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Hypoglycemia

Glucose is a chief energy source for cells throughout the body. However, too much or too little of it can cause serious adverse consequences (Berber 2013; Shrayyef 2010).

Despite the rampant, interrelated epidemic of obesity and type 2 diabetes, most Americans remain regrettably unaware of the long-term damage from chronically elevated glucose levels, also called hyperglycemia. Conditions like kidney damage, nerve damage, and often irreparable damage to the eyes that result from continuously elevated glucose take time to manifest (Campos 2012).

However, even less well-appreciated than the long-term risks due to chronically elevated blood sugar is that very low blood sugar, termed hypoglycemia, can cause significant, acute,  life-threatening consequences if not treated immediately (Berber 2013).

Blood sugar levels at or below 40 mg/dL characterize severe hypoglycemia (Desouza 2010; Tsai 2011; Carey 2013; Lacherade 2009). Low blood sugar levels in this range can cause a variety of symptoms ranging from weakness, sweating, fast heart rate, and tremors to confusion, irritability, or in severe cases, even coma and death (Sprague 2011; Berber 2013; McCrimmon 2012).

With overly aggressive pharmaceutical treatment, patients with diabetes, both type 1 and type 2, are at risk for episodes of severe hypoglycemia. For type 1 diabetics, hypoglycemia can result from overtreatment with injectable insulin (Cryer 2010). In fact, hypoglycemia represents a serious barrier to successful management of type 1 diabetes; about 2-4% of acute death among type 1 diabetics are likely caused by hypoglycemia (Briscoe 2006; Cryer 2008). Type 2 diabetics can also develop hypoglycemia as a result of overtreatment with glucose-lowering drugs, in particular the class of drugs known as sulfonylureas (Kalra 2013; Bodmer 2008).

In contrast to the potentially devastating consequences of over-aggressive drug treatment of hyperglycemia in diabetes patients with insulin and/or sulfonylureas, reactive hypoglycemia (or postprandial hypoglycemia) is a phenomenon in which blood sugar levels drop a few hours after eating (UW Health 2013). Typically, reactive hypoglycemia strikes people who are not diabetic but nevertheless manifest less than optimal glucose control (eg, individuals with prediabetes). These individuals are more prone to reactive hypoglycemia than healthy people. Reactive hypoglycemia is also more common in people who have undergone gastric bypass surgery for severe obesity. The drop in blood sugar level (or “crash”) observed in reactive hypoglycemia is the result of an overly exaggerated insulin spike following ingestion of carbohydrate, with a subsequent reactive plunge in blood sugar level due to the exaggerated spike in insulin (Brun 2000; Roslin 2011; Middleton 2012; Bell 1985).

There are other, less common causes of hypoglycemia as well. For example, pancreatic tumors that result in excess insulin being released into circulation or inherited genetic defects in metabolism. In addition, excess alcohol, if consumed while fasting, can cause hypoglycemia, as can several medications (Berber 2013).

Proactively taking steps to maintain glucose levels within a healthy range is an important long-term strategy. For diabetics, this includes ensuring medications are dosed appropriately and combined with careful monitoring of glucose levels. Among people who experience reactive hypoglycemia, effective prevention hinges upon avoidance of post-meal surges in glucose concentrations through diet modulation and a variety of natural interventions. For example, the rate of carbohydrate absorption can be slowed by inhibiting the alpha-glucosidase and alpha-amylase enzymes via supplementation with green coffee extract and Irvingia gabonensis (Ishikawa 2007; Oben 2008). Moreover, the prescription anti-diabetic drug acarbose also inhibits the alpha-glucosidase enzyme and slows the absorption of glucose. Unfortunately, many physicians overlook the potential of this well-studied drug to stabilize post-meal glucose levels and mitigate the exaggerated insulin spike that leads to hypoglycemia (Bavenholm 2006; Hanefeld 2007; Ozgen 1998).

In this protocol you will learn about the physiology of glucose control and how the body orchestrates a complex system of checks and balances to keep blood sugar levels in a healthy range. You will also learn about some of the ways these regulatory mechanisms can fail and lead to hypoglycemia and what kind of symptoms this can cause. Hypoglycemia management strategies will be outlined along with integrative approaches and dietary considerations to help stabilize glucose levels and avert episodes of low blood sugar.