Understanding Hypoglycemia
Your body breaks down the food you eat into a type of sugar called glucose. After you eat a meal or snack, that glucose makes its way into the bloodstream, causing the level of sugar in your blood to increase. Your pancreas responds by releasing the hormone insulin, which allows glucose to leave the bloodstream and enter into body tissues (including the liver, for later use). When the sugar supplied by your last meal is more or less used up, insulin levels go back down to keep your blood sugar from falling further. In addition, stored sugar is released back into the bloodstream from the liver with the help of another hormone called glucogon. Normal levels of blood glucose levels vary depending on when levels are measured and can range from 70- 145 milligrams per deciliter. Most people’s systems are remarkably adept at maintaining a fairly steady blood sugar level.

However, for people with hypoglycemia, which technically means "low blood sugar," this process doesn't come as easily. While it is not considered a disease itself, hypoglycemia is a medical condition that has many uncomfortable symptoms. Frequent episodes of hypoglycemia can also be related to other medical diagnoses, most commonly diabetes. There are two types of hypoglycemia.

Fasting hypoglycemia occurs when you have not eaten for eight or more hours. It can be caused by certain conditions that disrupt your body’s ability to balance the levels of glucose in the blood: eating disorders, and diseases of the kidney, liver, pancreas, and pituitary or adrenal glands. Taking a high dose of aspirin may also lead to fasting hypoglycemia.

Non-fasting (reactive) hypoglycemia occurs after eating a high-carbohydrate meal or snack. If your body is unable to respond appropriately, it releases insulin too late and in excessive amounts. This causes your blood glucose levels to drop too low.

Hypoglycemia can also be caused by:
  • Diabetes. Taking too much medication, eating inappropriately, changing your exercise routine, or illness can cause low blood sugar levels in people with diabetes.
  • Drinking excessive amounts of alcohol
  • Prolonged exercise
  • Waiting too long between meals and snacks, especially during pregnancy.
  • Prolonged fasting
  • Eating large amounts or the wrong types of food after certain stomach surgeries, such as gastric bypass surgery
  • Diseases of the glands that produce hormones important in blood glucose control, such as the pancreas, pituitary gland, or adrenal glands. (These are rare and generally require the care of an endocrinologist.)
  • Kidney failure, severe liver disease, severe congestive heart failure or severe widespread infection
  • Medication interactions
Signs of hypoglycemia include weakness, nausea, hunger, headache, sweating, nervousness, mental confusion, anxiety, shakiness, drowsiness, dizziness, and trembling.

Because these symptoms are similar to many other problems, including panic attacks and stress, it's important to get appropriate testing and an accurate diagnosis from you physician.

Eating with Hypoglycemia
The food you eat can play an important role in preventing the symptoms you experience when your blood sugars drop too low. While there are many causes of low blood sugar, the dietary recommendations are similar for all types of hypoglycemia. These general guidelines include:
  • Eating three balanced meals a day with two or three planned snacks. It is important that you don’t skip meals and snacks. Try not to go any longer than 3-4 hours between eating.
  • Eating the right amount of carbohydrates during each meal and snack. This helps to keep your blood glucose and insulin levels in balance. Ask your doctor for a referral to meet with a registered dietitian in your area. She can determine the correct amount of carbohydrates for you based on your health status, body size, lifestyle activities, work routine, and fitness program.
  • Avoiding concentrated sugars such as white sugar, brown sugar, honey, corn syrup, and molasses. These are found in cookies, candy, cakes, pies, soft drinks, jams, jellies, ice cream and other sweets. Click here to learn more about hidden sugars.
  • Eating foods high in complex carbohydrates and fiber such as whole grains, fruits, vegetables, and beans. High-fiber foods digest more slowly and help keep glucose from "dumping" into your blood stream too quickly.
  • Eating a high protein food at each meal and snack. Protein-rich foods include fish, chicken, turkey, lean beef and pork, tofu, cottage cheese, cheese, yogurt, milk, eggs, peanut butter, nuts and seeds. Protein can help to maintain your blood sugar levels between meals by delaying how quickly the carbohydrate is digested.
  • Achieving and maintaining a healthy body weight.
  • Limiting alcohol consumption. Always include a snack when drinking an alcoholic beverage. If you drink alcohol, limit your daily intake—no more than two drinks for men and one drink for women.
  • Avoiding caffeine, found in regular coffee and soda.
  • Avoiding large meals.

Sample Meal Plan for Hypoglycemia
Not sure how to get started? While SparkPeople strongly encourages you to follow the advice of both your doctor and your dietitian, the following meal plan incorporates the general principles of eating with hypoglycemia. (Please note that the meal times given are merely examples to illustrate eating every 3 to 4 hours.)

Breakfast (7 a.m.)
1 medium banana
1 cup bran flakes with 1 cup skim milk
1 cup decaffeinated coffee

Snack (10 a.m.)
1 slice whole wheat toast with 1 slice low-fat cheese

Lunch (1 p.m.)
1 whole wheat bagel with 2 oz. turkey breast, 1 lettuce leaf, and 2 tomato slices
1 medium orange
1 cup skim milk

Snack (3 p.m.)
1 whole grain muffin
1/2 cup sugar-free, fruit-flavored yogurt

Dinner (6 p.m.)
2 oz. lean roast beef
1 medium baked potato
½ cup steamed broccoli
1 slice whole wheat bread with 1 tsp. margarine
1 cup decaffeinated tea

Snack (9 p.m.)
3 graham cracker squares
4 apple slices with 2 Tbsp. peanut butter

If you suspect that you are experiencing hypoglycemia, visit your physician for medical testing and diagnosis and see a registered dietitian in your area for individualized dietary recommendations.
For more specific information or help, talk to your health care provider. The American Diabetes Association's National Call Center also offers live advice from 8:30 a.m. to 8 p.m. EST, Monday through Friday at 1-800-DIABETES or 1-800-342-2383.

This article has been reviewed and approved by Amy Poetker, Registered Dietitian and Certified Diabetes Educator.

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