Reactive hypo and weird symptoms

Have you access to a home meter to test your levels 2/3/4 hours post meals. Lets take the guesswork out of this.

Hi @Kulka,
Welcome to the forum.
I have reactive hypoglycaemia.

Kulka said:

Hello everyone

To start - I'm 33 year old female, rather slim. My diet for at least couple years back was rather correct, I also wasn't avoiding physical activity. Blood sugar on routine tests always ok (although on the lower side).

About six months ago I started experiencing some weird symptoms - frequent hunger, even shortly after meal, nausea during and after meal and in general feeling strange after eating. I was breastfeeding then, not sleeping very well and at the beginning I wasn't concerned about those things - If I felt hungry I just ate, more and more.
Three months ago I stopped breastfeeding, my baby started to sleep better, but my symptoms haven't gone away. Actually, they started to be worse. I had literally constant hunger, I felt terrible during and after every meal (nausea, fatigue, dizziness, feeling a bit unreal). After having some basic blood work (everything fine) I decided to go on 2h OGTT. After 2h my blood sugar was 4.06. Still within the range but once I got home it got pretty bad, I almost passed out before I had some food.

I went to see a doctor, she said its reactive hypoglycemia. Advised me to eat small meals every 3h, low GI and low carb. She was 100% that all my symptoms are due to low blood sugar.

I started a diet about 2 weeks ago (not being very strict on New Year's Eve to be totally honest). However, none of the symptoms is gone. I wasn't expecting to be 100% fine after this time, but I was hoping for at least small improvement. I still have this hunger (hunger-like?) feeling in my stomach almost all the time, even if I feel full at the same time and I simply don't have appetite for anything else. I can live 3h without eating, I'm getting "healthier hungry" after 2-3h and then I eat, but I feel terrible all the time. It's not like in RH from articles - the bad doesn't start x hours after meal. Also, all of those weird symptoms right after the meal - nausea etc. - they are still there no matter what I eat.

I have to say, this situation slowly destroys my life. I'm in constant discomfort, easily getting nervous, always too tired for home duties, playing with kids, spending time with my husband. I'm crying a lot recently, the smallest thing can ruin my mental stability. Meals are no longer a pleasure (if it will continue I think I will develop some kind of eating disorder...) I would follow the diet If I have a tiniest bit of hope that I would help. For now its not.

My questions is: Is this even possible that those symptoms are caused by reactive hypoglycemia? I've seen here some posts about after-meal nausea, but none of them gives any clarification and happy ending. I'm planning to consult another doctor, but I don't expect this visit to be game changer

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Let's take it that you have the condition, the dietary advice your doctor gave you doesn't work, for me.
With RH it is a reaction to what you eat, especially carbs and sugar.
If you have RH you are carb intolerant.
When you eat carbs, even low GI or complex carbs, it will effect your blood glucose levels. They spike quickly, which triggers an insulin response, this is what causes the hypoglycaemic episode or symptoms of a hypoglycaemic episode.
This is why the doctor recommended eating every three hours, it is to stop you going hypo, but it won't stop until you stop eating carbs.
So for instance, you have porridge for breakfast, because there is quite a lot of carbs in this so called super food. And if you have milk, that is more carbs, you have tea or coffee with milk, more carbs.
Because of the rapid spike, your brain does two things, the first is the insulin response and secondly tells you you need to eat, because of the excess insulin the brain is used to having a constant supply of glucose which is derived from, you eating carbs every three hours after breakfast.
A two hour OGTT is not long enough to see what happens after glucose is drank.
I have had quite a few eOGTTs, and my specialist had clues of my symptoms and having a hypoglycaemic episode in front of him helped.
I have what is known as Late Reactive Hypoglycaemia. This means I hypo after two, three, fours hours depending on how high the glucose load derived from the meal, drink.
Until you stop eating carbs, you will continue to feel awful.

So, as you have been advised already, you need a glucometer or a cgm. This will give you the best knowledge of what is happening to you. And if you do go hypo.
I have kept a food diary since 2012, this has been a great tool to use, and you can monitor results and see the trends and more importantly which foods you are intolerant to.

Everyone has different symptoms, one of the causes of RH is a bacteria called heliocobacter pylori. This I believe caused mine or the antibiotics that I took to cure it, your GP should be able to arrange a test for it. I have had constant stomach issues since a teenager, this cured it.
I'm not saying it is, but it is an alternative diagnosis.
Did you have gestational diabetes when you were pregnant?
If you did, did you have the same symptoms?
Because, gestational diabetes has very similar symptoms to RH.
Have you had any other tests, except the blood tests?
Sorry for all the questions.

I can only advise you how you carry on. I know how bad it is having RH, before diagnosis, I called it my hypo hell. But since, my dietary intake has changed, as little carbs as possible, good fresh food, cooked and made a at home. Protein, good fats (not low fat) above ground vegetables, full fat dairy, small pieces of fruit and lots of eggs, any which way, especially omelettes!
I know that you are not trying to lose weight, so you have to eat enough to maintain weight.
The best dietary advice is on the low carb forum, on here, great recipes and ideas.

If you have any questions, please ask, if you want some quick information, have a look on the RH forum threads.

Stay safe.

RH is very annoying. I have reactive hypo glycemia , it's been 5 years now. I take 2 metformines 850 g a day. I feel better when I did some walking or activities. Luckily for me I am a mailman and I walk allot. In week days when I work i feel much better than weekends. Weekends i feel hungry. Despite eating a big meal , i am hungry. So I can only rely it to being inactive due to corona. My endocrinologist recommended me to eat more vegetables and less fatty stuff.

Hi again,
If you have RH, usually your background insulin is either not much or none, so because of this initial low insulin response, your glucose derived from food will spike you within the first hour. This is the trigger for your brain to react by what is called an overshoot of insulin. This is what causes the drop in blood glucose levels, the symptoms, and why you should avoid carbs even healthy carbs, which if you look at, it's like lactose intolerance, which I have btw, you should not have anything with dairy in. The thing is, a healthy diet for most people is not healthy for me, because it really does make me ill.

There is no cure, only dietary management, the only thing other than dietary, is a drug called sitagliptin, what this diabetic drug does is inhibit dpp4, which is a stimulus for
more insulin at initial response. So you don't get a large spike, and the symptoms are lessened but you still go hypo, if you have carbs

I use dietary management, plus intermittent fasting to help with control.
I only start eating around 2-3pm. I have this window to have food, which ends at 7pm, so when I go to bed, I know I'm not going to hypo overnight.

We are all different, even when both of us are diagnosed with the same condition. There will be different symptoms and our treatment will be different, your favourite foods, will not be mine and what you can tolerate, I might not be able to.
I have been described as weird by my GP, and my endocrinologist endorsed this.
Because of the rarity most doctors have not had the training or the knowledge on how to treat the condition, or are just following the old advice, because there hasn't been a lot of research, there is still so much to find out when diagnosed.
There are other hypoglycaemic conditions and types. If may not be RH, but could be a metabolic condition. By all accounts, I can never have normal healthy diet but I will have a healthy diet for me.
But whatever it is, doing very low carb diet will always help.

Stay safe

Effect_one said:

RH is very annoying. I have reactive hypo glycemia , it's been 5 years now. I take 2 metformines 850 g a day. I feel better when I did some walking or activities. Luckily for me I am a mailman and I walk allot. In week days when I work i feel much better than weekends. Weekends i feel hungry. Despite eating a big meal , i am hungry. So I can only rely it to being inactive due to corona. My endocrinologist recommended me to eat more vegetables and less fatty stuff.

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Hi @Effect_one and welcome to the forum..
Walking is great, I have always walked.
However, vegetables are good for you, but you have to be aware of below ground vegetables, spuds, carrots, parsnips, Swede and similar vegetables.
Above ground are fine. The issue the amount of starch/carbs in them.
I would have to disagree with your endo, because good fats, and I mean saturated fats are far better than polyunsaturated fats are not recommended.
Do you eat fresh food, fruit, vegetables or ready meals, or the usual meat and two veg? Do you drink? Do you snack, have sugar?
I got advised to stop metformin, just before diagnosis.

I would definitely have a look around the RH forum. I have been hypo free for the majority of time since diagnosis. This is because I eat a diet that my metabolism needs and is carb free (ish).

If you're not aware, reactive hypoglycaemia is a dietary condition similar to a eating disorder, your hormone imbalance triggers a reaction to food.
Maintaining control will help you be healthier.

Stay safe

Hi again,
I live in U.K. and the same official NHS recommendations are exactly the same, the number of those seeking advice on here is because of this recommendation.
Because it doesn't work.
It is not logical to eat something that you are intolerant to.
I asked my specialist endocrinologist, if I had a peanut allergy, would you recommend me eating a couple of peanuts or peanut butter?
Of course he said no, well carbs have the same effect as an allergy but it's called an intolerance. But carbs were slowly killing me, I was eighteen (ish) stone or 250 pounds, 120 kilos (ish). I had a lots of problems with my organs and my brain function was awful. I wouldn't be here now if my specialist had not recognised the symptoms.

It is difficult to diagnose RH, because the tests are used to eliminate other conditions, until you don't have anything else it has to be RH.
Full blood panel tests, including c-peptide and GAD, EOGTT, followed by allergy tests, a mixed breakfast test, and finally the 72 hour fasting test.
Followed by more eOGTTs for research into the effects of a diabetic drug.

Keep safe

Lamont D said:

Hi @Effect_one and welcome to the forum..
Walking is great, I have always walked.
However, vegetables are good for you, but you have to be aware of below ground vegetables, spuds, carrots, parsnips, Swede and similar vegetables.
Above ground are fine. The issue the amount of starch/carbs in them.
I would have to disagree with your endo, because good fats, and I mean saturated fats are far better than polyunsaturated fats are not recommended.
Do you eat fresh food, fruit, vegetables or ready meals, or the usual meat and two veg? Do you drink? Do you snack, have sugar?
I got advised to stop metformin, just before diagnosis.

I would definitely have a look around the RH forum. I have been hypo free for the majority of time since diagnosis. This is because I eat a diet that my metabolism needs and is carb free (ish).

If you're not aware, reactive hypoglycaemia is a dietary condition similar to a eating disorder, your hormone imbalance triggers a reaction to food.
Maintaining control will help you be healthier.

Stay safe

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Hello there ! Happy new year

To answer to your questions, well I am a very balanced eater. To help prevent hypos I eat everything weighted. So this helps keeping my insulin levels lower. Basically 200 grams of potatoes as late dinner with 350 to 400 grams of green vegetables and a nice piece of meat. I avoid sauces because of starch or maïzena. Green vegetables creates a slower clim

Lamont D said:

Hi @Effect_one and welcome to the forum..
Walking is great, I have always walked.
However, vegetables are good for you, but you have to be aware of below ground vegetables, spuds, carrots, parsnips, Swede and similar vegetables.
Above ground are fine. The issue the amount of starch/carbs in them.
I would have to disagree with your endo, because good fats, and I mean saturated fats are far better than polyunsaturated fats are not recommended.
Do you eat fresh food, fruit, vegetables or ready meals, or the usual meat and two veg? Do you drink? Do you snack, have sugar?
I got advised to stop metformin, just before diagnosis.

Hello happy new year !

To reply to few of your questions, i try to eat everything weighted on my small kitchen scale. So for an example I eat 200 grams of potatoes with 350 to 400 grams of green vegetables. I am not really a carrots fan or parsnip eater. I love lettuces , broccoli or any given name to a salad, even brussel sprouts as I am a Belgian citizen.

About alcohol, i rarely drink. Didn't have a pint in 4 years. But 1 or 2 times in a month I'll sit in front of my tv with some Gin and a zero beverage to cut the gin. That's all i drink. I consume water mostly , almost 3 liters a day.

When I talked about fat i meant , too much cheese. I should cut a little bit in that. I do eat fatty fish and salmon etc... My hypos are far much lesser than a few years back. But when I ate something like pasta...then I feel hungry after like 1 hour.

Kind regards

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Well that post went wrong

Effect_one said:

Hello there ! Happy new year

To answer to your questions, well I am a very balanced eater. To help prevent hypos I eat everything weighted. So this helps keeping my insulin levels lower. Basically 200 grams of potatoes as late dinner with 350 to 400 grams of green vegetables and a nice piece of meat. I avoid sauces because of starch or maïzena. Green vegetables creates a slower clim

Click to expand...

Hi again,
I think you really can't understand what reactive hypoglycaemia is and what it does to your health.
In those five years, you have probably walked that much daily that the frequency of hypos never really gave you bad hypo symptoms.
This is because walking is the best exercise for keeping blood glucose levels in and around normal levels range.
Your diet that you posted, is quite good, but there is too much carbs, potatoes are one of the starchy vegetables I was referring to, even a very small potato, would cause a trigger reaction.
If you have reactive hypoglycaemia, you are carb intolerant and should avoid them as much as possible.
The normal dietary advice is to eat every three hours to stop going hypo, but the problem is not going hypo, it is the insulin overshoot which is drop your blood glucose levels down quickly. It is the high spikes and drops that causes the majority of symptoms. And it is carbs and sugars that cause the trigger.
I have found that avoiding carbs, my health is great and I don't go hypo. I have been hypo free for the majority of time since diagnosis. And finding this site with its excellent advice about low carb and higher saturated fats.
RH can be controlled, but eating every three hours is too much for anyone to sustain.
I have so far today only had fish and salad, and small pieces of fruit. I feel great except for my anxiety issues.

Keep safe, keep asking.

Kulka said:

Ok, today I got a glucometer. Not the most accurate one, but hopefully enough. I ate dinner (no carbs) which completely haven't satisfied my hunger... After about 1h hunger became even worse, so I decided to give it a try. I used three strips (?) one by one and results were 99, 115, 105. So no hypo. So why the hell do I feel like Im starving all the time?
Tomorrow Im planning to perform more organized test.

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Did you eat enough fats and protein? Carbs make us feel full. Eliminate those from a meal, and you'll have to add in something else for bulk. Fats are excellent. They don't make your blood glucose budge, and slow the uptake of the carbs you do have, thus avoiding a spike and an over-reaction of your pancreas. Add in some bacon, avocado, butter, fatty fish...

Kulka said:

Ok, today I got a glucometer. Not the most accurate one, but hopefully enough. I ate dinner (no carbs) which completely haven't satisfied my hunger... After about 1h hunger became even worse, so I decided to give it a try. I used three strips (?) one by one and results were 99, 115, 105. So no hypo. So why the hell do I feel like Im starving all the time?
Tomorrow Im planning to perform more organized test.

Click to expand...

Obviously you do need to be a bit more organised when testing. My advice is to test pre meal, two hours, three hours to see wether after the two hours you do go hypo.
The reason you feel like eating the cupboard or fridge, is you are so used to having high glucose spikes, and your brain is so used to those levels that it is telling you to eat more carbs to maintain that level.
This is called a false hypo, because your brain thinks that your blood glucose levels are going into hypo levels and you need glucose to stop it.
There is a syndrome, where you get all the symptoms of RH, but you don't actually go hypo.
Until you reduce the high blood levels, back to normal or just above normal levels, will the hunger craving won't go

Stay safe

Hi again,
I think you have been misdiagnosed. Reactive Hypoglycaemia is a reaction to carbs and sugar, you have hypoglycaemic episodes because wit. If you don't have hypos, it is some other condition. Which will require tests.
I think your GP has mistaken hypo symptoms with other hormonal issues, maybe!
I am only guessing and the readings you are getting, are normal.
I was going by what you referred to and saying that you have been diagnosed with RH.
The testing, pre meal is just before you eat.
One hour is from first bite.
Then two hours
Three hours.
But this may only happen if you have carbs. If you don't have carbs, the readings will stay in normal levels.


Keep safe