Long story is short I had some of these symptoms, fasting and keto made it way worse now even meat cause's a hypo. Would saying there is glucagon resistance due to long fasting and keto have any sense? And would eating carbs reverse this? An alternate could be cortisol resistance but I showed enough suppression to dexa. Any ideas? Its crippling my promising career because I can't think straight every 2/3h or so and I test between 4.2-4.6 when I feel "not bad". Also fasting insulin went down to 5 from 11. Any ideas? Last time I had a slice of bread (yesterday) I didn't suffer much even fruit.
Reactive Hypoglycaemia is a condition caused by food, it is over production of insulin after a certain amount of carbs.
If not eating carbs by fasting or dieting, if you are experiencing hypoglycaemic episodes then it is definitely not RH.
One of the tests to diagnose RH is a 72 hours fasting test.
If you don't go hypo, then it is probably is RH!
If you do go hypo, further tests are necessary to see if you have a pancreatic condition such as insulinoma.
Going back to your doctor, and discussing how to proceed would be most advisable.
Symptoms such as in diabetes, Hypoglycaemia and other conditions, and hormonal imbalance are similar across all these conditions.