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Hypoglycemia: Diagnosis and Dietary Control
by Gary F. Zeolla
The morning of November 19, 2007, I had a doctor's appointment. I didn't eat breakfast as I figured the doctor would order a blood test, including blood lipids, and you need to be in a fasting state to check that. And she did order the blood test. So I went to the blood testing place across the parking lot and had the blood test done.
I had a lot to do that day, so I rushed home and took a shower. But when I got out of the shower, the blood test lab had called and had left a message. They hadn't taken enough blood! So I had to get dressed and drive back up to the lab. I got very upset over the situation as this would really mess up my day's plans. They drew two more vials, and I figured that was that.
With Thanksgiving that week, it took a week to get the tests results back. To my great surprise, my fasting blood glucose was elevated. Normal is 70-100 mg/dl, but mine was 189. This made no sense. I never had a problem with my blood glucose being elevated before. At my previous blood test a year and half before, it was only 89. Moreover, I am not overweight and consume very healthy diet.
Also not making sense was that my blood triglycerides were very elevated. Normal is <150 mg/dl. At my previous blood test they were a very low 46. But this time they were 369.
Glucose Tolerance Test
My doctor ordered a glucose tolerance test, which I was able to get done the next day. For a glucose tolerance test, they first test your fasting blood glucose. Then you drink a solution containing 75 grams of pure glucose. The solution basically tastes like very sweet orange soda. Then they test how your glucose levels rise and fall afterwards.
For my test, they only tested it once again, two hours after drinking the solution. But a lady I was speaking to in the waiting room had hers tested half an hour afterward, then an hour after that, then again, after another hour. It all depends on what the doctor orders.
I had the glucose tolerance test done on a Friday (12/1/07). So I had to wait until Monday to get the test results back. So I spent the weekend worrying that I might have diabetes. Again, this made no sense, but I spent time on the Internet researching diabetes so I would be prepared, just in case.
When my doctor called, it turns out the original fasting blood glucose result was an anomaly. This time, it was only 96, within the normal range. However, the "tolerance" part of the test was abnormal, not abnormally high, but abnormally low. Normal blood glucose after eating is 70-120 mg/dl, but mine was a low 56.
What the test result meant is that rather than diabetes (high blood sugar, hyperglycemia), I had the opposite, low blood glucose, or hypoglycemia.
There are actually two types of hypoglycemia, fasting hypoglycemia and reactive hypoglycemia. Fasting hypoglycemia, as the name implies, is when the blood glucose is below normal in a fasting state. This is a very rare condition.
The other form of hypoglycemia is much more common and is called reactive hypoglycemia. The name means that the blood glucose is low in "reaction" to the ingestion of food, especially carbohydrates (carbs).
In more detail, when a person, any person, consumes carbs, blood glucose levels will rise. The body will then pump out insulin to drive the glucose into the cells and thus lower the blood glucose levels back down. In a normal person, the blood glucose will not rise any higher than 120 mg/dl, then it will not go down below 70. So the levels are kept within a relatively narrow parameter.
But in someone with hypoglycemia, the body will overreact to the ingestion of the carbs and will pump out too much insulin. This in turn drives down the blood glucose levels too much.
The resultant low blood glucose levels can cause the person to feel light-headed, fatigued, and hungry. And very often, the person will crave carb-rich foods like sweets. The consumption of such foods will in fact alleviate the symptoms as such foods will quickly once again elevate the blood glucose levels. However, once again, the body will overreact and pump out too much insulin and thus drive down the blood glucose levels too low. This cycle can easily be repeated throughout the day.
Over time, the above cycle can lead to weight gain. The reason is the more carbs that are consumed, the better the person will feel—initially, but the worse they will feel later. But then the craving for more carbs comes and more is eaten. Moreover, the type of foods that are craved are the type of foods that can easily lead to weight gain, namely processed carbs.
Such carbs are craved as they quickly and greatly elevate blood glucose levels. This means they are high-glycemic foods. But then insulin is pumped out to drive the blood glucose into the cells, including fat cells. So the frequent consumption of high-glycemic foods can lead to someone becoming overweight.
Moreover, as indicated, high-glycemic carbs greatly elevate the blood glucose levels. And the constant spiking of blood glucose can lead to the cells becoming resistant to the effects of insulin. In other words, over time, the same amount of insulin will not have the desired effect as the cells are not reacting to it as much as before, so the body will have to pump out more insulin to get the same result. Eventually, even that will not suffice, and the blood glucose levels become constantly elevated. This is especially the case if, as is very likely, the person has become overweight.
So basically, reactive hypoglycemia can lead to the seemingly opposite condition of diabetes. In fact, most likely, the majority of people with diabetes in the USA today started out with reactive hypoglycemia. But the important point is their current condition began with the hypoglycemia causing them to consume a large amount of high-glycemic carbs on a regular basis.
How Did I Avoid the Weight Gain and Diabetes?
When I got the glucose tolerance test back, the main suggestion my doctor gave me was to eat six times a day, and to eat protein with each meal. The reason for eating six times a day is so that food and thus carb consumption is spread out over several meals. That way, not as many carbs are consumed at one time and thus the blood sugar response will not be that great to any given meal. The idea of eating protein is that it tends to moderate the glycemic response, so the blood glucose levels do not rise as much or fall as greatly as when carbs are eaten by themselves.
This eating pattern was exactly what I had already been doing. In fact, most likely, I have had reactive hypoglycemia most of my life. I say this as it explains a lot. I used to get very strong cravings for sweets and the like. And when I would start eating them, it would be hard to stop! But I found that if I ate several times a day, then I didn't get such cravings. I also found that I just felt better by eating small meals more often. I also found it helped if each meal contained a "balance" of protein, carbs, and fat. Moreover, I found that if I ate sweets, I would crave more and more. But if I avoided them altogether, I would loose the cravings.
So I had discovered on my own by trial and error exactly the type of eating plan that is recommend for hypoglycemics. And it is this type of eating plan that I detail in my book God-given Foods Eating Plan. In other words, if I hadn't been following this type of eating plan for so many years now, most likely I would be overweight and diabetic today.
Blood Glucose Levels after Eating
My book provides many details on issues relating to hypoglycemia, although I never actually use that term in my book. I do, however, mention diabetes, and it may sound strange, but the type of eating plan that is good for controlling hypoglycemia is the same as for controlling diabetes. The reason for this is that for both conditions the ideal is to keep the blood glucose levels on an even keel.
In other words, what causes problems for both the diabetic and the hypoglycemic is for the blood glucose levels to be spiked very high after eating. In the diabetic, such a spike will leave the blood glucose levels elevated for an indefinite period of time, unless insulin is injected. The reason is, the diabetic's body is no longer reacting properly to its own insulin and is not able to pump out enough on its own to bring the blood glucose levels down. In the hypoglycemic, when the blood glucose levels are elevated, the body overreacts and pumps out too much insulin, and the levels drop too much.
But in both conditions, if the blood glucose levels do not rise that much after eating, then both problems can be averted. For the diabetic, if the levels do not rise greatly, then it doesn't take much to bring them down. For the hypoglycemic, if the levels do not rise that much, then the body does not overreact and drive them down too much.
So it might sound counter-intuitive, but the best thing for the hypoglycemic is for the blood glucose levels to not raise much after eating. In that way, they will not drop much either.
In my book, I detail three factors that affect how much blood glucose levels will raise after eating. They are:
1. How many carbs are consumed
2. What type of carbs are consumed
3. What is eaten with the carbs
Looking at each point in turn, it stands to reason that the more carbs you consume, the more your blood glucose levels will rise. As I state in my book, eating two slices of bread will elevate the blood glucose levels twice as much as eating one slice of bread.
But there is much more to it than just the amount of cabs consumed. The type of carbs is actually more important. This point relates to the glycemic index of the food. I mention the glycemic index of foods throughout my book and go into details about the glycemic index in Chapter Seventeen of my book.
I cannot repeat that entire chapter here. But basically, the glycemic index is a measure of how much a particular amount of carbs from a given food elevates blood glucose levels in a group of test subjects. Glucose is used as the standard and is given a rating of 100. Foods are then rated based on how much they affect the blood glucose levels in comparison to glucose. The ratings range from 0-100.
However, these ratings only apply to foods consumed in isolation. The actual glycemic response to a meal depends on what is eaten with the carbs. Specifically, a high-glycemic, high-carb food will elevate blood glucose much more if eaten alone than if it is eaten with protein, fat, and low calorie vegetables. Again, much more on all of three of these points is found in my book.
Blood Glucose Monitor
After the glucose tolerance test, my doctor's office gave me a blood glucose monitor. This is a small device, about the size of your palm. It comes with test strips, a lancet device, and lancets. You put a test strip in the device and a lancet in the lancet device. You then poke the end of your finger with the lancet and place a small drop of blood on the end of the test strip. A few seconds later, and the monitor gives you your blood glucose reading.
Using this device confirmed that I do not have diabetes or fasting hypoglycemia. My blood glucose levels first thing in the morning are always in the 70s. Again, normal is 70-100. It also has confirmed what was said above about what affects blood glucose levels after eating and thus what is said in my book about how different foods and food combinations affect blood glucose levels.
For instance, in my book I state that cold cereals have a high glycemic rating while oatmeal has a low rating. I also state that mixing in a handful of nuts with the cereal will moderate the glycemic response of the cereal. I also state that berries tend to have a low rating. I also mention about using reconstituted protein powder rather than milk to lower the overall carb level and to provide more protein. For years, this has been my basic breakfast: cereal, fruit, nuts, and protein powder. But even with the other foods, there is still a big difference between using cold cereal and oatmeal.
But first, let me explain that I have found that my blood glucose seems to spike about half an hour after eating, it then goes back down to its lowest level about an hour after that. Then it goes back up slightly and remains there. My fasting blood glucose and the reading at 2 hours or more after eating are rather stable. But it is at the half hour and hour and a half points that I see the most variation. So I have found it important to test meals at these two points. Again, the normal post eating range is 70-120.
Now, if I eat cold cereal, my blood glucose will rise to over 120 half an hour later, then drop to below 70, sometimes even below 60 an hour after that. So both readings are outside of the normal range. But with oatmeal, my blood glucose only raises into the 90s then drops to the 70s. So it stays within the normal range at both ends.
Just as importantly, is the cold cereal causes a greater range than the oatmeal. In other words, there is over a 60 point difference between the high and low readings after eating cold cereal but only about a 20 point difference with the oatmeal. And I think this difference is as important as the actual levels.
What I have found is that a food that causes a big spike then drop leaves me feeling hungry a couple of hours later even if both readings are within the normal range. So if a food spiked my blood glucose to say 115 then dropped it to 75, both readings would be within the normal range. But it would still be a 40 point drop, and I would be hungry and craving carbs about two hours after eating. But if my blood glucose follows the path of the oatmeal breakfast, then I'm fine, with no huger pangs or cravings.
This also shows why I think it is important to test a food or meal twice, at the high point and the low point. If it is only tested once, say at the 1-1/2 hour point, then both meals might give a reading of 75. But without knowing what happened in-between, this is meaningless. One meal might have caused a rise to 115 while the other to only 95. So the difference would be twice as great in the first than the second.
I should also mention that I have found that most often the higher my blood glucose goes at the half an hour point, the lower it will be at the hour and half point. This might sound contradictory, but remember that a hypoglycemic "overreacts" to the consumption of carbs. So if my blood glucose spikes over 120, it always drops to below 70.
However, by following the suggestions in my book about food choices, designing of meals, and meal frequency, my blood glucose almost always only spikes into the 80s-90s, then drops into the 70s. This is why I have not developed any complications from my hypoglycemia. This is also why I almost never feel hungry or crave sweets. So my "God-given Foods eating Plan" is in fact ideal for controlling hypoglycemia, and I would suspect, for diabetes as well.
The Initial Anomalous Test Results
Before closing this article, I want to go back to the beginning. What caused the high fasting blood glucose reading and even the extraordinarily high triglyceride levels? In a word, stress. Doing some research, I found that the body releases glucose and triglycerides into the bloodstream in response to stress. This is part of the "fight or flight" reaction.
Basically, the body is making sure you have the energy to fight off that wild animal or to run from it. At least, that is how your body interprets stress, as some kind of physical danger. But, of course, today most stressors are emotional or physiological. So that pent-up extra energy is not dispersed. That is why stress is so dangerous health-wise.
In this case, it was being stressed out about having to go back up to the blood testing lab that caused the anomalous readings. My home glucose monitor confirms this. If I am stressed out about something, no matter what I have eaten, my blood glucose levels are elevated, and I would suspect my triglycerides as well. So if you get a blood test done, be sure you are not stressed out or you could end up with anomalous readings as well.
Hypoglycemia is potential a dangerous problem as it can lead to being overweight and diabetic. Both of those conditions carry numerous potential health risks. But hypoglycemia can easily be controlled through a sound eating plan.
If you suspect you have hypoglycemia, then talk to your doctor about a glucose tolerance test. And if that is positive, then my book God-given Foods Eating Plan will give you the information you need to keep it under control.
American Diabetes Association.
Glycemic Index and Glycemic Load.
Hypoglycemia - Low Blood Sugar: Nutritional Causes, Prevention and Therapies.
LifeScan, Inc. - OneTouch Blood Glucose Meters for people with diabetes.
Stress - All About Diabetes.
The above article first appeared in the free
FitTips for One and All newsletter.
It was posted on this Web site January 3, 2006.
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