Reactive Hypoglycemia

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Reactive hypoglycemia or postprandial hypoglycemia is a recurrent episode of hypoglycemia within four hours of having a high-carbohydrate meal in people with or without diabetes. It may be due to excess insulin release triggered by a carbohydrate meal after digestion and absorptions of glucose.

What is reactive hypoglycemia?

After eating, if your blood sugar goes up at one hour and then drops below 70 mg/dl (3.9 mmol/L) at the two hour, this condition called reactive hypoglycemia. The blood sugar rises up after food; your body releases insulin to being back the blood-glucose level. Due to insulin resistance, glucose level stays high; your body reacting to this by rapidly releases a huge dose of insulin. This excess insulin dose ends up with low blood sugar. 

Reactive Hypoglycemia or Postprandial Hypoglycemia

Reactive hypoglycemia may sometime due to insulin resistance. Usually in insulin resistant, the insulin does not recognize as usual, so the pancreas does not shut off. This leads to blood-glucose crash. Normally working pancreas would immediately release glucagon, which signals the liver to dump glucose into the blood stream.  However, in case of reactive hypo, your pancreas does not do so leading to low blood sugar.

Reactive hypoglycemia may be an early-warning sign for diabetes. However, this may take many years or even decade until it becomes apparent. Although, you do not progress to diabetes, insulin resistant forcing your body to secrete too much of insulin driving your blood sugar low. Excess level of insulin in blood may be a precursor to heart disease. 

Reactive hypoglycemia symptoms

Symptoms of reactive hypoglycemia can vary from one person to another. Thus, the rate and magnitude of drop in blood-glucose concentration decide the development of symptoms. 

Some of the common food induced reactive hypoglycemia symptoms are: hunger, weakness, trouble concentrating, sleepiness, sweating, lightheadedness, anxiety, shakiness and confusion.

Reactive hypoglycemia causes

The exact cause of reactive hypoglycemia is still not clear; however, there are several assumptions to explain why it can happen.

  • Exaggerated insulin response due to insulin resistance, body cells are not properly reacting to insulin. Thus, pancreas gets confused and releasing excess insulin to clear blood glucose leading to very low blood-glucose level.
  • Exaggerated insulin response due to increased glucagon-like-peptide 1 - is a strong anti-hyperglycemic hormone, stimulates insulin secretion while suppressing glucagon secretion.
  • Renal glycosuria – is a defect in sodium-dependent glucose co-transporters causing more glucose to send out as urine.
  • Glucagon is a hormone causing the opposite effect of insulin; it raises blood-glucose levels if low. Defects in glucagon hormone response may not be able to stop hypoglycemia.
  • Sensitivity to epinephrine, a hormone releases in the body during stressful situation.
  • Gastric surgeries may pass food too quickly through the digestive system leading to hypoglycemia.
  • Hypothyroidism may effect on blood sugar levels.
  • Helicobacter pyloric infection induced gastritis - some reports show H. pylori may contribute to the occurrence of reactive hypoglycemia.

Reactive hypoglycemia treatment

Below are the common simple treatments to relieve reactive hypoglycemia:

  • Low-carbohydrate diet is the first treatment option for reactive hypoglycemia.
  • Limit or even avoid sugar or any other high-carbohydrate high glycemic food intake.
  • Exercising regularly can increase sugar consumption, which decrease excessive insulin release and thus stop hypoglycemia.
  • Choose to eat a variety of foods such as meat, poultry, fish, whole-grains, fruits, vegetables, and dairy products.
  • Prefer foods that are fiber rich, which help stop dumping of glucose into the blood stream thus chances of reactive hypoglycemia, can minimize.
  • Choose high-fiber foods.
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