can easily develop reactive hypoglycemia.
What are the best tests for hypoglycemia?
The five-hour glucose tolerance test (GTT) remains the gold standard for diagnosing hypoglycemia. The patient fasts overnight and a baseline blood glucose level is drawn. A cocktail of glucose in water is then consumed. Blood glucose levels are drawn at 30 minutes, one hour, two hours, three hours, four hours, and five hours from the time of the glucose consumption. If the blood glucose falls below fasting levels at any time during the test the patient is diagnosed with hypoglycemia. Another common response to the five-hour GTT is what we call a “flat curve.” Glucose levels do not fall below fasting, but they do not rise in response to the glucose load that was consumed. This, too, is diagnostic of reactive hypoglycemia.
There are many practitioners who consider the five-hour GTT too stressful for patients. Therefore, alternative methods of diagnosing reactive hypoglycemia have been used successfully. These include allowing the patient to eat a high carbohydrate breakfast as the glucose load prior to the 5 hour GTT. Other practitioners consider a fasting glucose below normal to be suggestive of reactive hypoglycemia and treat the patient accordingly. Still other healthcare professionals, who suspect reactive hypoglycemia, place the patient on a high-protein, low carbohydrate diet. If the patient responds favorably, the clinical diagnosis is made.
How do you treat low blood sugar symptoms?
The best way to treat low blood sugar symptoms is to avoid a drop in blood sugar with the use of diet. However, if symptoms do occur, the best response is to eat a high-protein snack with a small amount of whole food carbohydrate. The small amount of whole food carbohydrate will help raise the blood sugar, but not too quickly. The protein will then help stabilize blood glucose levels without precipitating another drop.
What is the relationship between low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia)?
Hypoglycemia and hyperglycemia are two sides of the same coin. They are commonly seen together, particularly if the hypoglycemia is long-standing. In reactive hypoglycemia the pancreas is producing too much insulin in response to a rise in blood glucose. Inevitably the pancreas will become fatigued, at which point it will fail to respond to blood glucose increases in a timely manner. Hyperglycemia is the result. When the pancreas finally does respond, it does so with too much insulin and a drop in blood sugar, i.e. hypoglycemia, occurs. Eventually, the patient can develop full-blown diabetes as the pancreas becomes more and more fatigued.
What is the best diet for for those who suffer from hypoglycemia?
The best diet for hypoglycemia is one that emphasizes healthy fat and protein, and low in carbohydrates – especially processed carbohydrates. Frequent feedings are often necessary to control long-standing functional hypoglycemia. The diet for hypoglycemia is designed to avoid a drop in glucose, NOT fix it after it falls. Eating sugar in all its forms, as well as eating refined carbohydrates, triggers excessive reaction by the pancreas. They must be avoided. There is a genetic tendency towards this condition, but much of the your pancreas is doing is caused by poor diet and lifestyle choices.
How does hypoglycemia affect those with type 1 diabetes versus type 2 diabetes?
In patients with type I diabetes the pancreas can no longer secrete insulin. It must be supplied by insulin injections. Hypoglycemia in type 1 diabetics is the result of excess insulin injections or insulin injections taken without food. In type 2 diabetics, the pancreas has the ability to produce some insulin. However, it has been abused by poor dietary choices. Therefore, excess insulin production is seen as a desperate attempt by the pancreas to continue working. This, as well as too much glucose-lowering medication, can result in hypoglycemic episodes. A type 2 diabetic will need to follow the same high protein low carbohydrate diet as the reactive hypoglycemic.
How does stress and lifestyle related to hypoglycemia?
Stress is a common cause of reactive hypoglycemia. Just as eating refined sugars and carbohydrates rapidly raise blood glucose levels, stress can do so as well. The adrenal glands, that sit on top of each kidney, produce adrenaline and noradrenaline in response to stress. These hormones are designed to raise the blood sugar, raise the blood pressure, and ready the body to fight or flee. Chronic stress will, therefore, produce chronically high blood glucose levels. The pancreas will respond to this condition by chronically secreting insulin. The resulting hyperinsulinemia results in hypoglycemia. Too much work, lack of sleep, and chronic stressful relationships, can all result in hypoglycemia, even if the diet is adequate.
What does hypoglycemia have to do with my mental health?
The brain’s preferred fuel source is glucose. Hypoglycemia starves the brain of this much needed fuel. When blood glucose is low, the brain will not function properly and all the symptoms of disturbed mental health can result. We have heard the term psychosomatic, which means emotions can affect our physical health, positively or negatively. In hypoglycemia our physical health (hypoglycemia) is negatively affecting our mental health. The term is “somatopsychic,” and it is just as real.
What information is available for health professionals?
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, relying heavily on drugs and devices rather than diet and lifestyle change.
The Hypoglycemia Support Foundation is working to change this, by developing high quality Continuing Medical Education (CME) for health care professionals. The HSF works with leading health care providers and institutions to develop educational partnerships and projects, like the first comprehensive infographic on hypoglycemia for patients and their healthcare providers. As CME programs become available, we will post the links here.
I have to have a colonoscopy... however, I have hypoglycemia and need some suggestions...
We can only share with you what has helped many others.
Consider making a pot of homemade chicken soup / or vegetable soup the day before you have to fast. Remove all the solids from the soup leaving just the broth. If you can’t make it yourself, purchase it fresh locally. As a last resort, get it from your local market deli. On the day of the fast, sip the 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.
Any tips on choosing a physician?
- 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 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. Click here to download and print your own, or here to view an electronic form.
- 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 and symptoms…it helps to have a list printed out when you arrive – sometimes we feel flustered or embarrassed when discussing personal health issues with a doctor and a list helps you to be sure you cover everything going on with you.
- 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!
Excerpted & condensed from The Do’s and Don’ts of Hypoglycemia: An Everyday Guide to Low Blood Sugar.
Can stress trigger hypoglycemia?
“I 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
Hypoglycemia and Medications
I have been diagnosed with hypoglycemia and am grateful I already see a big difference in my health and attitude since going on a hypoglycemia diet. However, I would like to stop my medication. I take antidepressants and tranquilizers. I don’t think I need them anymore. Any suggestions?
Congratulations on that fact that just changing your eating habits has made such a significant change in your life. Most likely you’ve omitted one or more of the big offenders—sugar, white flour, alcohol, caffeine and tobacco. Whatever your approach, it is working. Hurray!
As far as decreasing your medications and eventually getting off of them, it is imperative that you work with a healthcare professional who not only tests and treats hypoglycemia but also who knows your medical history, the type of medications you are on and the dosage.
I can only share with you what helped me. After my official diagnosis of hypoglycemia, a physician who combined holistic healthcare with orthodox medicine was a huge help to me. In time, vitamins, exercise and stress reduction techniques aided in my healing process. Although my doctor slowly started reducing the dosages of my medication, it wasn’t until I was introduced to hypnosis that was I able to get off them completely. Through deep relaxation, guided imagination and suggestions, and the help of a professional hypnotherapist, my goals were reached.
If you ever think of using hypnosis or any other type of alternative therapy, I urge you to learn everything you can about the treatment. Then take this information to your physician and decide together if this may be something you should consider.
Since depression can be caused by a chemical imbalance, hypnosis alone may not work for you. DO NOT stop your medication on your own, and if you are advised that you can stop it, make sure you are under medical supervision while doing so and report any symptoms such as worsening depression, suicidal thoughts or other side effects immediately.
—Roberta Ruggiero, Founder of the Hypoglycemia Support Foundation and Author of Do’s & Don’ts of Hypoglycemia : An Everyday Guide to Low Blood Sugar Too Often Misunderstood and Misdiagnosed!
Is there just one thing that causes hypoglycemia?
There are certainly some things in our life, that if we cut out, or significantly reduced, might help control hypoglycemia… like sugar or processed carbohydrates. But, as we point out in our infographic, there are many different types of hypoglycemia and many different causes. One concept that might help to understand this is called the “exposome“. Here is a great article introducing the concept and why it is the “next big thing in your health.” You might consider getting a hold of a copy of the Do’s and Don’ts of Hypoglycemia or watching “Sweet Revenge: Turning the Tables on Processed Foods“. These educational resources don’t propose radical steps – just cutting out or reducing the worst offenders. A more advanced technology solution is offered by our partner “perfact“ – a platform that allows you to filter out the thousands of potentially harmful ingredients in our food (and beauty product) supply…based upon your own preferences.
What are "obesogens" and what do they have to do with hypoglycemia?
You can start by reading this article introducing you to the subject of obesogens. Thousands of chemicals are added to our food supply, and many are not even listed in the ingredients (herbicide and pesticide residues, and chemicals from plastic food packaging, for example). There are some studies demonstrating a link between food additives, preservatives, colorants, fixatives, stabilizers, etc. that indicate they cause inflammatory and negative metabolic responses. A few studies specifically list symptoms such as hypoglycemia. There are very few studies showing what the effects of all these substances are when they are combined in processed food products…the food industry basically uses us a guinea pigs, and there is very little government oversight of these substances and their effect upon our health. The Hypoglycemia Support Foundation takes the position that we should try and eliminate as many of these substances as possible from our diet. But how? We offer a solution for this here: https://hypoglycemia.org/perfact-solution.
What is the link between hypoglycemia and mental health?
“The condition of relative hypoglycemia is one of the most common causes of neuropsychiatric illness.” – Relative Hypoglycemia as a Cause of Neuropsychiatric Illness, by Harry M. Salzer, MD. Whole new fields of science are emerging that underscore the connection between diet and health and the neurophysiology of the food mood connection. In addition to established fields of neuroendocrinology and other metabolic specialties, new fields of research and practice are developing, such as nutritional psychiatry and nutritional cognitive neuroscience. The studies that have emerged so far are confirming what most of us already know intuitively and experientially – that what we eat profoundly affects both our physical and mental health. Many of the mental health symptoms associated with hypoglycemia are featured in our comprehensive infographic on reactive hypoglycemia.
What does hypoglycemia have to do with type 2 diabetes?
The HSF has conducted ongoing Hypoglycemia Questionnaires. What was the most startling conclusion of the questionnaire? Leslie Lee, RD, the HSF Medical Advisor who played a major role in its inception and results states that “There were many interesting conclusions. The most important result to me was what we learned about reactive hypoglycemia preceding the development of type 2 diabetes. Two-thirds of respondents who have been diagnosed with type 2 diabetes or pre-diabetes reported they experienced hypoglycemia before their diabetes diagnosis. Most of them (85%) experienced hypoglycemia for two or more years before their diabetes diagnosis, which presents a very clear window of opportunity for education and diet improvement. I believe the same metabolic dysfunction that presents as reactive hypoglycemia now can develop into insulin resistance and type 2 diabetes later, if diet is not modified. That was always my hunch and my greatest fear. It’s a simple observation, but I think it’s highly significant in that we can now interpret reactive hypoglycemia as a red flag or a call-to-action to intervene with diet modification and prevent diabetes from developing.”
According to Anita Flegg, author of Hypoglycemia; The Other Sugar Disease. “Hypoglycemia, a precursor of Type 2 Diabetes, affects as least 25% of North Americans. That means that there are at least 80 million people living and working at much less than optimal productivity and creativity.” Given that prediabetes and diabetes no affect over 50% of the U.S. population, we can hypothesize that hypoglycemia affects over 50% of the population.
What is "relative hypoglycemia"?
Relative hypoglycemia is a clinical syndrome in which patients develop symptoms referable to any system of the body as the result of a relative drop in blood sugar level in response to a high carbohydrate food intake and drinks containing caffeine. In the past the syndrome has been called functional hyperinsulinism, essential hypoglycemia, functional hypoglycemia, dysinsulinism, hypoglycemic fatigue, and neurogenic hypoglycemia. These older terms according to Buehler’ are all inaccurate inasmuch as a patient may present this syndrome when there is only a relative drop in blood sugar levels without an absolute drop into low blood sugar or hypoglycemic levels. Also studies have never showed an excessive amount of insulin circulating in the blood. -Henry M. Salzer, MD, Relative Hypoglycemia as a Cause of Neuropsychiatric Illness
What is "personalized nutrition" and what does it have to do with blood sugar health?
For much of modern nutrition history, a rather large assumption/concept has dominated thinking by experts in nutrition as well as in the general population: “One size fits all.” An example is the U.S. government food pyramid, or the current iteration “MyPlate”. Almost every government peddles some version of this – and sadly most are wrong… just look at the pandemic of metabolic diseases plaguing our planet.
In reality, current science supports the idea that nutrition plans and diets should be tailored for individuals, their culture, genetics, microbiome, environmental exposures, metabolic health, etc. Science supports using data to make decisions about what you eat, not fads, macronutrient ratios, etc. Modern nutrition science requires us to learn some actual science, use validated information to support decisions about what we eat, and last but not least, to cook and eat whole, real food (not food-like products and additives).
This means, when you hear someone tell you how to manage your blood sugar by giving you rote directions from a standardized diet plan, or worse yet, proffers some half-baked diet philosophy, commercialized proprietary food product regimen, or snake oils in form of expensive supplements, health-shakes, etc., then walk away. Some may do better on a low-fat diet, some on a low-carb diet, some on plant-based foods, and others on an animal-based foods – or all of the above. Don’t let food fanatics and philosophers, and with all due respect, kettlebell instructors, mislead you about what is good for you. Added sugar? Processed carbohydrates? That isn’t food or nutrition, so it is a “no-brainer” to cut these out.
Regrettably, some (many) healthcare institutions and providers don’t have a clue about nutrition – just look at the last meal you had in a hospital – either as a patient or as a visitor. Less than 30% of doctors are required to take a nutrition course during medical school. This means you have to shop around, find the right expert to guide you: someone who uses actual data, and then tailors a plan for you based on what the data and the science say, not their opinion or belief system. It is relatively easy to sort out the charlatans from the professionals – the professionals gather information, ask questions, and then formulate a plan… the charlatans just prescribe the same thing to all their patients, like you are a member of a herd. Don’t be part of the herd – be heard!
In closing, here are a few articles and resources for you to get acquainted with this issue:
Personalized Nutrition References
- Blood Sugar Responses to Diet Highly Individualized
- Weizman Institute of Science – Personalized Nutrition Project
- Challenges in Personalized Nutrition and Health
- The “Internet Of Food,” DNA Testing, And The Quest For The Perfect Diet
Personalized Nutrition Companies and Organizations
Doctors and Books That Might Help Expand Your Thinking on Nutrition
- Dr. Robert Lustig – Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease
- Dr. David Ludwig – Always Hungry: Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently
- Dr. Aseem Malhotra – The Pioppi Diet: A 21-Day Lifestyle Plan
Over the years, a number of books have been written on Hypoglycemia. Only one has been reprinted in a 5th Edition – Hypoglycemia Do’s and Don’ts, written by Roberta Ruggiero, Founder of the Hypoglycemia Support Foundation. Click below to learn how to get your own copy of this book.
Roberta Ruggiero saved my life. When I was first diagnosed I didn’t know where to turn for help. I stumbled on her book, The Do’s and Don’ts of Hypoglycemia, at the local library and decided to contact her for some advice. I was a total stranger and this amazing angel called me weekly to give me advice and make sure I was doing okay for months. I will forever be grateful to her.
Check out this detailed infographic about reactive / functional hypoglycemia!
Parker has chronic hypoglycemia. In the past, he had daily symptoms, was hospitalized frequently, and struggled to stay focused in school. The Do’s and Don’ts of Hypoglycemia has been a true blessing for us. Parker relates to some of the personal stories and information on foods, and learning what to add or subtract from his diet has been a wonderful tool for me. The chapter of FAQ’s has been an invaluable resource that we refer to time and time again. Parker still struggles, however Roberta’s book enables us to make changes in his diet that ensure his success.