Hypoglycaemia

Also indexed as: Low Blood Sugar, Reactive Hypoglycaemia

When blood-sugar levels fall fast, symptoms such as fatigue and anxiety may arise. Simple changes can control many cases of hypoglycaemia. According to research or other evidence, the following self-care steps may be helpful:

Choose foods with fibre
Stabilise your blood sugar by eating fibre from whole grains, beans and other pulses, vegetables, and fruit

Eat light, eat often
Spread out your meals during the day to sustain a consistent supply of absorbable sugar

Give chromium a go
Take 200 mcg a day of this essential mineral to help stabilise blood sugar swings

Cut back on refined carbs
Avoid carbohydrates that are quickly absorbed, such as sugar and white flour, which may trigger hypoglycaemic reactions

Say no to alcohol and caffeine
To improve blood-sugar control, reduce or eliminate alcoholic and caffeinated drinks

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full hypoglycaemia article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About hypoglycaemia

“Hypoglycemia” is the medical term for low blood sugar (glucose).

Occasionally, hypoglycaemia can be dangerous (for example, from injecting too much insulin). It may also indicate a serious underlying medical condition, such as a tumour of the pancreas or liver disease. More often, however, when people say they have hypoglycaemia, they are describing a group of symptoms that occur when the body overreacts to the rise in blood sugar that occurs after eating, resulting in a rapid or excessive fall in the blood sugar level. This is sometimes called “reactive hypoglycaemia.”

Many people who believe they have reactive hypoglycaemia do not, in fact, have low blood sugar levels,¹ and many people who do have low blood sugar levels do not have any symptoms of reactive hypoglycaemia.² Some evidence suggests that reactive hypoglycaemia may be partly a psychological condition.³ Consequently, some doctors believe that reactive hypoglycaemia does not exist.⁴ Most doctors, on the other hand, have found reactive hypoglycaemia to be a common cause of the symptoms listed below.

Product ratings for hypoglycaemia

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Nutritional Supplements

Herbs

Vitamin B3 (niacinamide)

Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars

Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star

For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

Common symptoms of hypoglycaemia are fatigue, anxiety, headaches, difficulty concentrating, sweaty palms, shakiness, excessive hunger, drowsiness, abdominal pain, and depression.

Medical options

A diet of frequent, small, high-protein, low-carbohydrate meals is often recommended. If illness prevents eating, hospitalisation for intravenous glucose injections is typically required. In cases of pituitary or adrenal insufficiency, hormone replacement may be prescribed. For hypoglycaemia due to an insulin-producing tumour, surgical removal of the tumour is usually recommended.

Dietary changes that may be helpful

Doctors find that people with hypoglycaemia usually improve when they eliminate refined sugars and alcohol from their diet, eat foods high in fibre (such as whole grains, fruits, vegetables, pulses, and nuts), and eat small, frequent meals. Few studies have investigated the effects of these changes, but the research that is available generally supports the observations of doctors.⁵ ⁶ ⁷ ⁸ Some symptoms of low blood sugar may be related to, or made worse by, food allergies.⁹

Even modest amounts of caffeine may increase symptoms of hypoglycaemia.¹⁰ For this reason, caffeinated beverages (such as coffee, tea, and some soda pop) should be avoided.

Some people report an improvement in hypoglycaemia episodes when eating a high-protein, low-carbohydrate diet. That observation appears to conflict with research showing that increasing protein intake can impair the body’s ability to process sugar,¹¹ possibly because protein increases insulin levels¹² (insulin reduces blood sugar levels). However, some doctors have seen good results with high-protein, low-carbohydrate diets, particularly among people who do not improve with a high-fibre, high-complex-carbohydrate diet.

Vitamins that may be helpful

Research has shown that supplementing with chromium (200 mcg per day)¹³ or magnesium (340 mg per day)¹⁴ can prevent blood sugar levels from falling excessively in people with hypoglycaemia. Niacinamide (vitamin B3) has also been found to be helpful for hypoglycaemic people.¹⁵ Other nutrients, including vitamin C, vitamin E, zinc, copper, manganese, and vitamin B6, may help control blood sugar levels in diabetics.¹⁶ Since there are similarities in the way the body regulates high and low blood sugar levels, these nutrients might be helpful for hypoglycaemia as well, although the amounts needed for that purpose are not known.

Glucomannan is a water-soluble dietary fibre that is derived from konjac root (Amorphophallus konjac). In a preliminary trial,¹⁷ addition of either 2.6 or 5.2 grams of glucomannan to a meal prevented hypoglycaemia in adults with previous stomach surgery. A trial of glucomannan in children with hypoglycaemia due to a condition known as “dumping syndrome” produced inconsistent results.¹⁸

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

References
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1. Palardy J, Havrankova J, Lepage R, et al. Blood glucose measurements during symptomatic episodes in patients with suspected postprandial hypoglycemia. N Engl J Med 1989;321:1421–5.

2. Kwentus, JA, Achilles JT, Goyer PF. Hypoglycemia etiologic and psychosomatic aspects of diagnosis. Postgrad Med 1982;71(6):99–104.

3. Johnson DD, Dorr KE, Swenson WM, Service J. Reactive hypoglycemia. JAMA 1980;243:1151–5.

4. Yager J, Young RT. A non-editorial on non-hypoglycemia. N Engl J Med 1974;291:905–8.

5. Sanders LR, Hofeldt FD, Kirk MC, Levin J. Refined carbohydrate as a contributing factor in reactive hypoglycemia. South Med J 1982;75:1072–5.

6. Permutt MA. Postprandial hypoglycemia. Diabetes 1976;25:719–33.

7. O’Keefe SJD, Marks V. Lunchtime gin and tonic as a cause of reactive hypoglycemia. Lancet 1977;1:1286–8.

8. Hofeldt FD. Reactive hypoglycemia. Metabolism 1975;24:1193–208.

9. Rippere V. “A little something between meals”: masked addiction not low blood blood-sugar. Lancet 1979;1:1349 [letter].

10. Watson JM, Jenkins EJ, Hamilton P, et al. Influence of caffeine on the frequency and perception of hypoglycemia in free-living patients with type 1 diabetes. Diabetes Care 2000;23:455–9.

11. Anderson JW, Herman RH. Effects of carbohydrate restriction on glucose tolerance of normal men and reactive hypoglycemic patients. Am J Clin Nutr 1975;28:748–55.

12. Ullrich IH, Peters PJ, Albrink JA. Effect of low-carbohydrate diets high in either fat or protein on thyroid function, plasma insulin, glucose, and triglycerides in healthy young adults. J Am Coll Nutr 1985;4:451–9.

13. Anderson RA et al. Chromium supplementation of humans with hypoglycemia. Fed Proc 1984;43:471.

14. Stebbing JB et al. Reactive hypoglycemia and magnesium. Magnesium Bull 1982;2:131–4.

15. Shansky A. Vitamin B3 in the alleviation of hypoglycemia. Drug Cosm Ind 1981;129(4):68–69,104–5.

16. Gaby AR, Wright JV. Nutritional regulation of blood glucose. J Advancement Med 1991;4:57–71.

17. Hopman WP, Houben PG, Speth PA, Lamers CB. Glucomannan prevents postprandial hypoglycaemia in patients with previous gastric surgery. Gut 1988;29:930–4.

18. Kneepkens CM, Fernandes J, Vonk RJ. Dumping syndrome in children. Diagnosis and effect of glucomannan on glucose tolerance and absorption. Acta Paediatr Scand 1988;77:279–86.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.

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