Signs and Symptoms: Hypoglycemia Symptoms despite Normal Lab Values

By: Michael Lam, MD, MPH


Sufferers of adrenal fatigue frequently feel a need to eat in order to feel less fatigued or anxious. Then, soon after completing their meal, they experience brain fog, only to become hungry again in a few hours. This leads to a feeling of “hangry”, a combination of always being hungry and angry from the frustration of reactive hypoglycemia. This is sometimes referred to as postprandial reactive hypoglycemia, meaning hypoglycemia that occurs after eating.

A patient listens as her doctor explains hypoglycemia symptoms.Reactive hypoglycemia can be difficult to diagnose. Lab tests, like blood glucose, are typically normal, leaving sufferers perplexed and frustrated. Doctors often tell their patients everything is okay. Let’s take a look at what’s really going on.

Technically, hypoglycemia occurs when blood glucose levels drop below about 60-70mg/dl. However, reactive hypoglycemia, may not cause blood sugar levels to drop this low. In this type of event, it’s not the absolute blood sugar, it’s the sudden rise and fall that can occur after eating. So, if you have a blood sugar level in the 100-120mg/dl range, that suddenly drops to around 70-80mg/dl, you may start to experience the symptoms of hypoglycemia, even with a blood sugar well within the normal range.

Metabolism of Food

As your body digests food, it is broken down, and glucose from the food is absorbed into the bloodstream. The pancreas responds by releasing insulin. This is needed to convert the glucose into energy for your cells. As the glucose is used, the pancreas responds by releasing another hormone known as glucagon. Glucagon helps maintain stable blood glucose levels by tapping the liver for glucose stored in the form of glycogen. Diabetes occurs when the insulin response doesn’t work properly, while hypoglycemia occurs when the glucagon response doesn’t work properly. All of these mechanisms are designed not just to provide energy for the cells, but also to ensure that the brain has enough glucose to function. Brain fog, irritability, and many other symptoms of hypoglycemia are caused by the brain not having adequate glucose to function normally.

The easiest way to address reactive hypoglycemia is to eat smaller meals that are high in complex carbohydrates and protein more frequently, and limit or eliminate sugar and simple carbohydrates. It is important to understand the physiology behind what is happening, so you can eat more strategically. Eating simple sugars and processed carbohydrates tend to produce a big spike in insulin production in your pancreas. This causes a large amount of the glucose to go from the blood into the cells. When this happens, your body feels the weakening symptoms of reactive hypoglycemia. This tricks your mind into thinking it’s hungry again and causing you to eat more and more.

However, when you eat complex carbs that are high in fiber, good protein and fats, your pancreas doesn’t produce a big spike in the insulin, but only a small gradual peak over a longer period of time. Your GI system has a longer time to digest the foods because it has to break down the complexity of the food, causing you to stay satiated for a longer period of time. This is why it’s so important to evaluate your diet to see if what you’re eating could be causing your spikes in symptoms.

Reactive Hypoglycemia Symptoms Linked to Adrenal Fatigue

A young woman holding her mouth and looking uncomfortable with hypoglycemia symptoms.Reactive hypoglycemia, and its symptoms, just like a symptom of any other ailment, is your body’s way of telling you something is wrong. In this case, your body is telling you that your metabolism isn’t working properly. Reactive hypoglycemia often indicates late stage adrenal fatigue. It is frequently accompanied by brain fog, irritability, nausea, shaking, and nighttime wakefulness and can occasionally be accompanied by joint pain, fainting and heart palpitations. In very severe cases of reactive hypoglycemia, seizures may occur. This is rare, but very serious. During the day, you may experience a drowsiness that may be helped by eating every couple of hours, otherwise you find yourself struggling to stay awake or feeling weak.

Sufferers of adrenal fatigue are unable to regulate normal levels of adrenaline and other stress hormones. This makes it more difficult to regulate blood sugar in general, and in stressful situations in particular. It has long been known that adrenal fatigue and blood sugar imbalances (most often reactive hypoglycemia) go hand in hand.

Cortisol and other stress hormones stimulate the liver to release stored glucose into the bloodstream to be used by the cells for energy. These hormones also help convert fats and proteins into glucose. When the adrenal glands are not functioning optimally, generating the energy needed to deal with stressful situations is much more difficult. In advanced stages of adrenal fatigue, it becomes downright impossible.

For people under a lot of chronic stress, and especially those with advanced adrenal fatigue, reactive hypoglycemia can be a real problem. This is because stress hormones play an important role in blood sugar regulation, and adrenal fatigue interferes with normal stress hormone levels. The metabolic circuit in the Neuroendometabolic (NEM) Stress Response System consists of the pancreas, thyroid, and liver. The idea of the NEM response is that your whole body is affected by stress and reacts differently to chronic issues. In the metabolic circuit, the pancreas is in charge of glucose control, and thus in stressful situations, the body responds by raising blood sugar levels so that additional energy stores are available to meet increased demand. Hypoglycemia occurs when the body is unable to meet this demand. The thyroid is a key player in metabolism, and having a high basal metabolic rate could cause you to burn off your energy faster, thus getting hungry faster. The liver is important in gluconeogenesis and producing enough glucagon to balance the insulin from the pancreas. This is why it’s important to look at hypoglycemia in a whole-body approach rather than just targeting one organ system.

Diet and Reactive Hypoglycemia Symptoms

A frazzled looking man clutching a coffee cup, who would benefit from diet changes to soothe hypoglycemia symptoms.In our modern culture, people mask adrenal fatigue and hypoglycemia symptoms with sugar and caffeine. This works, for a time, but is followed about an hour or so later by a dramatic drop in blood sugar levels, typically even lower than before. This leads to a vicious cycle. People stuck in this cycle often do not realize that they are simply making the problem worse.

The body sees hypoglycemia as an emergency stressor all on its own. Using sugar and caffeine causes blood sugar levels to spike and then plummet, throwing hormone levels into more chaos than before. Recovering from blood sugar swings, and getting the hormones back into balance, involves significant and consistent lifestyle changes.

The first step to recovering from this cycle is getting good nutrition from small, frequent meals. These meals should contain good quality complex carbohydrates, and sugar and caffeine should be limited or, better yet, eliminated. To manage your sweet tooth, enjoy occasional treats made with raw honey. Avoid sweeteners, as they trick your body into thinking it’s about to be flooded with sugar, stimulating the release of insulin, and triggering or aggravating hypoglycemia. This can also occur with natural sweeteners such as stevia, so if you use these sweeteners, pay attention to how you feel afterward.

Regulating blood sugar is a delicate balancing act. Any hormonal imbalance can influence blood sugar, which can, in turn, stress the adrenal glands and intensify fatigue. This doesn’t mean you should treat your symptoms yourself. It’s still important to talk to your doctor and rule out any other metabolic issues, especially if you have a family history of diabetes. Pre-diabetes can mimic reactive hypoglycemia. The difference is that one is a result of insulin resistance, while the other is the result of insulin sensitivity. Understand that those feelings of hunger and anger are fixable if you target the right organs and direct your diet to satiate you for a longer period of time. Due to the tremendous variation in each person’s metabolic profile, the precise kind of food and frequency should best be customized. The wrong approach can make the adrenal glands work even harder and damage the already impaired metabolism, trigger adrenal crashes, and predispose a person to diabetes and insulin dysregulation.

© Copyright 2016 Michael Lam, M.D. All Rights Reserved.

A patient listens as her doctor explains hypoglycemia symptoms.

DrLam.com
5 -
This is truly extraordinary info.I experienced adrenal exhaustion for a long time and this is the sort of guidance that truly helped me to defeat my issue. In this way, to all you sufferers, YES! There is trust! Simply don't lose confidence and realize that your body can mend itself. I was fortunate to locate some incredible exhortation that helped me beat my adrenal weariness and show ` of improvement.




5 Comments

  • Sushil says:

    Thank you very much for such a nice video Respected doctor,
    I found that I have fatty liver and thyriod deficiency.
    When i drive many times I feel I am loosing consciousness(loosing awareness) especially in high speed. I feel dizzy when mostly after 3 hours after eating but also after eating i feel same. I doubt it is because of diabetes.
    Please help me

    • Dr.Lam says:

      Fatty liver is common, and so is thyroid deficicnecy. How they are tied in together for you needs more investigation. Something is going on. A detailed history by someone who knows more about AFS and metabolic issues is needed.

      Dr Lam

  • Rebecca L Hall says:

    After eating, I become shaky, my heart pounds and the sound of blood rushing in my ears is temporarily deafening. I will heed your advice! I had stopped taking my thyroid medication ( I hated the side effects even though my levels are very low). I will begin taking the Synthroid again today. My mother and brother both developed adult onset diabetes. Your information may very well save me from their fate. Thank you!

    • Dr.Lam says:

      You need to first talk to your doctor and see if there is a metabolic component to your problem as that is the most common associated issue.

      Dr Lam

  • Michele Finizio says:

    Will fruit be ok to eat.