It’s common to associate hypoglycemia, or low blood sugar, with diabetes. However, hypoglycemia, also called a sugar crash, actually isn’t exclusive to diabetes.
Reactive hypoglycemia, or postprandial hypoglycemia, occurs within four hours of eating a meal. This differs from fasting hypoglycemia, or a sugar crash that happens as a result of fasting.
The exact cause of reactive hypoglycemia isn’t known. Most experts think it’s related to the foods you eat and the time it takes for these foods to digest. If you have frequent sugar crashes and don’t have diabetes, it may be time to talk to your doctor about dietary changes and potential treatments.
Reactive hypoglycemia is one of the two types of non-diabetes-related hypoglycemia. The other type is fasting hypoglycemia.
According to the Hormone Health Network, having hypoglycemia without having diabetes is relatively rare. Most people with frequent sugar crashes either have diabetes or prediabetes.
Still, it’s possible to have hypoglycemia without having diabetes. All cases of hypoglycemia are related to low blood sugar, or glucose, in the body.
Glucose is procured from the foods that you eat, not just sugary foods. You can get glucose from any source of carbohydrates, including fruits, vegetables, and grains.
Glucose is important because it’s your body’s main source of fuel. Your brain also depends on glucose as its primary fuel source, which explains the weakness and irritability that often occur during sugar crashes.
In order to deliver glucose to the muscles and cells in your body, as well as maintain proper levels of glucose in the bloodstream, your body relies on a hormone called insulin. This hormone is made by the pancreas.
Insulin issues are the hallmarks of diabetes. In type 2 diabetes, your body doesn’t have enough insulin to regulate blood glucose. You may also have insulin resistance. In type 1 diabetes, the pancreas doesn’t make insulin at all.
Still, insulin problems aren’t exclusive to diabetes. When you have hypoglycemia, you have too much insulin circulating in the blood. You may start feeling the effects of a sugar crash when your glucose reading reaches 70 mg/dL or lower. This is the threshold for hypoglycemia, according to the American Diabetes Association.
Most people with reactive hypoglycemia don’t appear to have any other underlying causes.
There are some known risk factors for reactive hypoglycemia. These include:
- Prediabetes. This is the first stage before the full development of diabetes. During prediabetes, your body may not be making the right amount of insulin, which is contributing to your sugar crashes.
- Recent stomach surgery. This can make it difficult to digest food. The foods you eat may pass through the small intestine at a more rapid rate, causing subsequent sugar crashes.
- Enzyme deficiencies. Though rare, having a stomach enzyme deficiency can prevent your body from properly breaking down the foods you eat.
In most cases, reactive hypoglycemia is diagnosed based on your symptoms. It’s important to keep a food diary and make note of your symptoms so your doctor can see the timing.
If severe or frequent hypoglycemia is suspected, your doctor may run blood tests. One important test is a blood glucose reading. Your doctor will prick your finger and use a blood glucose meter to get a reading. True hypoglycemia is measured at about 70 mg/dL or lower, according to the American Diabetes Association.
Other tests that can help diagnose hypoglycemia include an oral glucose tolerance test (OGTT) and a mixed meal tolerance test (MMTT). You’ll drink a glucose syrup for the OGTT or a beverage with a mix of sugar, protein, and fat for the MMTT.
Your doctor will check your blood sugar before and after consuming these beverages to determine any differences.
Additional testing may be needed if your doctor suspects prediabetes, diabetes, or other conditions that might be raising your insulin production.
Symptoms of reactive hypoglycemia may include:
These symptoms typically go away after eating 15 grams of a carbohydrate.
Most cases of reactive hypoglycemia don’t require medical treatment. Even if you’ve had stomach surgery or have another risk factor for sugar crashes, dietary approaches tend to be the preferred treatment measure for this condition.
If you start experiencing symptoms of a sugar crash, the short-term solution is to eat 15 grams of a carbohydrate. If your symptoms don’t improve after 15 minutes, eat another 15 grams of a carbohydrate.
For frequent sugar crashes, you’ll likely need to make some long-term changes to your diet. The following can help:
- Eat smaller, more frequent meals. Snack throughout the day, or about every three hours.
- Avoid high-sugar foods. These include processed foods, baked goods, white flour, and dried fruits.
- Eat a balanced diet. Your diet should include all the essential macronutrients, including proteins, carbohydrates, and healthy fats. Plant-based foods should be No. 1 in your diet overall.
- Limit your alcohol intake. When you drink alcohol, be sure to have something to eat at the same time.
- Avoid caffeine. If possible, switch to decaffeinated coffee or herbal teas.
- Try to quit smoking. This should be done gradually under the guidance of a doctor.
While you might see several websites for hypoglycemia “diets,” the truth is that there’s no one-size-fits-all diet to treat sugar crashes.
Start by making long-term changes to your diet, such as the suggestions listed above. From there, you might find it helpful to keep a food diary to help you pinpoint any foods that could be affecting your blood sugar.
Dietary changes can help you manage and prevent sugar crashes. However, if you’ve had surgery or are managing ulcers, you may need to see your doctor for additional treatments.
You should also see your doctor if you continue to have sugar crashes despite dietary changes. Your doctor may check for diabetes or other underlying health conditions.
When blood glucose isn’t controlled, it can lead to complications, including:
Once you’ve identified reactive hypoglycemia as the cause of your sugar crashes, dietary changes are usually enough to help prevent future episodes and symptoms. However, if you continue to have frequent sugar crashes despite changes to your diet, talk to your doctor.