Dietary advice for reactive hypoglycaemia

What is it?

Reactive hypoglycaemia is a term used to describe a drop in blood glucose after eating certain foods. It is typically seen 2 to 4 hours after eating.

This condition can be seen for no apparent reason, although it is often seen following surgery to your stomach.

After eating something sugary our body releases insulin (a hormone that allows sugar to move from blood into other cells) which results in a drop in your blood glucose level.

It is best to try and prevent this from happening, but if hypoglycaemia (hypo) occurs it does need treatment.

What are the symptoms of hypoglycaemia?

• Feeling dizzy, shaky or faint.
• Sweating.
• Blurred vision.
• Loss of concentration.
• Hunger or craving for sugary foods.
• Anxiety.
• Fatigue.

How do you treat hypoglycaemia?

When you experience hypo symptoms, or you test your blood and it shows a result of below 4 (<4mmol), you should immediately take 15g of high glycaemic index (GI) carbohydrate. Some examples of this are:

• Small packet of jelly sweets.
• ½ glass (200ml) or small carton of fruit juice.
• 3 to 4 glucose tablets.
• 4 fruit pastilles or wine gums.
• 150ml or small can of full sugar fizzy drink.

After having the sugar you should wait 10 minutes before repeating your blood test (if you have tested your blood).

Follow up the sugar intake with a snack containing slow release (low GI) carbohydrate to keep your blood glucose stable. Some examples are:

• 1 slice of seeded or wholegrain bread.
• 1 to 2 oat cakes with low fat cheese or a slice of cold meat.
• A small bowl of cereal such as porridge or nutty muesli with milk.
• 2 tablespoons of raisins or a small cereal bar.
• A piece of fruit.

This will help to prevent a further drop in your glucose level.

It is important to still avoid foods you are allergic to (i.e. if allergic to peanuts do not eat cereal containing peanuts).

How can you prevent hypoglycaemia?

Eating a regular balanced diet high in fibre and low in sugary foods can help to control blood glucose levels. Studies also suggest limiting your carbohydrate portions can also help.

Carbohydrates are found in a lot of foods, including the following:

What is Glycaemic Index (GI)?

This can be described as the rate at which carbohydrates are released from food during digestion. A low GI food is absorbed by the body more slowly and can help to stabilise your blood glucose. Often these foods are higher in fibre such as the wholegrain versions of our starchy carbohydrates (detailed in the above table).

High GI foods release sugars very quickly and can raise our blood glucose quickly, which is why they are used as an immediate treatment for a hypo.

The GI ranking of a food is often given as a number from 1 to 100. 100 would mean a high GI food.

Carbohydrate foods are an important source of energy and other micronutrients (minerals the body needs) and should be included as part of a healthy balanced diet. It has been found that the portion size and type of carbohydrates in the diet can be important in minimising hypos.

Main points to consider:

• Eat a healthy balanced diet.
• Limit high GI foods/foods high in sugar – such as sweets, jam, honey.
• Limit alcohol – as this can lower your blood glucose.
• Try to eat small, frequent meals – aim to eat every 3 hours.
• Avoid full sugar drinks – choose diet or zero sugar fizzy drinks.
• Include fibre within your meals.
• Avoid large carbohydrate portions.
• Combine protein (usually meat or dairy) with carbohydrate at meals (combining foods can lower the GI index of a meal).
• Consider decaffeinated drinks as this may help.

Meal suggestions

Each bullet point is a separate meal.

Breakfast:

• 2 slices of wholegrain seeded bread with cheese or eggs.
• Small pot of yoghurt and piece of fruit.
• 30g cereal with semi-skimmed milk.
• Celery with peanut butter with optional slice of wholegrain bread.
• 40g uncooked cornmeal or 30g oats or 35g uncooked basmati as porridge/congee.
• ½ avocado with 2 eggs and 2 slices of wholegrain seeded bread.
• Smoked salmon with 1 egg and 1 slice rye bread and rocket.
• 60g flatbread with cheese or aubergine and tahini dip.

Light meals:

• 2 egg omelette and 2 slices of wholegrain or seeded toast.
• Soup with 2 slices wholegrain bread or 1 pitta.
• 3 to 4 oat cakes with cheese or ham.
• 3 crispbreads with cottage cheese or cold sliced meat or tuna.
• Baked sweet potato with cheese or beans.
• Wholemeal wrap with chicken and salad.

Main meals:

• Lean meat, poached fish or skinless chicken with 4 egg sized potatoes and salad or vegetables.
• Vegetable/meat or fish curry with <150g basmati/brown rice.
• Pasta dish (<150g cooked) with mince or tuna and salad.
• Meat or vegetables stir fried with 100g noodles (cooked).
• 2 small (60g) or 1 large chapatti (60g) with curry.
• Soup/stew with <150g of FuFu/Pap/Banku/Gari or pounded yam.
• 150g tagine and 100g couscous.
• 150g of rice and peas with meat or fish.

Snacks (15g of low GI carbohydrate):

• 1 medium slice of multigrain, seeded or granary bead.
• 2 oatcakes.
• 1 apple or 1 orange or 1 small banana.
• 1 125g pot of yoghurt.
• 2 digestive biscuits.
• Vegetable sticks with hummus.

Drug Treatment

Some people may be referred to an Endocrinologist (doctor who specialises in the endocrine system which regulates hormones throughout the body) who may suggest some medication to help. Two such medications are Acarbose and Diazoxide.

Acarbose works by slowing down the rate that carbohydrates are broken down and absorbed by the body.

Diazoxide works by slowing down the rate at which insulin is released.

These medications are not suitable for everyone.

Further reading and references

British Dietetic Association – www.bda.uk.com

Diabetes UK – www.diabetes.org.uk

Carbs and Cals – www.carbsandcals.com/resources/free-resources
(or using their free app ‘Carbs & Cals’ available on your app store)

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