Hypoglycemia

True hypoglycemia is abnormally low blood sugar below 50mg/dl. It's unusual in people without diabetes. It can happen to people past stomach surgery, those with rare tumors, conditions of the pituitary, adrenal, liver or kidneys and those who drink too much alcohol without eating. The symptoms are sweating hunger, weakness, tachycardia and inward trembling. One might also experience headache, blurred vision, mental confusion, incoherent speech, and even convulsions, which occur past a slow but severe decline in blood sugars.

Under normal conditions, complex carbohydrates in food get broken down in the simple sugar, glucose. Insulin, a hormone secreted from the pancreas enables glucose to move from the bloodstream into the cells where it is used for fuel. Excess glucose is stored in the liver for later use, so blood can stay in a normal range at all times. Most adults maintain normal blood sugar in a narrow range (70-110mg/dl).

Reactive hypoglycemia is a type of hypoglycemia in which the body overreacts to sugar intake. This sends blood sugars soaring, which triggers the release of excessive insulin, causing blood sugar to plummet 2-5 hours past eating. The body has a safety net- adrenaline kicks in stimulating the liver to dump sugar into the blood to correct the deficiency and ward off brain damage. A constant supply of sugar is absolutely essential for the brain. (In the opinion of some authorities this is one of the earliest manifestations of diabetes).

The metabolic response to anxiety and hypoglycemia are similar. Anxiety can trigger the release of adrenaline and cause the same nervousness, sweating, pounding heart, trembling and faintness as hypoglycemia. Often times hypoglycemia is misdiagnosed as a result.

If you suffer suspicious symptoms see your doctor. To diagnose hypoglycemia you need a proper work-up. Only when low blood sugar consistently coincides with symptoms and they subside within 5-15 minutes after eating, is hypoglycemia diagnosed. A glucose tolerance test does not appear to be useful in diagnosis.

Nutritional Management of Hypoglycemia

Eat five or six small meals day that contains a mix of complex carbohydrates (whole grains, legumes, vegetables), protein and some fat.

Avoid eating sugary foods and drinking sugary drinks. If you eat simple sugars eat them with the foods mentioned above to blunt their impact.

Limit caffeine - it can produce anxiety like symptoms.

Alcohol can potentiate hypoglycemia by blocking internal glucose production (gluconeogenesis).

If symptoms arise, drink juice or eat fruit or hard candy right away.

June 2000

Donna Tinnerello, MS, RD, CD/N is a registered dietitian, living in Manhattan, with more than 10 years experience in HIV and nutrition. Her subspecialties are cardiovascular, renal, gastrointestinal disease, diabetes and weight management.
Donna is available for private consultation by referral only. Ms.Tinnerello has donated time and articles to our web site at always your choice and we sincerely appreciate her contributions.