The Best Diet for Non-Diabetic Hypoglycemia

Hypoglycemia is a condition that happens when your blood glucose levels are too low. Although usually associated with having diabetes, non-diabetic hypoglycemia can also occur. If you have symptoms of hypoglycemia, it is useful to monitor your blood glucose levels, especially around mealtimes and while you are sleeping. However, this can be tricky if you don't want to do an invasive finger prick test every time you eat a meal or in the middle of the night when you should be sleeping.

Continuous glucose monitoring offers a less invasive solution that is quick and accurate. You can wear the discreet sensor from a continuous glucose monitor (CGM) on the back of your arm. The sensor is easily scanned with your phone to quickly and effectively read and store glucose results. You can use these results to alter your diet and lifestyle to lower your glucose levels.

Do you want to know more about the right types of things to eat for hypoglycemia? This article will explore different types of hypoglycemia, how you can change your diet to manage the symptoms, and the advantages of glucose monitoring.

Can a non-diabetic have low blood sugar?

The simple answer to this question is yes. Low blood glucose (sugar) can occur in people without diabetes too. There are two types of non-diabetic hypoglycemia:

1. Reactive Hypoglycemia (postprandial hypoglycemia). Sometimes after someone eats their blood sugar levels can drop and this is known as reactive hypoglycemia. It usually occurs within the few hours following a meal. In some instances, reactive hypoglycemia can be an early sign of diabetes.‍
2. Fasting Hypoglycemia (non-reactive hypoglycemia). This is not related to meals and occurs when you are in a fasted or while you are sleeping. Some potential causes of fasting hypoglycemia are specific medications (common medications include insulin, Beta blockers, ACE/Inhibitors), excess alcohol, hypocortisolism, hypothyroidism, pregnancy, menopause, pancreatic tumors, or anorexia.

Hypoglycemia can also occur in non-diabetics if you have had specific types of bariatric surgery. In this case, the body releases too much insulin after eating carbohydrate-rich meals. This can result in hypoglycemia and is known as 'dumping syndrome.'

How do you define hypoglycemia?

The glucose level that defines hypoglycemia is variable. In those with diabetes, glucose levels below 70 are considered low. However, in those without diabetes, hypoglycemia is more often defined as blood sugar drops <55 mg/dL and a person has symptoms (e.g. tiredness, dizziness, difficulty concentrating, confusion, blurred vision, hunger, shakiness, elevated heart rate, anxiety, and sweating).

There are people who do not have diabetes and have glucose readings of less than 70 mg/dL and will feel fine. People who are very active, who have great blood sugar management, eat very low carbohydrate diets, or are adapted to regular fasting can have very low blood sugar readings without any clinical symptoms. In this case, where no symptoms are present, it is likely the values are fine for the individual, and no action is needed.

However, if you do have hypoglycemia symptoms then this is usually a signal from your brain that your glucose is too low and your body isn't getting the energy it needs. If you have hypoglycemia, you may experience any of the following symptoms:

• Hunger
• Irritability
• Blurred vision
• Pale skin
• Weakness
• Shakiness
• Excess sweating
• Lightheadedness/dizziness
• Anxiety
• Confusion
• Difficulty speaking
• Headaches
• Inability to concentrate

If you experience symptoms of hypoglycemia, it is vital to discuss it with your doctor so that they can help you find the underlying cause and discuss your treatment options.

Who is at risk of non-diabetic hypoglycemia?

Non-diabetic hypoglycemia can affect people for several reasons. However, you are more at risk if you:

• Have a genetic/family history of diabetes
• Have prediabetes
• Are obese
• Have other health problems (in particular issues with anorexia, your kidneys, adrenal glands or pituitary glands, or pancreas)
• Have had a specific type of stomach surgery including some bariatric surgeries like gastric bypass surgery
• Take medication for kidney disease
• Drink excessive amounts of alcohol

What is the treatment for non-diabetic hypoglycemia?

When diagnosing non-diabetic hypoglycemia, a doctor will take a full medical history and conduct several blood tests. If reactive hypoglycemia is suspected, then your doctor might recommend a mixed-meal tolerance test (MMTT). During a MMTT, you will be asked to consume a drink that contains protein, fats, and sugar. Your blood glucose levels are then checked several times over the following 2-5 hours.

If your doctor suspects non-reactive hypoglycemia due to a medical condition, medication, or other problem, then they will aim to address the problem causing the hypoglycemia. For example, if it is medication-related, your doctor might make changes to your medication.

For reactive hypoglycemia, medical treatment is not usually required, and dietary or lifestyle changes are recommended to lessen the symptoms.

If you have severe hypoglycemia or hypoglycemia related to diabetes, you may be prescribed medication to manage your blood glucose levels. Your doctor might also advise that you carry glucose tablets or injectable glucose (glucagon) if you have very severe symptoms.

What is the hypoglycemic diet?

A high-protein, low-carbohydrate diet is sometimes recommended to manage hypoglycemia. However, this type of diet has not been proven to help hypoglycemia. Overall, the following dietary changes are advised to help manage hypoglycemia:

• Try eating small meals and snacks throughout the day, approximately every three hours. This helps to regulate the amount of glucose in your bloodstream. However, this is not suitable for everyone. It is worth trying it to see how it affects you. For some people limiting carbohydrates is more successful- which can allow you to go longer between eating without having symptoms of hypoglycemia.‍
• Make sure your diet consists of a variety of foods. This should include protein (meat and non-meat), dairy, and high fiber but low carb foods such as non-starchy vegetables. Whole grain and high fiber foods take longer to break down, keeping your blood glucose levels more consistent.‍
• Limit high-sugar foods. If you do have something sweet, eat it with a meal.‍
• Limit or avoid alcohol as excess drinking can cause hypoglycemic symptoms. If you drink alcohol, avoid mixing it with sugary drinks and drink it with food.‍
• Limit or avoid caffeine can cause an increase in adrenaline, which can mimic the symptoms of hypoglycemia.‍
• Choose the right carbohydrates in your diet. This is essential to managing your blood glucose levels. Carbohydrates (carbs) can have a low or high glycemic index. The glycemic index is a measurement of how quickly and how high the carb raises your blood glucose levels. Eating foods with a low glycemic index has been shown to help control blood sugar levels. So when picking the carbs you want to eat, aim for ones that are low on the glycemic index. Aim for two to four servings of carbs at each meal (30-60 grams) and one to two servings (15-30 grams) at snack times. Everyone has a unique response to carbohydrates, which you can only find out when wearing a CGM.‍
• Include protein, fat, and fiber in all your meals. All these components slow down the rise in your blood glucose after you eat.

What to eat when you have a hypoglycemic event?

If you have a hypoglycemic event, and you monitor your blood glucose levels, then follow the 15:15 rule by doing the following:

• Take 15 grams of glucose/carbohydrates - this can be in the form of a glucose tablet, glucose gel tube, 1 tbsp sugar or honey, or hard candies‍
• Wait for 15 minutes
• Measure blood glucose levels
• Repeat this treatment until blood glucose levels reach at least 70 mg/dL

If you do not measure your blood glucose levels but suffer from symptoms of hypoglycemia, you will still need to consume fast-acting carbohydrates. These are simple sugars with little to no fiber, like the suggestions above. Other options include fruits like bananas, grapes, apple sauce, dates, or raisins.

When having a hypoglycemic event, it is best to avoid high-fat foods like chocolate or cookies. They don't raise blood sugar quickly enough as the fat can delay how quickly your body absorbs the required sugar. The 15:15 rule is a band-aid fix for hypoglycemia in the moment, the aim of using a CGM is to address the root cause and prevent further hypoglycemia attacks.

What is the best food to eat when your blood sugar is low?

If you suffer from frequent hypoglycemia, it's best to try and avoid low blood sugar by always carrying a snack with you. Ensure you do not go long periods without eating, and eat regular meals or snacks to help prevent hypoglycemia. Snacks such as granola bars with protein or nuts, trail mix, and dried fruits are good portable snacks to carry with you.

Hypoglycemia food list

Choose low glycemic index foods to help you control your blood glucose levels.  Meat and fish do not have a glycemic index because they do not contain carbohydrates. The table below displays foods containing carbohydrates in low, moderate, and high glycemic index categories to give you an idea of the best types of foods to choose.

Breads
‍Low GI: Spelt bread, sourdough bread, whole grain tortilla, heavy-mix grain breads
Moderate GI: Chapati, linseed bread, flaxseed bread, pita bread, pumpernickel bread, roti, rye bread, whole-grain wheat bread
High GI: White and whole wheat bread, naan bread‍

Cereals
Low GI: All-bran, oat-bran, steel-cut oats
Moderate GI: Instant, quick, or large-flake oats
High GI: Cornflakes, Rice Krispies, Puffed Wheat, Cream of Wheat, Special K

Grains
Low GI: Barley, bulgur, firm/al dente pasta, quinoa, pulse flours, mung bean noodles
Moderate GI: Basmati rice, brown rice, cornmeal, couscous, rice noodles, wild rice, short/long-grain white rice
High GI: Jasmine rice, millet, sticky rice, instant white rice‍

Other starches
‍Low GI: Peas, popcorn, sweet potato, winter squash
Moderate GI: Beets, corn, parsnip, potato, rye crisp crackers
High GI: Carrots, instant mash potato, pretzels, rice cakes, soda crackers‍

Fruits
‍Low GI: Apple, apricot, unripe/green banana, berries, cantaloupe, grapefruit, honeydew melon, mango, orange, peach, pear, plum, pomegranate, prunes
Moderate GI: Ripe banana, cherries, cranberries, figs, grapes, kiwi, lychee, pineapple, raisins
High GI: Brown/overripe banana, watermelon‍

Milk and yogurt
‍Low GI: Almond milk, 1% and 2% cow’s milk, frozen yogurt, Greek yogurt, soy milk, yogurt
Moderate GI: N/A
High GI: Rice milk

Beans, peas, and lentils
‍Low GI: Baked beans, chickpeas, kidney beans, lentils, mung beans, romano beans, soybeans/edamame, split peas
Moderate GI: Ready-made lentil or split pea soup
High GI: N/A

Alongside low glycemic index foods choose:

• High-quality protein (meat, fish, or eggs)
• Alternative sweeteners such as Stevia rather than sugar
• Fresh vegetables, especially dark leafy greens

Does exercise help reactive hypoglycemia?

Regular exercise is always a positive aspect of maintaining good health. However, if you frequently experience hypoglycemia then you may need to adjust your diet slightly depending on your exercise regime. For some people, strenuous or sustained physical activity can cause blood glucose levels to drop.

The best way to manage this is to eat a small snack containing both carbs and protein before exercising. Keep the snack small and remember to stay hydrated with plenty of water throughout your physical activity. Examples of pre-exercises snacks include:

• Greek yogurt and berries
• A small amount of mixed dried fruits and nuts
• An apple and some peanut butter

Monitoring your blood glucose levels can help manage hypoglycemia

Blood glucose levels can be affected by diet, exercise, lifestyle choices, medication, and medical conditions. If you have problems with hypoglycemia, then having a CGM is an efficient and effective way to monitor and control your blood glucose levels. CGMs are beneficial for both people with or without diabetes. Wearing a CGM has been shown to reduce the risk of hypoglycemia as it tracks your glucose levels in real-time, measuring, and continuously storing glucose data.

If you are thinking about taking the next step to monitor your blood glucose levels, and take charge of your health, then join the NutriSense Continuous Glucose Monitoring Health Program. NutriSense combines leading technology with access to the expertise of a registered dietitian. If you are interested in learning more about using a CGM to control your blood glucose levels and help take control of hypoglycemia, then contact NutriSense.