REACTIVE HYPOGLYCEMIA

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Organs responsible for blood glucose regulation

The liver is primarily in control of blood glucose regulation during non-fed states- the best example of this being overnight. The pancreas is primarily in control of blood glucose regulation during fed states via hormones insulin, which allows glucose to enter the cells, and glucagon, which allows stored glycogen to enter the bloodstream.

So if we’re waking up in the morning with elevated blood glucose, this is most likely an issue with liver (and more often than not mediated by cortisol triggering release of glycogen from liver). If we have blood sugar dysregulation after meals, this is more of an issue with pancreatic hormones- either insulin or glucagon. We’ve already covered hyperglycemia in a previous post, so let’s look at hypoglycemia **worth noting we are discussing this process in humans without diabetes**

Symptoms of reactive hypoglycemia

-Anxiety/ irritability

-Shaking

-Sweating

-Dizziness

-Cold hands/ feet

-Blurred vision

-Decreases in reaction time

Potential causes of reactive hypoglycemia

-An exaggerated/ or poorly timed insulin response- characteristic pattern is slow initial release of insulin and then a delayed insulin peak that is misaligned with the peak blood glucose value

-An increase in insulin sensitivity causing too much glucose to be removed from the blood stream

Who is more prone to hypoglycemia?

Very lean humans

Humans who have recently lost a large amount of weight

Humans who have had weight loss surgery (can occur here due to accelerated gastric emptying)

 

Labs to consider

HOMA-IR

Fasting blood glucose

Fasting insulin

HA1C

What to do about it?

-Consider a low carbohydrate diet and splitting up meals frequently throughout the day. Avoid rapidly digesting carbohydrates- especially in isolation- you can probably give yourself a bit more flexibility here if you consume them in a mixed meal with protein, fiber, and fat.

-There is a rare condition where the body cannot properly make glucose in the case of fructose 1-6 diphosphate enzyme deficiency. If this is you, symptoms of hypoglycemia will be worsened by low carb diet.

 

References

Brun, Fedou, Mercier (2000). Postprandial Reactive Hypoglycemia. Diabetes and Metabolism. 26. 337-351.