I think I have reactive hypoglycemia. How can I address my symptoms?
Answer From M. Regina Castro, M.D.
Reactive hypoglycemia (postprandial hypoglycemia) refers to low blood sugar that occurs after a meal — usually within four hours after eating. This is different from low blood sugar (hypoglycemia) that occurs while fasting. Signs and symptoms of reactive hypoglycemia may include hunger, weakness, shakiness, sleepiness, sweating, lightheadedness and anxiety.
It's possible to have symptoms that are similar to reactive hypoglycemia without actually having low blood sugar. True reactive hypoglycemia symptoms that are caused by low blood sugar occurring after eating are uncommon. For the majority of people with postprandial symptoms, the actual cause of the symptoms is not clear but may relate to what food was eaten or variations in the timing of the food moving through the stomach and intestinal tract.
Generally, a medical evaluation is done to determine whether symptoms are caused by low blood sugar — and whether symptoms resolve once blood sugar returns to normal. Further evaluation of reactive hypoglycemia depends on the severity of symptoms.
For the majority of people, reactive hypoglycemia usually doesn't require medical treatment. It may help, however, to pay attention to the timing and composition of your meals:
- Eat a well-balanced diet, including lean and nonmeat sources of protein, and high-fiber foods, including whole grains, fruits and vegetables.
- Avoid sugary foods, especially on an empty stomach.
- Be sure to eat food if you're consuming alcohol, and avoid using sugary soft drinks as mixers.
- Eat several small meals and snacks throughout the day, no more than three hours apart during the waking hours.
Most people will try to find out what dietary changes are helpful for them to minimize the symptoms. For some, particularly those who have had stomach surgery (gastric bypass or surgery for the management of ulcer disease), further evaluation by a doctor may be warranted, but dietary changes are still recommended and very important.
It's also important to include physical activity in your daily routine. Your doctor can help decide what's right for you.
M. Regina Castro, M.D.
Oct. 14, 2016
- Stone CK, et al., eds. Metabolic and endocrine emergencies. In: Current Diagnosis & Treatment Emergency Medicine. 7th ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://www.accessmedicine.com. Accessed Aug. 19, 2016.
- Service FJ. Postprandial (reactive) hypoglycemia. http://www.uptodate.com/home. Accessed Aug. 19, 2016.
- Hypoglycemia. Merck Manual Professional Version. http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/hypoglycemia. Accessed Aug. 19, 2016.
- Low blood glucose (hypoglycemia). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/preventing-diabetes-problems/low-blood-glucose-hypoglycemia. Accessed Aug. 19, 2016.