I frequently see patients complaining that they can get “spacey”, i.e., unable to concentrate, words a little jumbled, headachy, or a little dizzy and irritable if they haven’t eaten for several hours. These are the basic symptoms caused by blood sugar falling a little low, or hypoglycemia, and it occurs from having gone too long without eating.
Low blood sugar is a condition that can be remedied quickly with some orange juice, or raisins, right away, and then making sure you follow that with a more balanced nutritious meal. I’d like to share more detail about this condition with you, especially if it happens to you frequently. It may be a warning sign for other underlying conditions.
What Is Hypoglycemia?
There are, really, two types of hypoglycemia; that which occurs in insulin-dependent diabetics and that which occurs in non-diabetic people. The symptoms can be:
➢ Mild – you get very hungry, a little jittery possibly, possible heart palpitations.
➢ Moderate – you may get blurry vision, become very irritable, or confused.
➢ Severe – you may have a seizure, pass out, or go into a coma.
As I explain to my patients with seemingly low blood sugar symptoms, we all can have a kind of mild to moderate, garden variety hypoglycemia where our blood sugar falls a little too low now and then. Usually, unless you’ve gone more than several hours without eating, and/or you are in a very hot or very cold environment, your symptoms shouldn’t be more bothersome than the mild, perhaps even moderate, ones mentioned above.
However, true hypoglycemia, the one in which the symptoms can be severe, almost always only occurs in insulin-dependent diabetics as a result of taking more insulin than is required to balance the amount of sugar in their blood. To prevent this type of hypoglycemia, insulin-dependent diabetics should observe the following:
➢ Monitor insulin closely – work with your doctor to fine tune this amount, always balancing it with the amount/type of food you eat, and blood sugar levels.
➢ Plan your meals – never skip a meal.
➢ Always carry a rescue kit that includes glucose tablets and glucagon.
➢ Identify yourself as a diabetic – wear a medic alert bracelet or necklace. Always let someone around you know you are a diabetic if you start to feel poorly.
For non-insulin dependent diabetics, usually you have enough stored glucose in your liver that gets released by secreting the hormone glucagon when your blood sugar dips. This will release a little extra glucose into your blood to keep you from passing out until you can eat again. However, do not ignore these initial low blood sugar warning signs, get something to eat quickly.
What Else Can Cause Hypoglycemia?
As I tell my non-diabetic patients who seem to frequently be affected by hypoglycemic episodes, there are other factors and situations which can cause hypoglycemic events that you should be aware of. They include:
➢ Certain medications: Some antidepressants, i.e., MAO (monooxidase inhibitors), quinine, aspirin in general. However, certain classes of antibiotics (fluoroquinolones such as Levaquin, Levofloxacin, Cipro, Avelox) have also been associated with blood glucose abnormalities as well, mostly in elderly patients with type 2 diabetes.
➢ Underlying Medical Conditions: Certain conditions can cause moderate to severe hypoglycemic events. One of them is pheochromocytoma, a big medical word for a little tumor of the adrenal gland. If you experience low blood sugar events frequently, your doctor will likely want to test you for pheo, as well as another condition called insulinoma, a tumor of the pancreas which causes you to secrete too much insulin and blood sugars to drop frequently. Also, hepatitis, as well as cancer, abnormalities of the adrenals or pituitary glands, or kidney conditions can create low blood sugar events.
➢ Alcohol: Many of my patients experience low blood sugar after drinking too much alcohol. Be sure when you drink alcohol to also eat a good meal with it.
➢ After-Eating: Some of my patients experience low blood sugar after eating a big meal because you released more insulin than you actually needed to process it. This can also occur in people who have had gastric bypass surgery or gastric banding for weight loss. Certain medical tests can determine this condition.
Blood Sugar – Keep It Normal
Obviously, the best way to prevent hypoglycemia episodes from occurring is to keep blood sugar normal through eating the proper combinations of nutritious foods evenly spaced throughout the day. To do this, try to remember these nutritional guidelines:
➢ 4-6 oz of high quality protein at each meal
➢ Don’t be afraid of a little fat, like that from nuts, olive oil, levels blood sugar longer
➢ Add some low glycemic load foods like vegetables and legumes (lentils, kidney beans, garbanzo beans), low glycemic fruits (a good glycemic index chart can help you choose).
➢ Vitamins/minerals: A potent, all inclusive multivitamin including minerals like chromium, magnesium, zinc, and antioxidants like alpha-lipoic acid, bilberry, resveratrol.
As I tell my patients, hypoglycemia can have some uncomfortable symptoms. However, if you eat nutritious meals every day, and rule out any underlying medical conditions, you should be able to prevent low blood sugar, stay energetic and at the top of your game everyday!
Mark Rosenberg, M.D.