In my practice, I often 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 totally takes over. From lightheadedness to irritability, digestive symptoms to fatigue, sometimes something as small as missing a snack can send your whole day into a downward spiral!
Can you relate?
For many, the symptoms of hunger are a little more than a mildly irritable mood, a grumbling stomach, and a little fatigue. In fact, many people don’t even feel hungry in their stomachs when they need to have a snack, which can make it difficult to identify that blood sugar levels are at risk of dropping. If going long stretches of time without eating, skipping post-workout snacks, eating sweets on an empty stomach, or having an especially busy day causes symptoms such as the above (fatigue, irritability, weakness, dizziness, feeling cold, breaking out in a sweat, fainting, headaches, stomach pain) then you may be struggling with 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.
The idea of “more food, more often” sometimes seems counter-intuitive, especially if you have a goal of weight loss. It may seem like eating more is the last thing you’d want to do. However, the case I’ll make in this post and what I want you to know is that for women, especially women with health concerns like PCOS, perimenopause, hypothalamic amenorrhea or hypothyroidism, eating more is exactly what you want to do.
Concerned you have a hormone imbalance but not sure how to find out? Download my FREE hormone guide to figure out your symptoms once and for all!
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.
What Is Reactive Hypoglycemia?
Reactive hypoglycemia is a condition where blood sugar levels drop too low (typically below 70 mg/dL) within a few hours after eating, particularly following a high-carbohydrate meal. It occurs when the body produces too much insulin in response to the rise in blood glucose, leading to a rapid and excessive decrease. Symptoms can include shakiness, sweating, fatigue, irritability, and dizziness. While not usually imminently dangerous, reactive hypoglycemia can be a sign of underlying metabolic dysfunction and may be managed through dietary changes or a targeted supplementation strategy.
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 we’re taking care of ourselves 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. Personally, 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. This 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:
- 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
Many of my patients liken the feeling of low blood sugar to feeling drunk. They describe feeling tired, disoriented, and like they have tunnel vision. They say their muscles also get weak, they might feel sweaty, or their moods becomes either anxious or irritable.
How Is Reactive Hypoglycemia (Low Blood Sugar) Diagnosed?
There are a number of different ways to evaluate a person’s blood sugar. In my practice, here are a few key flags that I look for on blood work:
- Low fasting insulin levels (less than 4 mUnits/L)
- Low fasting glucose at the time of the blood draw (<75 mg/dL)
- Low a1c (less than 4.8%)
- Low levels of LDH (less than 100 units/L)
Bear in mind that these are functional labs, which means that not all healthcare providers are willing to run them (however a fasting glucose level is usually included as part of a comprehensive metabolic panel on annual preventative wellness labs run by most primary care doctors. A1c is also often included.) You might need to ask for insulin and LDH to be run as well, to get a complete picture.
Testing for Reactive Hypoglycemia at Home
If you don’t want to make an appointment with your doctor, there are two ways that you can test your blood sugar at home. The first is with an old-fashioned fingerstick and the second is with a newer piece of technology: a continuous glucose monitor.
Finger Stick:
To test your blood sugar using a finger stick, you’ll need test strips, a lancet and a glucometer. Often, these tools can be purchased together as a package, such as the iHealth glucometer kit, which is FSA eligible. I recommend starting out by testing your blood sugar several times per day, including:
- Fasted levels, first thing in the morning
- 30 minutes after meals
- 60 minutes after meals
- 2 hours after meals
Continuous Glucose Monitor (CGM)
As an alternative to using a finger stick method, you could consider tracking your blood sugar using a continuous glucose monitor. This method tests glucose levels in the interstitial space (tissue just below the skin) which changes and updates the Bluetooth app in real time. To use, a subdermal needle connected to some adhesive and a Bluetooth device is applied to the arm, abdomen, hip or thigh and continuously monitors blood sugar levels. For many, this is less painful than recurrent finger sticks. Stelo by Dexcom is a continuous glucose monitor with both iOS and Android-compatible technology.
When tracking my blood sugar with a CGM, I log the following data:
- Meals and snacks I ate that day
- My quality of sleep
- My stress levels
- My exercise
- Blood sugar levels overnight, 30 minutes after meals, and 2 hours after meals
How Is Reactive Hypoglycemia Managed with Diet?
The number one way to manage reactive hypoglycemia is to eat frequently, and make sure to pair carbohydrate foods with protein, fiber and fat to stabilize the release of glucose into the blood stream. I often recommend that my patients consume a fiber supplement, like a teaspoon of chia seed of psyllium husk with water, about 15 minute sbefore meals. It’s also a good idea to eat a protein-rich snack with fiber 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 for my patients. 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.)
While reactive hypoglycemia can be extremely debilitating, it’s not the end of the story for your health. It isn’t a sentence for weight gain and you definitely aren’t doomed to feel that way your whole life. With a little digging and some strategic hacking of your nutrition and supplements, you can feel like 100% again, no matter your season of life.
Don’t miss out! Join the email list.
Love this post? Share it!
Want more? Check out my new guidebook, The Hormone Hacker!
I’m Dr. Alexandra MacKillop, a functional medicine physician, food scientist and nutrition expert.
I specialize in women’s health & hormones, addressing concerns like fertility, PCOS, endometriosis, dysmenorrhea (painful periods), PMS symptoms like bloating and mood changes and more.
If you’re looking for a new way to approach your health, I’m here to help you through it. Click to learn more.
Leave a Reply