Reactive Hypoglycemia

I have had what has been unofficilaly diagnosed as reactive hypoglycemia since about the time my migraines entered my life (25 years). Typically, I would have a dip in blood surgar within 1/2 - 1 hour after dinner, most notably after some physical activity (e.g., playing with the kids). To get over it, I would eat a bowl of cereal and be fine within minutes. This occurred maybe 2-4 times a month. Since my MAV has started last June, my episodes of reactive hypoglycemia have increased in number and severity. Now it takes at least an hour and larger amounts of food or drink before I start feeling better after trying to combat an episode. Also, I now get the episodes after any meal, not necessarily dinner. I had a very bad episode this afternoon (after having turkey on wheat bread and an orange for lunch). This was the first one that I had in a few weeks. I am in the midst of a bad few days, although I am not sure if that is because of the Nortriptyline that I started last week or if I am just having worse days. Does anyone have any experiece or thoughts with respect to reactive hypoglycemia and MAV? Thank you. Ben

I am convinced that I have this also, but I cannot eat oranges at all they send me into a tailspin with my MAV.

I am not sure that would have anything to do with the RH but I just know I cannot eat them at all, I tried one over the holidays and that was a big mistake.

Scott knows a lot about the Glycemic index so maybe he can shed some light on why this might be happening as I have thought the two of mine are connected as I was really bad about what I was eating before all this started last year.

Hi Ben,

We do a lot of research at the university with glycemic index (my PhD involved GI and cardiovascular disease risk). It would definitely be worth trying this approach. I do a monthly blog with another lady you can do a search through for tips on this ( This was something we put together in 2006:

[size=150]Dispelling some myths about … Hypoglycemia[/size]

Hypoglycemia is a condition in which the glucose level in the blood falls below normal levels. It derives from the Greek words “hypo” meaning under and “glycemia” meaning blood glucose – hence blood-glucose level below normal. People with diabetes know all about it. If you don’t have diabetes, but you have vague health problems ranging from tiredness to depression and think you may have hypoglycemia or someone tells you that you probably have ‘low blood sugar’, see your doctor and get a proper diagnosis.

• Hypoglycemia is far less common that once was thought in people who do not have diabetes.

• Hypoglycemia due to a serious medical problem is rare.

• The most common form is reactive hypoglycemia, which occurs after eating.

[size=120]What you need to know about reactive hypoglycemia[/size]
What is it?
If you have reactive hypoglycemia, it means that your blood-glucose level rises too quickly after you have eaten causing the release of too much insulin. This then draws too much glucose out of the blood, your blood-glucose levels fall below normal and you suffer a variety of unpleasant symptoms from sweating, tremor, anxiety, palpitations, and weakness to restlessness, irritability, poor concentration, lethargy, and drowsiness.

[size=120]How is reactive hypoglycemia diagnosed?[/size]
Diagnosis is difficult because there are no clear diagnostic criteria. Your doctor may:

• ask you about signs and symptoms test your blood glucose while you are having symptoms (The doctor will take a blood sample from your arm and send it to a laboratory for analysis. A personal blood glucose monitor cannot be used to diagnose reactive hypoglycemia.)

• check to see whether your symptoms ease after your blood glucose returns to 70 mg/dl or 3.5 mmol/L or above (after eating or drinking)

• If your doctor uses an oral glucose tolerance test (OGTT) to diagnose hypoglycemia you have to continue it for at least 3-4 hours (the normal time is 2 hours). Your insulin levels would be measured at the same time.

[size=120]How is it treated?[/size]
The aim of treating reactive hypoglycemia is to prevent sudden large increases in your blood-glucose levels so you won’t produce excessive, unnecessary amounts of insulin and your blood-glucose levels will not plunge to abnormally low levels.

You can achieve smooth, steady blood-glucose levels by changing from high- to low-GI foods. This is particularly important when eating carbohydrate foods by themselves. Low GI foods like wholegrain bread, low-fat yogurt, and low GI fruits are best for snacks. If you can stop the big swings in blood-glucose levels, then you will not get the symptoms of reactive hypoglycemia and chances are you will feel a lot better. … wered.html

Ben, I’d probably also reduce my carb intake to about 45% of daily intake and increase protein (lean meats). Note, this in no way constitutes a low carb diet which no one over here supports (as an aside, low carb diets do promote weight loss as well but are not sustainable over time for most people and may have negative health effects).

Hope that helps!

Scott 8)

Thanks, Scott! This is great stuff!


my wife is reactive hypo-glycemic and recently found out it was due to a hormone imbalance. Going from that alone, and how you say your body has reacted to the med, it does sound plausible that your med might be affecting it. I think that Scott’s advice would probably be best.

If your reactive hypoglycemia is something that your doctor is aware of (I’ve been with my wife at doctors offices and when she said that she was reactive hypoglycemic they kind of scratch their heads and asked what that was) , I would talk to him about it and see if it is a concern.

Hi Ben,

Are you still on Zoloft and Topamax? Sorry if I’ve got that wrong. Brian may be right that the meds are somehow giving you added grief but then I think I read that you’ve had this issue for 25 years, before the meds. Is that correct?


I have proven reactive hypoglycemia (glucose tolerance test) hospital.
I have BS drops every day (especially morning). I can normally control the afternoon and evening ones, but never the morning ones, no matter what I eat. I eat about 4 times in the mornings. I go down to 2.8, 2.9 sometimes. I think there may be a connection as I noticed the other day, a severe vertigo attack started after a very low BS reading.I am wondering about the cortisol, adrenaline etc. connection. Am planning on asking the neurologist when I see him in April.

“A personal blood glucose monitor cannot be used to diagnose reactive hypoglycemia.”
Huh, why not? :slight_smile: Unless you really mean diagnose, as in not just “check if you might have it” but literally state an official diagnosis.
It sure works for me, but in the unofficial way.

Scott, right now I am only on Nortriptyline and struggling quite a bit with a mere 10 mg. This is only my second med try. I started with Effexor and it didnt work out for me (made me more anxious and dizzy and I started grinding my teeth very badly). Nortriptyline is causing some of the same anxiousness and I am not sleeping well and feel very weak/shaky and disoriented. With both Effexor and Nortriptyline my blood pressure has been a bit elevated. Interestingly, I had no reactive hypoglycemic episodes on Effexor but have on Nortriptyline. Thank you all for the thoughts and advice. Ben

Hey Ben,

I had no reactive hypoglycemic episodes on Effexor

That is interesting. I have no idea why that would be. :? You and I seem to both have a rough time on these antidepressant meds. How did you handle coming off Effexor? One of the things that worries me about this drug is that it has such a short half-life. Coming off these sorts of meds really kicks the s**t out of me. I get hard core flu-like symptoms every time I make a small drop in the dose.

Scott 8)

Scott, I did ok coming off. I went down to 37.5 after having only been on about 50 mg for 4 days. Then I would take 10 of those little grains out every night. It took about two weeks. I was only on it for a total of 8 weeks so it may not have been built up in my system enough to really cause me withdrawal issues. I then waited 10 days before trying the next one - Nortriptyline, which I am struggling with greatly. I agree that we seem to be having issues with the antidepressants. We are evn on fairly low doses compared to what they are intended for! Good luck on it and I really hope it works for you. Ben


What you describe sounds very similar to my wife. She can’t eat anything in the morning without passing out. She recently went to a hormone therapy specialist who said that this can be treated for women (especially the morning episodes) with hormone therapy. Maybe this is something that you might want to look into?


Benh…a number of years i had myself checked to see if i was hypoglacemic and blood tests turned out negative. But what is interesting is if i miss a meal i notice myself not feeling as well…increased motion, less stationary, etc. Maybe this is a commond symptom of Migraine…if someone misses their meals??


Just wanted to add on Joe’s point - low blood sugar is a definite trigger for migraines and MAV - I’ve got a couple of pamphlets with this listed as a common trigger.
And since I’ve had labyrinthitis/MAV I’ve noticed that low blood sugar causes me to feel very bad - dizzy, spinny, etc. I was also checked out for low blood sugar/diabetes problems but there were no other problems. Low blood sugar is a major trigger for migraines for me hence the symptom increase - I cannot miss a meal.

Benh - sorry to detract from your condition - hope you get sorted with the meds and this soon.

Thank you for all of the replies! What is odd is that it seems that if I am having a bad MAV day, my blood sugar is easily lowered by an over production of insulin when I eat. In other words, the low blood sugar seems to be a reaction instead of a trigger for me…yet another point that shows how variant this illness is!

Scott -
Very interesting, I am going to ask my endocronologist next week when I go about that. I have some of the symptoms you described after eating certain foods. Thanks for the helpful info. once again, Scott!! You’re awesome! :smiley: