Reactive Hypoglycemia: Symptoms, Causes, Treatment

Blood sugar control is important1. When considering blood sugar control, diabetes is a condition that gains a lot of attention. The condition is also known as diabetes mellitus.

Diabetes and insulin resistance are both common. These conditions cause blood sugar levels to rise. In some patients, other conditions can also affect blood glucose control.

There are cases where blood sugar levels may rather decline. In such a case, the patient experiences hypoglycemia.

Reactive hypoglycemia is a specific type of condition. This refers to a case where blood sugar levels decline after the patient had a meal.

The post-meal drop in blood glucose levels can cause unpleasant symptoms to develop. It is often difficult to determine the cause behind reactive hypoglycemia.

In this post, we consider what reactive hypoglycemia is. We also look at symptoms that patients should look out for. The post also looks at how the condition is diagnosed and what treatment options are available.

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What Is Reactive Hypoglycemia?

Hypoglycemia refers to a low blood sugar count2. The concentration of plasma glucose in the blood becomes too low. Hypoglycemia is defined as a plasma glucose count of 70 mg/dL or lower. Many people will only experience signs of hypoglycemia when their blood glucose levels fall to 55 mg/dL.

Reactive hypoglycemia is a condition. It refers to the development of hypoglycemia after having a meal. The condition is also called postprandial reactive hypoglycemia.

The patient experiences a sudden drop in blood glucose concentration after eating. This is a sympathetic condition, which means the patient will experience symptoms when the decrease in blood glucose occurs. It is also considered a condition that causes the patient to experience distress3.

What Are The Symptoms Of Hypoglycemia?

Many symptoms can happen when a person experiences hypoglycemia. The sudden drop in blood sugar can cause both mild and severe symptoms. Most people will experience a few mild symptoms.

Appropriate action can then be taken to counter the hypoglycemia. There are also cases where patients experience more serious symptoms. In rare scenarios, these symptoms become life-threatening. When this happens, the patient needs urgent medical care.

Common Symptoms

Some of the more common symptoms that people may experience with an episode of reactive hypoglycemia include:

  • A tingling sensation near their mouth.

  • An increase in hunger.

  • Tremors or shaking.

  • Excessive sweating.

  • Fatigue.

  • Headache.

  • Feeling of panic and anxiety.

  • There may be a rapid heartbeat.

  • The pupils may become dilated.

  • Some people become irritable.

  • Nausea is possible.

  • Many patients report a feeling of weakness.

  • Dizziness may occur.

  • The patient will experience concentration difficulties.

  • There may also be a loss of the patient’s muscle control.

  • Heart palpitations could occur too.

Severe Symptoms

Patients must be able to recognize more serious hypoglycemia symptoms. Medical care is needed when the patient is faced with these symptoms. The serious and sometimes even life-threatening symptoms that should be taken into consideration include:

  • Severe confusion.

  • Movement may become clumsy.

  • The patient may experience a seizure.

  • There may be a blurry vision.

  • Some patients report double vision.

  • Speech may become slurred.

  • There may be changes in the patient’s behavior.

  • Some patients with severe hypoglycemia experience a loss of their consciousness.

How Is Reactive Hypoglycemia Diagnosed?

The doctor will ask the patient about the symptoms they experience. If reactive hypoglycemia is suspected, certain tests need to be performed. The condition cannot be diagnosed without these tests.

A blood glucose test needs to be done while the patient experiences symptoms of reactive hypoglycemia. This gives the doctor an idea of whether low blood sugar is the cause behind the symptoms. Glucose levels are then returned to a normal state. The doctor sees if the patient’s symptoms go away once glucose levels restore. A glucose tolerance test may also be ordered.

When the postprandial glucose level is 70 mg/dL or lower, a mixed meal tolerance test is ordered. This test is also called an MMTT.

With an MMTT test, either Boost or Ensure is used in most cases. These drinks contain carbs, healthy fats, and protein. The patient is asked to drink the beverage quickly. Blood glucose testing is done before and after the patient drinks the beverage. Additional blood glucose tests are done every 30 minutes. The test takes up to five hours to complete. Tests for fasting hypoglycemia should be considered too.

The results provided by this test can help the doctor make a diagnosis.

What Causes Hypoglycemia?

Reactive hypoglycemia is a complex condition. This is primarily because, in most patients, no cause can be identified. Researchers have found that there are a few possible reasons for reactive hypoglycemia to develop.
Some of these causes and risk factors include:

  • Insulinoma4. This is a rare condition. Abnormal beta cells cause a benign tumor. These cells play a role in insulin release. Insulin levels may be abnormal. This may also alter insulin sensitivity and insulin response.

  • Excess insulin intake. This is generally the case in patients with diabetes. This can lead to diabetic hypoglycemia.

  • Hernia surgery.

  • Gastric bypass surgery.

  • Inherited metabolic disorders.

  • Certain enzyme deficiencies.

Treatment Options

Doctors often try to find an underlying cause for reactive hypoglycemia. There are a few reasons why a patient may experience these symptoms.

Understanding the reason for the symptoms is crucial. This would allow a doctor to target the underlying factors. When the underlying factors are addressed, patients usually experience a reduction in episodes. Thus, the treatment differs from one patient to the next.

When insulinoma is identified, the tumor should be removed. This requires a surgical procedure. A partial pancreatectomy may sometimes be needed in these cases5.

The patient may also be provided with instructions on what they should do when they experience an episode. This is generally the case when no underlying cause is identified. Since no underlying cause is found, treatment cannot address the reason for reactive hypoglycemia to occur.

The patient may also be advised to make specific lifestyle changes. The doctor will need to consider the current lifestyle and habits of the patient carefully. This gives the doctor an idea of what lifestyle factors might be contributing to the reactive hypoglycemia. Appropriate recommendations are then made to the patient. This helps to reduce the chances of experiencing further episodes.

Dealing With An Episode

When an episode of reactive hypoglycemia occurs, the patient should know how to deal with it. The “rule of 15” is essential. This is a strategy that helps the patient recover quickly.

About 15 grams of carbs should be consumed. Several foods contain fast-acting carbs. This will help to stabilize blood sugar levels. The patient should wait about 15 minutes after eating the fast-acting carbs. They should see if the symptoms fade.

If the symptoms still persist, another 15 grams of carbohydrates should be consumed. The patient should then wait another 15 minutes and see if the symptoms go away.

Half a banana is a great choice. This is a fast-acting carb-rich food that can help to stabilize blood glucose levels. Other options include:

  • Honey

  • Glucose tablets

  • Glucose gel

  • Fruit juice

  • Corn syrup

  • Nonfat milk

  • Sugar

  • Orange juice

  • Raisins

  • Jelly beans

  • Gumdrops

  • Syrup

  • Other sugary foods

Once the symptoms go away, the patient should eat a small snack. The snack should consist of both carbs and protein. This strategy helps to prevent another episode of reactive hypoglycemia soon after the first.

Preventing Hypoglycemia

There are ways to prevent hypoglycemia. Patients experiencing reactive hypoglycemia should consider implementing some of these strategies into their daily lives.

A hypoglycemia diet can help to control blood sugar levels. Foods that have a high GI (Glycemic Index) should ideally be avoided. This causes a spike in sugar, followed by a drop. This results in reactive hypoglycemia symptoms. Simple carbs, which include pasta and white bread, should also ideally be avoided. Instead, complex carbohydrates are often considered better.

Meals and snacks should be divided into smaller and more frequent portions. Protein and fiber should be included with every meal. The patient should avoid not eating for periods of three hours or more.

If the patient uses alcohol, they should eat while they drink. A balanced diet is also important. Dairy foods, fiber, whole-grains, fruits, and vegetables should all be balanced in their diet. Regular exercise is another vital strategy to prevent hypoglycemia. A specialized reactive hypoglycemia diet should be considered. This can also help with weight loss in obese patients.


Reactive hypoglycemia happens after the patient had a meal. Blood glucose levels drop. This leads to unpleasant symptoms. There are various potential causes. Doctors focus on identifying underlying factors.

People with diabetes are not the only ones at risk. These factors and conditions are targeted through a treatment program. Treatment focuses on reducing episodes of reactive hypoglycemia. Some strategies may help to reduce the risk of experiencing an episode.

Explore More

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Reactive Hypoglycemia Diet: Foods To Eat And Avoid.


  1. Clinical Methods: The History, Physical, and laboratory Examinations. 3rd edition. (1990) Chapter 141: Blood Glucose. [online] Available at:
  2.  StatPearls [Internet]. (2019) Hypoglycemia. [online] Available at:
  3.  Case Reports in Medicine. (2013) Postprandial Reactive Hypoglycaemia: Varying Presentation Patterns on Extended Glucose Tolerance Tests and Possible Therapeutic Approaches. [online] Available at:
  4.  StatPearls [Internet]. (2019) Insulinoma. [online] Available at:
  5. Merck Manual. (2019) Hypoglycemia. [online] Available at:

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