Hypoglycemia or Reactive Hypoglycemia?
The term hypoglycemia, or low blood glucose, is associated with a glucose level less than 70 mg/dL. It can result from a need for medication or insulin adjustments, increased physical activity, or prolonged periods of fasting(more than the typical 8-12 hours we normally fast overnight).
The term reactive hypoglycemia on the other hand, is actually associated with a quick and sharp rise in glucose levels followed by a sudden drop soon after eating a meal (usually within 2-4 hours after the start of a meal). The body ‘reacts’ to rapidly absorbed carbohydrates by quickly releasing insulin from the pancreas. It’s the body’s way of ridding excess glucose in the bloodstream as quickly as possible to help maintain a more preferred glucose level.
Reactive hypoglycemia can occur in all types of diabetes including prediabetes.
In fact, it can be an early sign of developing prediabetes.
- Certain medications for diabetes, such as Sulfonylureas/glinides, can squeeze the pancreas to make more insulin than needed or for those taking insulin with meals, it might mean a dose adjustment.
- The quality and quantity of carbohydrates consumed at a given meal time, such as high intake of sugary foods, or carbs with minimal amount of fiber. For such foods, insulin is required almost immediately upon consumption, often leading to excessive insulin production, even after the meal is digested leading to a low blood sugar.
Here are examples of foods that may cause reactive hypoglycemia
- Foods with high amounts of added sugar + highly processed flour - a large donut, pastries, McDonald’s size milkshake
- Large quantity of minimal fiber foods- rice with no protein or veggies, big bowl of rice krispies or frosted flakes, stack of pancakes
- Liquid carbohydrates - juices, regular soda
How to reduce the risk
- Aim for balanced meals that include high fiber carb choices, lean proteins (animal or plant based) and heart healthy fats. The plate method is a simple yet effective guide that helps with balancing macronutrients.
- Avoid fast acting carbohydrates on an empty stomach
- Aim for low glycemic index foods. For people with diabetes taking meal time insulin, here are some guidelines to time meal time insulin based on the glycemic index of the food
- Talk to your care team if you take medication to manage diabetes at meal times or you take insulin with meals.
Identify patterns on your CGM
- Follow your glucose patterns from the start of the meal to 3-4 hours after the meal
- If you notice a pattern as below, it could indicate reactive hypoglycemia
Image reference: diabetes.co.uk
Symptoms of Reactive hypoglycemia
Symptoms of reactive hypoglycemia are similar to mild-moderate hypoglycemia. Familiarize yourself with what these symptoms might be. Click here to learn more.
When in doubt chat it out
Talk to your care team if you notice post meal glucose patterns as above, or are experiencing symptoms of hypoglycemia. Do know that Reactive Hypoglycemia can be resolved to help your glucose levels get back to your Safe Range.
Reference: Reactive Hypoglycemia