Reactive Hypoglycemia HF#396

  

What is Hypoglycemia?

Hypoglycemia is a medical term for low blood sugar (glucose).  Glucose is the sugar that our bodies use for energy.  In most people, a normal level of glucose in the blood is within a range of 70-99 mg/dL.  Hypoglycemia can be a concern for people with diabetes, but it also affects people who do not have diabetes.

 

There are two types of hypoglycemia: fasting and reactive.  

• Fasting hypoglycemia can occur when a person does not eat or drink anything with calories for eight or more hours.  It may be caused by certain underlying disease (tumors of the pancreas, liver disease), surgical procedures or drugs that upset the body’s ability to balance blood glucose.  
• Reactive hypoglycemia is more common.  This type of hypoglycemia happens when blood glucose levels fall too low within a few hours after eating.  Reactive hypoglycemia can be caused by several different problems, such as hypothyrodism, congenital enzyme deficiencies, H. pylori-induced gastritis, etc.  The nutrition advice is similar no matter the underlying cause.

Symptoms of Hypoglycemia

In reactive hypoglycemia, a fall in blood glucose occurs within 2-4 hours after a meal.  People have some or all of these symptoms:

 

 

Hunger Sweating Shakiness Weakness Fatigue Nausea/vomiting Numbness/coldness in arms or legs Mood swings

Double vision/blurred vision Fast pulse rate Headache Anxiety Craving for sweets Flushing Confusion Irritability

 

Diagnosis and Treatment

Hypoglycemia is diagnosed by measuring blood glucose when symptoms are occurring.  A small blood sample is taken and sent to a laboratory for analysis.  If blood glucose is below normal (less than 70 mg/dL) and the symptoms disappear when food is eaten, hypoglycemia probably is the cause of these symptoms.  To manage this type of hypoglycemia you need to make changes in your eating habits.  The goal is to maintain a blood glucose between 70 –99 mg/dL and prevent symptoms from occurring.

 

Eating Suggestions for Preventing Hypoglycemia

• Limit simple carbohydrates (sugars) and concentrated sweets:  Eating these foods can cause a rapid increase in blood glucose.  This may lead to overproduction of insulin, resulting in a rapid fall in blood glucose.  Low blood glucose usually causes hypoglycemic symptoms.

 

Simple sugar and concentrated sweets include:

 

Cakes	Jelly
Cookies	Jams
Pies	Flavored gelatin mixes
Puddings	Corn syrup
Carbonated drinks	Honey
Sweetened drink mixes	Syrups
Sugar	Fruit juice greater than 4 ounces

 

Sweet foods are usually better tolerated if eaten with a meal since the other foods at the meal reduce the effects of the sugar.  If simple carbohydrates are included in your diet, make them part of a meal.

 

• Spread your intake of carbohydrate foods throughout the day.  Eating large amounts of rice, bread, cereal, pasta at one time can stimulate the production of large amounts of insulin much like simple sugars or sweets and can cause glucose levels to drop sharply.

 

• Eat five or six small meals or snacks during the day.  Eating several small meals each day rather than 3 large ones helps regulate the amount of glucose in your bloodstream.

 

• Don’t skip meals.

 

• A usual intake of carbohydrates is about 2 to 4 servings at each meal (30 –60 grams) and 1 to 2 servings (15-30 grams) at snack times.  One carbohydrate serving has 15 grams of total carbohydrate.

 

Each of these foods contains about 15 grams of carbohydrate:

 

1 regular slice of bread	6 saltines
½ English muffing, hot dog or hamburger bun	3 cups popcorn
½ cup rice, pasta, cooked cereal	½ small bagel
1 medium potato (about ½ cup)	1 (6”) flour tortilla
1 small apple (tennis ball size)	1 medium orange
½ cup fruit canned in its own juice	¾ cup grapes
¾ cup breakfast cereal, such as Corn Flakes, Special K, Wheaties	1 cup cantaloupe

 

• Choose complex carbohydrates and increase high fiber foods.  Complex carbohydrates take longer to break down. This helps to keep blood glucose levels more consistent.  Whole grain breads and cereals, legumes, vegetables and whole fruits are high in complex carbohydrates and fiber and should be included in your daily diet.

Include protein foods at each meal and snack.  Our body breaks down protein more slowly than carbohydrates and provides a long-lasting source of energy.  So, high-protein foods such as soy foods, poultry, fish, cheese, eggs, peanut butter or meat should be included in each meal and snack.  The protein helps to keep blood sugar in the desired range.  

 

• Use high-fat foods in small amounts throughout the day. Fats such as butter, margarine, mayonnaise, salad dressings, and oil are slowly digested as well but are high in calories and can lead to weight gain.  

 

• Reduce your intake of foods and beverages containing caffeine.  Caffeine stimulates the production of adrenaline and can cause the same symptoms as hypoglycemia.

 

• Limit or avoid alcoholic beverages.  Drinking can cause hypoglycemia all by itself, especially on an empty stomach.  If you choose to drink alcohol, do so in moderation and always eat food with it.

 

• Keep some non-perishable foods readily available in your car, desk, or briefcase to prevent or treat low blood sugar symptoms.  Nuts, dried fruit, or trail mix are examples of quick, but healthy, snacks.  Having these foods available may help you avoid running to the vending machine or the convenience store for a high-calorie candy bar.

 

Glycemic Index (GI) and Glycemic Load (GL)

 

• Glycemic Index (GI) is a measure of how your blood sugar is affected by what you eat.

Many factors affect GI, such as how a food is prepared and whether it is eaten alone or as part of a meal along with fat, protein, and fiber.  The GI is not a fool-proof tool for maintaining adequate blood sugar but it can serve as a guide for comparing carbohydrates and choosing the ones that may be better tolerated.

 

• Low GI foods cause less of a raise in insulin and may prevent hypoglycemia

Some carbohydrate foods are digested more slowly than others.  The carbohydrate foods that are digested more slowly are often called “complex” carbohydrates.  Because they are digested slower, they don’t cause your blood sugar to rise as quickly as other carbohydrate containing foods.

 

• High GI foods cause a fast release of insulin and may cause hypoglycemia

Processed carbohydrates or “simple” carbohydrates (sugars and white flour starches) are digested much quicker than other types of carbohydrate. Because of their fast rate of digestion, they cause your blood sugar to rise faster and your insulin levels to increase.  The quick and large rise in insulin is what can result in hypoglycemia.

 

• Glycemic load (GL) considers the amount of carbohydrate in a food in addition to the effect on blood sugar.

The amount of carbohydrate in a food will also influence your blood sugar response.  Some, but not all, low GI foods are relatively high in total carbohydrate. So even though they are digested slowly, they could cause your blood sugar to rise more than other low GI foods because they have more carbohydrate.  Low GL foods are digested slower and cause a smaller rise in blood sugar.

 

When making choices about the carbohydrate foods you are going to eat, it is important to consider both the type of carbohydrate (complex or simple) and the amount of total carbohydrate in the food.  Use this table to help you pick out foods that may prevent hypoglycemia.

 

	LOW GI	MED GI	HIGH GI
LOW GL	Eat frequently   All-bran cereal Barley Buckwheat Carrots Chick peas Dried beans, cooked or canned Fettuccini Fresh fruit (most) Lentils Oatmeal, old fashioned Peas Soybeans Strawberries Sweet Corn Sweet potato Vegetables (most) Whole wheat spaghetti	Eat moderately   Bananas Pineapple Table Sugar (sucrose)	Eat moderately   All-bran cereal Mueslix Popcorn Pumpernickel bread Seven-grain bread Sourdough bread Watermelon Whole grain wheat bread
MED GL	Eat moderately   Apple Juice Beets Cantaloupe Orange Juice	Eat moderately   Brown rice Couscous Life Cereal New potatoes, boiled Spaghetti Wild rice	Eat less often   Cheerios Corn tortillas Corn bread Pita bread Rye bread Shredded wheat White Rice
HIGH GL	Keep amounts small, and eat less often   French fries Instant oatmeal Linguine Macaroni	Keep amounts small, and eat less often   Mashed potatoes	Keep amounts small, and eat less often   Baked Russet Potatoes Cornflakes English muffin Wheat bread, not whole grain White bread

 

Table adapted from Glycemic Matrix Guide to Low GI and GL Eating by Richard A Price, ©2008

 

Those foods with low GI and low GL (upper left corner of the chart) are likely to promote a slower, smaller rise in blood sugar and insulin, while foods that are high GI and high GL (lower right hand corner) can contribute to a faster, higher spike in blood sugar and subsequently insulin which can promote hypoglycemic symptoms.

 

If you are a patient of UW Health and have more questions please contact UW Health at one of the phone numbers listed below.

 

 

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 08/28/2012

Copyright © 03/24/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#396

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