Nutrition Articles

Understanding Hypoglycemia

Eating to Prevent Low Blood Sugar

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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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Member Comments

  • Too many carbs here.
  • I have hypoglycemia and it is the OPPOSITE of diabetes. Yes another misleading article from someone who is claiming to be a dietician. Seriously, get your facts straight. Also, the menu you listed would be very bad to a diabetic with how much carbs you put on that menu. A dietician? I think not.
  • That suggested menu is carb overload and would not be recommended to a diabetic. It would send my blood glucose soaringly high, hyperglycemia is as bad as hypo and is a hidden killer.
  • I had episodes of severe hypoglycemia, but it went away after I got on thyroid hormones. Most of the doctors did not recognize that I had low thyroid hormones since they like to rely on TSH. But an integrative medical doctor caught it, thankfully!
  • I wonder how many are eating 3 meals and 2 to 3 snacks each day because they beleive their hypoglycemic reactions are on account of waiting too long between meals and snacks, when it is really a reactive hypoglycemic reaction being experienced following high-carbohydrate meals and snacks.
  • Basically, to summarize all the comments.........
    .........
    Eat what keeps your BS level, and that DOES VARY FROM PERSON TO PERSON. Not everyone will fit your mold. Protein is not the end all of end alls. See your diabetic educator. Carbs are the definite "evil" is part of what I am hearing. I have never heard of protein bringing anyone out of a low. A 1/2 a cup of OJ has 15 carbs, and more often than not it will bring you out of your low in 15 minutes (up to 70). Then make yourself half of a sandwich when your BS is 70. 15 carbs every 15 minutes until your low is back up to 70. Then eat your protein with a carb. This is what I have always been advised to do. I have been a diabetic for 54 years, since I was 9. But always check with your diabetic educator.
  • While the article is informative, that sample menu is, I'm sorry, ludicrous. Please, if you even think you have low blood sugar, find another source for a recommended menu.

    Disappointed!
  • It would be great to see this article updated so that the "sample menu" actually reflected the instructions for having a high protein source with each meal and snack that is advocated in the text. I don't believe that a total of 89g of protein for the day is even close to what the text of the article alludes to.

    While staying within the generally recommended ranges, the 62 carb / 19 fat / 19 protein split of this sample menu is ludicrously low in protein when looking at the recommendations in the text. It's also worth noting that it only has 3, maybe 3-1/2 servings of fruit and vegetables, and is low in zinc, potassium, and vitamin A at the least.

    I'm with all of the other commenters who would find that the sample menu would be disastrous for controlling hypoglycemia. I find that a 50 carb / 30 prot / 20 fat split works the best for me, with the majority of the carbs being vegetables, fruits, legumes, and maybe one or two servings of "whole grains" at most. I do include dairy, but only Greek style yogurt (plain) since it is high protein, full fat cheese, or an ounce of skim milk at a time in a cup of tea and must be accompanied by a snack or meal.

    Seriously, ditch all of the bagels and toast and bran flakes and add in some eggs and larger servings of meats, along with at least 6-10 servings of vegetables and fruits and you might actually have a healthy diet that will help control hypoglycemia as well as being satisfying and sustainable.
  • My husband was diagnosed with hypoglycemia this past summer after an incident last spring when he thought he was having a stroke (leg numbness & shakiness and lack of feeling, trying to get out of bed and leg gave out on him etc. Hospital could find no stroke or heart issues.). The dietitian we visited after dismissal from hospital suggested more proteins like nuts, peanut butter etc, and she (apparently ignorantly) shot down my suggestion about Tahini (sp?) being higher in protein (it is basically a sesame seed 'butter' in the same sense as peanut butter or almond butter). I have to agree with some of the other comments where dietitians are not staying current with what is available and what works...as I went home and I had two different brands of tahini and both showed more protein than peanut butter!! My husband did notice that when he had a small protein snack before bed, he has dreams now - he never had dreams before. His sleep apnea and his regular family practice doctors were both impressed to learn that, since evidently dreaming only occurs in the deep REM sleep - so he evidently had never really been hitting the deep REM sleep as much (even after 10+ years of CPAP treatment.). So... and you do have to figure out the total proteins for the day and carve your snacks out of that protein. Otherwise, too many nuts can cause constipation etc. He usually has nuts and maybe raisins or grapes.
  • ANGEL115707
    While the article is good to make people aware and glad she is trying, her diet suggestion is extremely dangerous. Dietitians especially the ones with 20= years are outdated and give very bad diet advice. If I ate all those whole grains as its called... man breakfast, I would be shaking and trembling and nauseous before that carb snack, the snak would make me sicker and the carb lunch... I'd be bed ridden. WRONG WRON WRONG!!!! I literally have to have protein in the morning or my day is over. protein is the only thing that keeps me from crashing. If I even try to eat cereal, full of fiber even, I'm done for... its awful. My blood sugar only gets up to 80 when I am not fasting... NOT fasting! fiber doesn't help in true hypoglycemic cases. mild low blood sugar symptoms can be covered by whole grains but the ups and downs that even that produces can lead to more severe hypoglycemia down the road. I see others commenting on what carbs to do them as well.... PLEASE spark people dietitians, I know you mean well. I know you care, but you need to update your knowledge. read Wahl's protocol for example, dietary schooling should be a crime until they can update its info!!!
  • I am very hypoglycemic. I have to eat 5 times a day and my dr thought 6 might even be better. A protein with each meal is so important. So I am not sure about this meal plan. Bagels are empty carbs with lots of calories. Carbs turn to sugar in your body and sugar makes my hypoglycemia worse and my dr can't figure out why. Lots of protein sure helps me a lot. I eat 1 gram per pound of what I weigh. I talked to the diabetic dr and she told me that I am doing all the right things but still my blood sugar takes a nose dive once in a while. I have learned to pack a snack where ever I go...to keep some at my 2 jobs...and one in Dennis's motorcycle. Planning is so important. I am glad the article was written as the word needs to get out about this.
  • CRAMPERELLA
    I don't need to wait 8 hours between meals to begin feeling the effects of hypoglycemia. If I go more than four hours without eating I start feeling cranky. If I go much longer I turn into a monster.
  • I did want to say, I do eat a lot of protein - egg with breakfast, my lunch has chicken as does my dinner...
  • I am severely hypoglycemic. I am not diabetic. The doctors actually aren't sure what the cause of my hypoglycemia is, however my symptoms present as such (it comes on from fasting or waiting too long between meals)

    *Unfocused
    *Yawning (not tired, yawning)
    *Uncontrollable Crying
    or
    *Passing out

    I've managed to maintain my blood sugar by eating complex carbohydrates and lots of fruit. For instance, this morning I had oatmeal with flax, wheat germ, and chia with a banana and blueberries. My lunch includes brown rice and a lot of vegetables. For snack I have a small nonfat blueberry yogurt and 1/4C honey toasted pecans. For dinner I'm making sesame chicken with broccoli and bok choy.

    I absolutely cannot do a low carb diet or a sugar free diet or I'm unable to function. But I'm also not eating all the time. I eat breakfast around 8ish, lunch around 2:30pm, snack around 4pm (before work as my work is very active), and then dinner around 8pm. I have found if I do not eat before exercising, I not only lack any energy to put into my workout, but I have gotten off the elliptical and passed out before. So it's important for me to eat something with protein and some sugar some 30 minutes-hour before my work out (so yogurt and nuts, cheese and fruit) and it will carry me through without drops in blood sugar. If I'm unable to have a full meal, yogurt, protein powder and a Naked juice will stick with me and fill me up and keep me going. Everyone will be different though, and finding the right balance is difficult, especially if you have to eat carbs and sugars to remain healthy. But I feel so much better when I am actively controlling my blood sugar levels.
  • Why can't I get spark points for any of these articles today? There is no visible button for me to click, and no I haven't reached 25 points for these articles yet today. And yes, I am reading until the final page. Anyone else having the same issue? Very odd. I've been a member since March and never experienced this.

About The Author

Becky Hand Becky Hand
Becky is a registered and licensed dietitian with almost 20 years of experience. A certified health coach through the Cooper Institute with a master's degree in health education, she makes nutrition principles practical, easy-to-apply and fun. See all of Becky's articles.

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