Reactive Hypoglycemia - Symptoms & Diet

An abnormally low glucose level in the bloodstream, hypoglycemia occurs when glucose bums up too rapidly, when the glucose release rate falls behind tissue demands, or when excessive insulin enters the bloodstream.

Hypoglycemia is classified as reactive or fasting. Reactive hypoglycemia results from the reaction to the disposition of meals or the administration of excessive insulin. Fasting hypoglycemia causes discomfort during long periods of abstinence from food, for example, in the early morning hours before breakfast.

Although hypoglycemia is a specific endocrine imbalance, its symptoms are often vague and depend on how quickly the patient's glucose levels drop. If not corrected, severe hypoglycemia may result in coma, irreversible brain damage, and death.

Causes

• meals or snacks that are too small, delayed, or skipped
• excessive doses of insulin or some diabetes medications.
• increased activity or exercise
• excessive drinking of alcohol

Causes in infants and children

Hypoglycemia is at least as common in neonates and children as it is in adults. Usually, infants develop hypoglycemia because of an increased number of cells per unit of body weight and because of increased demands on stored liver glycogen to support respirations, thermoregulation, and muscle activity.

In full term neonates, hypoglycemia may occur 24 to 72 hours after birth and is usually transient. In infants who are premature or small for gestational age, onset of hypoglycemia is much more rapid - it can occur as soon as 6 hours after birth-due to their small, immature livers, which produce much less glycogen. A rare cause of hypoglycemia in infants is nesidioblastosis, a benign condition of the insulin-producing islet cells. The treatment is surgical.

Signs and symptoms

Reactive hypoglycemia causes fatigue, malaise, nervousness, irritability, trembling, tension, headache, hunger, cold sweats, and rapid heart rate. The same clinical effects usually characterize fasting hypoglycemia.

In addition, fasting hypoglycemia may cause central nervous system (CNS) disturbances, for example, blurred or double vision, confusion, motor weakness, hemiplegia, seizures, and coma.

In infants and children, signs and symptoms of hypoglycemia are vague. A neonate's refusal to feed may be the primary clue to underlying hypoglycemia. Associated CNS effects include tremors, twitching, weak or highpitched cry, sweating, limpness, seizures, and coma.

Diagnosis

To diagnose hypoglycemia in people who do not have diabetes, the doctor looks for the following three conditions:

• The patient complains of symptoms of hypoglycemia
• Blood glucose levels are measured while the person is experiencing those symptoms and found to be 45 mg/dL or less in a woman or 55 mg/dL or less in a man
• The symptoms are promptly relieved upon ingestion of sugar.

For many years, the oral glucose tolerance test (OGTT) was used to diagnose hypoglycemia. Experts now realize that the OGTT can actually trigger hypoglycemic symptoms in people with no signs of the disorder. For a more accurate diagnosis, experts now recommend that blood sugar be tested at the same time a person is experiencing hypoglycemic symptoms.

Treatment

Reactive hypoglycemia and fasting hypoglycemia require different treatments.

Reactive hypoglycemia

Effective treatment of reactive hypoglycemia requires dietary modification to help delay glucose absorption and gastric emptying. Usually, this includes small, frequent meals; ingestion of complex carbohydrates, fiber, and fat; and avoidance of simple sugars, alcohol, and fruit drinks.

The patient may also receive anticholinergic drugs to slow gastric emptying and intestinal motility and to inhibit vagal stimulation of insulin release.

Fasting hypoglycemia

In fasting hypoglycemia, surgery and drug therapy are usually required. In patients with insulinoma, removal of the tumor is the treatment of choice. Drug therapy may include nondiuretic thiazides such as diazoxide to inhibit insulin secretion, streptozocin, and hormones, such as glucocorticoids and long-acting glycogen.

In neonates

Therapy for neonates who have hypoglycemia or who are at risk of developing it includes preventive measures. A hypertonic solution of dextrose 10%, calculated at 5 to 10 ml/kg of body weight administered I. V. over 10 minutes and followed by 4 to 8 mg/kg/ minute for maintenance, should correct a severe hypoglycemic state in neonates.

To reduce the chance of hypoglycemia in high-risk infants, they should receive feedings - either breast milk or a solution of dextrose 5% or 10% in water-as soon after birth as possible.

Hypoglycemia Diet

Individuals with reactive hypoglycemia respond favorably to high-carbohydrate, high-fiber, restricted-simple sugar diets. All of our patients who closely follow this regimen do well and rarely have hypoglycemic attacks. In sharp contrast, individuals treated with high-protein, low-carbohydrate diets continue to have hypoglycemic attacks and, also, develop abnormal glucose tolerance tests.

• Start off with a healthy breakfast every morning. Your body is in a "fast" state upon wakening, so your blood sugar will be naturally low.
• Eat six small meals a day or three meals with snack in between. Remember not to over eat.
• Avoid foods and beverages containing caffeine, white sugar and white flour.

Prevention

Diabetics should follow their doctors' advice regarding diet, medications, and exercise.

Pregnant diabetic women should maintain careful control of their blood sugar. Gestational diabetes, or diabetes that occurs during pregnancy, is diagnosed by repeat testing of expectant mothers. Upon delivery, routine blood sugar levels are taken from the infant until blood sugar levels are normal.

People who are known to experience hypoglycemia should keep a snack or drink containing sugar available at all times to take as soon as symptoms appear. If symptoms do not improve in 15 minutes, additional food should be eaten. A glucagon kit is available by prescription for episodes of hypoglycemia that respond poorly to other types of treatment.