Posted by Dr. Robin Terranella
Are you having hypoglycemia or reactive hypoglycemia? Maybe this is a new thing for you and you're trying to figure it out. In this post we'll look at some approaches to resolving reactive hypoglycemia — both the obvious things and some less obvious ones that often get missed.
One thing worth pointing out before we get to strategies: the symptoms and problems from hypoglycemia can linger in your body far longer than the actual blood sugar episode itself. The reason is that the body's compensatory responses — the cascades that kick in to resolve the low blood sugar — keep playing out for hours after the blood sugar itself has stabilized.
Think of it like dropping a stone into a still lake. The larger the stone, the larger the waves, and they spread out from the moment the stone drops. As the wave moves outward you notice it less and less, but it's still rippling for a long time.
The first place to look is the amount of carbohydrate you're eating in a given setting. Some people need more based on their activity level, and you can get a sense of how much you need by using a continuous glucose monitor.
One thing's for sure — if you're having reactive hypoglycemia, you're eating too many carbs. But sometimes it's the type of carbohydrate more than the total quantity. There's a measure called the glycemic index, which categorizes how quickly different carb sources raise your blood sugar. Looking at this and limiting the high-glycemic-index foods will go a long way toward reducing reactive hypoglycemic events.
Two factors that get overlooked: the depth and amount of sleep you're getting each night, and your overall digestive health.
Digestive health, in particular, can lead to alterations in the metabolism of bile acids and other products that affect glucose metabolism. One example: people with post-infectious IBS can develop decreased barrier function in the digestive tract — also known as leaky gut. People with leaky gut are more likely to have metabolic dysfunction in general — higher triglycerides, higher glucose, insulin resistance.
The mechanism involves problematic microbes (or microbial proteins) crossing the intestinal barrier and activating the immune system. There's interplay there with GLP-1, a satiety hormone, and immune cells. The immune activation from problematic microbes can disrupt the regulation of glucose-related signals.
So the digestive piece is real — and underappreciated. If your blood sugar is misbehaving and you've already cleaned up the carbs and your sleep, the gut is the next place to look.
If reactive hypoglycemia is a problem for you, the order I'd work through:
First, look at the amount of carbohydrates relative to your activity level. Cut down if needed.
Second, look at the type. Limit high-glycemic-index foods. Lower-glycemic options keep blood sugar from spiking and crashing.
Third, fix sleep — depth and quantity. Poor sleep destabilizes blood sugar regulation.
Fourth, look at the gut — especially if you've had a history of GI infections, IBS, or any reason to suspect leaky gut. Chronic inflammation from gut sources can drive metabolic dysfunction.
Reactive hypoglycemia isn't always solved just by eating more often. The real fix usually involves looking at carb amount and type (glycemic index), sleep, and digestive health — particularly the gut barrier. These less obvious levers are often what's actually driving the issue once the obvious carb piece is handled.
If you've been dealing with reactive hypoglycemia and the standard advice hasn't worked, work with me directly to look at all four pieces — carbs, glycemic index, sleep, and gut.