Understanding Hypoglycemia

Eating to Prevent Low Blood Sugar

-- By Becky Hand, Licensed & Registered Dietitian

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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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About The Author

Becky Hand
Becky is a registered and licensed dietitian with almost 20 years of experience. Through her company, An Ounce of Prevention, she makes nutrition principles practical, easy to apply and fun. See all of Becky's articles.

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Member Comments

LAST20FORME

I always thought I may have this but never tested. I have to have a protein every few hours or I feel weak and if I go several hours without eating I will see a little trembling in my hands when I hold them out. Since just 6 almonds cures my problem, why be tested. I agree with the other posters that each body is different and one has to find what works for them. - 5/12/2013 1:39:56 PM
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KYLIECAT1

I couldnt eat that meal plan without having a reaction no protein for breakfast and bagels are empty carbs :o
- 4/9/2013 2:21:18 PM
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NK1959

I agree with most of the others here who suffer from post prandial hypo. This sample diet would have me in a faint by an hour after breakfast. Protein, protein, protein! I wonder sometimes what dieticians are taught. I am seeing one at my endocrinologist's office who knows what she is talking about re: post prandial hypo. My diet, 8 meals a day, 150 cal every 2 hrs. Each with protein, fat and 5 gms or less of complex carbs. An example would be an egg with cheese and spinach; a cracklebred with chopped bell pepper on it and cheese melted on top; stir fry; a slice of crustless quiche made with egg beaters, heavy cream, cheddar, ham and veggies. Listening to the dietician at the bariatric office who gave me the above type of diet just made me much sicker and had me gaining back 11 lbs in 6 wks. - 2/3/2013 12:23:51 PM
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MOM1014

I was very interested in reading the comments of those who have or have had hypoglycemia. I think it is good input and should be taken under consideration when reading "fixes". I do agree that protein at breakfast and within an hour of waking is good for everyone! - 1/14/2013 2:18:46 PM
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AWILLABLE

A part of some of these comments sounds true but only to the writer. Everyone is different and must choose their own individual health plan. Just because it works for one doesn't mean it will work for everyone. I was shocked to discover that I have diabetes because I had been a vegetarian for sixteen years. Obviously I did not follow a balanced diet and now my doctor wants me to follow a diet loaded with processed foods. To me that's going backwards and I object. I will make my changes, meal after meal until I get there. Your comments are very interesting though and I like the enthusiasm I feel when I read some of them.
P.S. I do believe that protein is a must in breakfast, within one hour of awaking. - 10/9/2012 7:11:37 PM
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DJONES3423

I have had reactive hypoglycemia for probably 20 or more years now. The breakfast that SparkPeople recommend here:

1 medium banana
1 cup bran flakes with 1 cup skim milk
1 cup decaffeinated coffee

is guaranteed to give me a blood sugar plunge because it's almost all carbs, no fat, and little protein. Within an hour or so of eating it, I would have all of the typical signs of hypoglycemia, and my blood sugar would be low (under 70) when I took it. The only way that I could eat what you listed is by including a couple of eggs, maybe with some shredded cheese on top. Skim milk and low-fat cheeses are not my friend, causing more blood sugar issues than they fix. If I followed up your recommended snack and lunch after the recommended breakfast, I would be in bad shape by early afternoon, having one blood sugar incident after another.

For those with reactive hypoglycemia, like me, the best breakfast is high in protein, moderate in fats, and low in carbs (but not no-carb). I can usually eat more carbs later in the day, but not first thing in the morning. My research on this has shown me that I'm not alone in this.

Rather than following a high-bread, high-carb diet like the one recommended in this article, a dietician told me to envision my plate divided in half. Fill one half with vegetables. Then divide the empty half of the plate in two, and fill one part with a lean meat and the other with whatever high-carb side you might want (bread, pasta, potato, ...). Following that recommendation has worked wonders for my blood sugar.

The diet recommended here would pretty much have me with type 2 diabetes in a fairly short time. I would NOT recommend it to anyone in a situation similar to mine. - 10/1/2012 11:38:37 AM
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ROTTENMONKEY

I have been hypoglycemic for probably 30 years. I have a plethora of physicians and NOT one gives a whoot about it. I'm a disabled veteran, and so far I do not have diabetes. The lowest my blood sugar level I was aware of was 43.
I have yet to find a doctor who understands this can kill me likely quicker then diabetes because physicians just don't care or are oblivious to this condition.
Why is hypoglycemia ignored? - 9/10/2012 6:00:55 PM
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CRANKYLADY2

I related to several of the posts. I was diagnosed hypoglycemic in my late 20's and followed a diet of equal amounts of carbs and protein w/ minimal fat for a couple of years and the doctor declared me normal again. Fast forward to my 50's and I have a diagnosis of diabetes. I too wish I still had my old written diet plan, but I don't and have been having troubles with the foods and eating plans for about 3 years. I never got back in check after I retired: my exercise went w/ my job. So now, I an using insulin and other drugs just to bring my sugars down. I am getting better w/ the food stuff and have finally turned the corner I hope. I am very happy to have found Spark. The tracking software is fabulous. Best on the internet so far as I can tell. And w/ me tracking my food intake is really major. I enjoy reading the comments. - 6/17/2012 9:26:55 AM
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PAULIEMACKS

I was diagnosed with Hypoglycemia when pregnant with my daughter years ago. Now I am thinking it is reactive hypoglycemia as when I eat carbs, I can pass out for hours at a time. Potatoes, bread put me out. - 5/31/2012 10:49:53 PM
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TRESA7

I've experienced Reactive Hypoglycemia for most, if not all of my life. Recently, I started getting headaches while exercising and can keep a headache for hours (or even a full day). I did NOT know that headaches can be caused by low blood sugar!!

The one time I received a "Diet" for my hypoglycemia, you were only supposed to eat HALF of a banana at a time. Eating every three hours was highly recommended. I also remember that servings of lean meat were suppose to outnumber servings of "starch" (7 to 5 in my case). Protein was supposed to be present at EVERY meal and all three snacks. I wish I still had that Food Plan! - 5/24/2012 1:23:17 PM
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SANDRALEET

I eat 3 meals and 3 snacks.Each has a protean in it. I cut out sugar and eat only whole grains.I drink 3 milks skim 3 fruit and 3 vegetables all so nuts and beans and good fats.I have controlled my low blood sugar for 3 years - 5/21/2012 7:29:14 PM
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PSALM42

I agree with GraceMcdog... the carbs and sugars (even NATURAL ones!) only cause issues with hypoglycemia! I've struggled with this since childhood. I'd be fine then get to school and feel terribly sick- throwing up too- and my mom would drive all the way to school to give me a snack and then I'd go back to class. It took us a long time and I have to admit that I didn't learn to control it (not deal with it once it happened but actually prevent it!) until college.
I've also cut out all grains, carbs, artifical fruits, natural sweeteners (except for a bit in my coffee!), and excessive fruit. I'll still partake in a bit of fruit- berries- and some 85% dark chocolate. Moderate protein. High natural fat (animal, coconut, olive). - 5/21/2012 4:34:11 PM
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LITTLETINYFISH7

Good article ... I have had hypoglycemia since I was in high school and it got debilitating in college ( apparently my body didn't take too kindly to years of anorexia but only consuming coffee and dr pepper :-/ ) ... while I used to use it as an excuse to "have" to constantly drink Dr Pepper at a slow even pace through the day, I have found that a healthier and much more effective alternative is snacking on high fiber fruits and veggies through the day, increasing my water intake, and balancing carbs with protein during meals and ensuring that at every meal I get a serving of veggies. To keep from passing out during working out or being outside, I drink Special K Protein Water instead of sports drinks or even plain water - as my sugar will plummet when it's either over 80 degrees outside and I am exposed for more than five minutes, or if i work out in a warm room for more than about a half hour ( let's face it - gyms are not well air conditioned ... ). - 5/21/2012 1:41:55 PM
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GRACEMCDOG

And, also, now that I am eating low carb/good high fats/moderate protein I can go for up to 24 hours between meals without hunger, cravings or low blood sugar. I almost never am hungry enough to need three meals now. I've lost 40 lbs in 4 months and have more energy than ever before in my life. I'm 61 and have hypothyroidism. - 5/21/2012 12:33:59 PM
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GRACEMCDOG

That high sugar/carbohydrat
e breakfast of banana and bran you recommend is the one I ate for years. I recently discovered that it is also the one that was CAUSING my daily episodes of debilitating hypoglycemia. I quit the oats/bran and banana in February and have never had another episode of hypoglycemia. The 'healthy' whole grains you recommend will spike blood sugar more than table sugar!!! If you don't believe me, get out your glucometer and test it for yourself. I stopped following this kind of advice and am now no longer diabetic. Cut out all fruit other than a few berries, all grains and all sugar, eat a low carb, good fats diet if you really want to get your blood sugar under control and not have to be on medication for diabetes. - 5/21/2012 12:28:14 PM
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