Reactive hypoglycemia
Reactive hypoglycemia | |
---|---|
Other names | Postprandial hypoglycemia, sugar crash |
HbA1c blood test, 6-hour glucose tolerance test | |
Differential diagnosis | Alimentary hypoglycemia, factitious hypoglycemia, insulin autoimmune hypoglycemia, noninsulinoma pancreatogenous hypoglycemia syndrome, insulinoma, hereditary fructose intolerance |
Prevention | Low-carbohydrate diet, frequent small meals |
Reactive hypoglycemia, postprandial hypoglycemia, or sugar crash is a term describing recurrent episodes of symptomatic hypoglycemia occurring within four hours[1] after a high carbohydrate meal in people with and without diabetes.[2] The term is not necessarily a diagnosis since it requires an evaluation to determine the cause of the hypoglycemia.[3]
The condition is related to homeostatic systems used by the body to control the blood sugar level. It is described as a sense of tiredness, lethargy, irritation, or hangover, although the effects can be lessened if a lot of physical activity is undertaken in the first few hours after food consumption.
The alleged mechanism for the feeling of a crash is correlated with an abnormally rapid rise in
Sugar crashes are not to be confused with the after-effects of consuming large amounts of protein, which produces fatigue akin to a sugar crash, but are instead the result of the body prioritising the digestion of ingested food.[6]
The prevalence of this condition is difficult to ascertain because a number of stricter or looser definitions have been used. It is recommended that the term reactive hypoglycemia be reserved for the pattern of
To assist in diagnosis, a doctor may order an
According to the
Signs and symptoms
Symptoms vary according to individuals' hydration level and sensitivity to the rate and/or magnitude of decline of their blood glucose concentration.[citation needed]
A crash is usually felt within four hours of heavy carbohydrate consumption. Along with the symptoms of hypoglycemia, symptoms of reactive hypoglycemia include:[7][8][9]
- blurry vision
- unclear thinking
- brain fog
- insomnia
- palpitation or fibrillation
- fatigue
- dizziness
- light-headedness
- sweating
- headaches
- depression
- nervousness
- muscle twitches
- irritability
- tremors
- flushing
- craving sweets
- increased appetite
- rhinitis
- nausea, vomiting
- panic attack
- numbness/coldness in the extremities
- confusion
- irrationality
- hot flashes
- bad temper
- paleness
- anxiety
- trouble talking
- cold hands
- disorientation
- the need to sleep or 'crash'
The majority of these symptoms, often correlated with feelings of hunger, mimic the effect of inadequate sugar intake as the biology of a crash is similar in itself to the body's response to low blood sugar levels following periods of glucose deficiency.[10]
Causes
The NIH states: "The causes of most cases of reactive hypoglycemia are still open to debate. Some researchers suggest that certain people may be more sensitive to the body’s normal release of the hormone epinephrine, which causes many of the symptoms of hypoglycemia. Others believe deficiencies in glucagon secretion might lead to reactive hypoglycemia.[1]
Several other hormones are responsible for modulating the body's response to insulin, including cortisol, growth hormone and sex hormones. Untreated or under-treated hormonal disorders such as adrenal insufficiency (see also Addison's disease[11]) or growth hormone deficiency[12] can therefore sometimes cause insulin hypersensitivity, and reactive hypoglycemia.
There are several kinds of reactive hypoglycemia:[13]
- Alimentary hypoglycemia (consequence of dumping syndrome; it occurs in about 15% of people who have had stomach surgery)
- Hormonal hypoglycemia (e.g., hypothyroidism)
- Helicobacter pylori-induced gastritis (some reports suggest this bacteria may contribute to the occurrence of reactive hypoglycemia)[14]
- Congenital enzyme deficiencies (hereditary fructose intolerance, galactosemia, and leucine sensitivity of childhood)[15]
- Late hypoglycemia (occult diabetes; characterized by a delay in early insulin release from pancreatic beta-cells, resulting in initial exaggeration of hyperglycemia during a glucose tolerance test)[16]
"Idiopathic reactive hypoglycemia" is a term no longer used because researchers now know the underlying causes of reactive hypoglycemia and have the tools to perform the diagnosis and the pathophysiological data explaining the mechanisms.[13]
To check if there is real hypoglycemia when symptoms occur, neither an oral glucose tolerance test nor a breakfast test is effective; instead, a hyperglucidic breakfast test or ambulatory glucose testing is the current standard.[13][17]
The body requires a relatively constant input of glucose, a sugar produced upon digestion of carbohydrates, for normal functioning. Glucagon and insulin are among the hormones that ensure a normal range of glucose in the human body.
Treatment
Reactive hypoglycemia can usually be relieved by dietary changes:[20]
- Avoiding or limiting sugar intake, including
- Eating only small amounts of starchy foods, including potatoes, pasta, breakfast cereals, and rice.[20]
- Eating a variety of foods, including:
- whole-grain carbohydrates, such as eating whole wheat bread instead of white bread,[20] and
- more fruits and vegetables (but not fruit juice), with 5 A Day being a recommended goal for most people.[20]
- Eating more leafy greens, and most fruits and vegetables.[20]
Other tips to prevent sugar crashes include:
- Exercising regularly, as exercise increases cellular sugar uptake, which decreases excessive insulin release.[22][23]
- Avoiding eating meals or snacks composed entirely of carbohydrates;[20] simultaneously ingest fats[dubious ] and proteins, which have slower rates of absorption;[citation needed]
- Consistently choosing longer lasting, complex carbohydrates to prevent rapid blood-sugar dips in the event that one does consume a disproportionately large amount of carbohydrates with a meal;
- Monitoring any effects medication may have on symptoms.[4]
As it is a short-term ailment, a sugar crash that was not caused by injecting too much insulin does not usually require medical intervention in most people. The most important factors to consider when addressing this issue are the composition and timing of foods.[24]
Acute (short-term) low blood sugar symptoms are best treated by consuming small amounts of sweet foods, so as to regain balance in the body's carbohydrate metabolism. Suggestions include sugary foods that are quickly digested, such as:
- Dried fruit
- Soft drinks
- Juice
- Sugar as sweets, tablets or cubes.[25]
The anti-hypertensive class of medication known as
Postprandial syndrome
If there is no hypoglycemia at the time of the symptoms, this condition is called idiopathic postprandial syndrome. It might be an "
See also
- Spontaneous hypoglycemia
- Refeeding syndrome
References
- ^ a b c "Hypoglycemia." It can also be referred to as "sugar crash" or "glucose crash." National Diabetes Information Clearinghouse, October 2008. http://diabetes.niddk.nih.gov/dm/pubs/hypoglycemia/ Archived February 8, 2015, at the Wayback Machine Archived version at https://web.archive.org/web/20180415102429/https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood-glucose-hypoglycemia
- ^ "Hypos After Eating - Reactive Hypoglycemia". Retrieved September 8, 2018.
- ^ Service, FJ; Vella, A (June 11, 2018). "Postprandial (reactive) hypoglycemia". UpToDate. Retrieved September 8, 2018.
- ^ a b Hendrickson, Kirstin. "Side Effects of a Sugar Overdose". Demand Media, Inc. Retrieved November 8, 2011.
- PMID 25320065.
- ^ "The Truth about Tryptophan". WebMD.
- ^ "Hypoglycemia". National Diabetes Information Clearinghouse. U.S. Department of Health and Human Services. Archived from the original on February 8, 2015. Retrieved November 8, 2011.
- ^ "Hypoglycemia". Mayo Foundation for Medical Education and Research. Mayo Clinic. Retrieved November 8, 2011.
- ^ Simpson, Jamie. "Causes of Low Blood Sugar". Demand Media. Retrieved November 8, 2011.
- ^ "Diabetes". American Dietetic Association. Retrieved November 11, 2011.
- .
- S2CID 1411317.
- ^ PMID 11119013.
- S2CID 22096584.
- ^ Hamdy O, Srinivasan V, Snow KJ. "Hypoglycemia". Medscape. WebMD LLC. Retrieved July 6, 2007.-Updated March 2018
- ^ Umesh Masharani (2007). "Postprandial Hypoglycemia (Reactive Hypoglycemia)". The Hypoglycemic states - Hypoglycemia. Armenian Medical Network.
- PMID 7962339.
- ^ "How the Body Controls Blood Sugar". Web MD Diabetes. Healthwise Incorporated. Retrieved November 8, 2011.
- ^ "Hypoglycemia". Hormonal and Metabolic Disorders. Merck Sharp & Dohme Corp. Retrieved November 8, 2011.
- ^ a b c d e f g h "Healthy Eating for Reactive Hypoglycemia". National Health Service (3rd ed.). UK. 2017. NHS Trust Docs ID: 10513 (Review date: 2020-06-11).
- ISBN 978-0-557-07407-5"
- PMID 31474750.
- PMID 20843832.
- ^ Collazo-Clavell, Maria. "Reactive Hypoglycemia". Mayo Foundation for Medical Education and Research. Retrieved November 11, 2011.
- ^ "Hypoglycemia (Low Blood Sugar) in People Without Diabetes". Diabetes Health Center. WebMD, LLC. Retrieved November 8, 2011.
- PMID 3762399.
- PMID 19625246.
- ^ "Postprandial Hypoglycemia". Retrieved November 29, 2011.
Further reading
- Açbay O, Celik AF, Kadioğlu P, Göksel S, Gündoğdu S (1999). "Helicobacter pylori-induced gastritis may contribute to occurrence of postprandial symptomatic hypoglycemia". Dig. Dis. Sci. 44 (9): 1837–42. S2CID 22096584.