My husband and I joke that “hungry” is its own emotion. It looks a lot like other emotions — anxiety, anger, sadness — but is, in fact, its own thing. And sometimes, the hunger is REAL. Like, really. Most of our less than stellar moments as a married couple can be 100% attributed to being hungry. And were solved with a very simple food + apology combo. It’s amazing what a snack can do! Can you relate?

For me, the symptoms of hunger are a little more than a mildly irritable mood, a grumbling stomach, and a little fatigue. In fact, I don’t always feel hungry in my stomach when I need to have a snack, which has led to problems for me in the past—especially before I started eating according to a 3/2/1 framework. Whenever I go long stretches of time without eating, skip post-workout snacks, eat sweets on an empty stomach, or have an especially busy day, my blood sugar tends to get too low. This is called reactive hypoglycemia.

Just like some individuals struggle to maintain blood sugar balance because their cells are less sensitive to insulin than normal or they don’t produce enough insulin (as with diabetes), individuals who struggle with hypoglycemia have difficulty maintaining blood sugar balance because their cells are more sensitive to insulin than normal or they produce too much insulin. The number one way to promote healthy blood sugar balance with reactive hypoglycemia is to eat balanced, regular meals. That means more food, more often.

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The idea of “more food, more often” would have been a nightmare for me in my dieting days. The last thing I ever wanted to do was eat more. After all, my number one goal in life was to lose weight, and I firmly believed that I needed to eat as little as possible while simultaneously exercising as much as possible in order to do that.

As I shared in this post, I still struggled with the idea of eating when I wasn’t hungry, even once I felt I was recovered. Fortunately, I was able to do the hard, heart work of recognizing that avoiding food was not helping me live life according to my values. I got serious about eating regular meals, supporting my blood sugar, and making the choice that feeling good was more important to me than weighing less. As a result, the unpleasant symptoms I was experiencing as a result of uncontrolled reactive hypoglycemia resolved, and I actually felt better about my appearance than I had when I was avoiding food. When I feel good and have the energy/mental clarity to do things I’m passionate about, I don’t need to try to find fulfillment in the size/shape of my body or the food I’m eating.

All that being said, the main purpose of this post is to share a little bit about what reactive hypoglycemia looks like clinically, what causes it, and how to someone might go about managing it.

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As with everything on my blog, this post is not intended to diagnose, treat, or cure any illness. If you are experiencing symptoms of reactive hypoglycemia or any health condition, talk to your doctor.

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What Is Reactive Hypoglycemia?

What Causes Reactive Hypoglycemia?

As with any condition, the contributing factors to reactive hypoglycemia are complex and varied. More often than not, a person has a genetic predisposition to the development of the condition, which is ultimately triggered by environmental/lifestyle factors, namely stress. As I explain in this post about hormones, stress affects almost every system of our bodies, especially our metabolism. Stress interrupts the delicate web of signals between our brains and our organs, and over time this can lead to more long-standing patterns of dysfunction.

Stress comes in many forms, though we most classically think of it as being related to emotional or relationship triggers. But just like a hectic schedule, tight deadlines, or unhealthy relationships contribute to stress, too much exercise, not eating well, poor sleep habits, chronic illness or allergies, and other environmental exposures can contribute to our levels of stress. I like to describe our stress tolerance as a bucket, and each of those different types of stressors fills the bucket. When the bucket gets full, our bodies start to overflow into dysfunction and disease.

But just like stress contributes to the onset or exacerbation of our symptoms, stress management and self-care can help increase our body’s margin, making us better able to handle triggers. When I’m taking care of myself well, missing a snack is less likely to send me into a crisis.

Note: Stress is the most notable contributing factor to metabolic dysfunction like reactive hypoglycemia, but other factors can also contribute such as alcohol use, surgeries, liver or kidney disease, tumors, or other metabolic disorders. If you are concerned about any of your symptoms, always make an appointment with your doctor.

What Are the Symptoms of Reactive Hypoglycemia?

The symptoms of low blood sugar are varied, which is why it can be challenging for some people to recognize patterns between their eating habits and their health. However, I find that paying attention to my body’s signals and checking in with myself regularly has helped me to better understand how to care for myself. Intuitive eating helps me know when my body needs food even if it isn’t a “normal” meal time.

Some of the symptoms of low blood sugar include: [source]

• Feeling shaky
• Being nervous or anxious
• Sweating, chills, and clamminess
• Irritability or impatience
• Confusion
• Fast heartbeat
• Feeling lightheaded or dizzy
• Hunger
• Nausea
• Color draining from the skin (pallor)
• Feeling sleepy
• Feeling weak or having no energy
• Blurred/impaired vision
• Tingling or numbness in lips, tongue or cheeks
• Headaches
• Coordination problems, clumsiness
• Nightmares
• Insomnia or waking during the night
• Seizures

For me personally, I liken the feeling of low blood sugar to feeling drunk. I feel tired, disoriented, and I get tunnel vision. My muscles also get weak, I often feel sweaty, and my mood becomes either anxious or irritable.

How Is Reactive Hypoglycemia Managed?

The number one way to manage reactive hypoglycemia is to eat frequently, and make sure to pair carbohydrate foods with protein and fat to stabilize the release of glucose into the blood stream. It’s also a good idea to eat a protein-rich snack before bed to keep blood sugar stable enough for a good night’s sleep.

A good recommendation is also to avoid alcohol, as this can be a big trigger for hypoglycemia. Of course, there are situations when moderate alcohol use is part of a normal, healthy lifestyle, and so my recommendation is usually to restrict drinking to no more than 1 drink at a time, no more than 3 nights per week, always taken with a meal or snack that contains protein.

It’s also really important to manage stress—all types of stress. That means addressing relationship conflicts, creating boundaries to support work/life balance, eating high-quality food, exercising in moderation, developing productive coping skills, and practicing sleep hygiene. These are the most effective ways to support a healthy stress response, but in a clinical setting, I also sometimes use adaptogenic herbs and other supplements to balance inflammation, manage cortisol, and support a healthy blood sugar response. If you are interested in using herbs or supplements to manage stress or blood sugar, always check with your doctor first. Even better, work with a functional medicine doctor to find the herbs that are right for you. (This is important because some adaptogens have a blood sugar lowering effect, which could worsen symptoms of hypoglycemia.)