Non Diabetic Hypoglycemia: All Your Low Blood Sugar Questions Answered

Metabolism

By Dr Joe

Do non diabetics get hypoglycaemia; is a question I get asked often.

So, I figured I will deal with this issue and other questions relating to non-diabetic hypoglycemia right here on this page.

Feel free to use the links below to jump down the page to the specific topic but be rest assured that on this page, you will learn about:
Do Non Diabetics Get Hypoglycemia?
Do non diabetics experience dawn phenomenon?
What is normal blood sugar levels for a non diabetic?
What is low blood sugar?
Should non diabetics check blood sugar?
What can cause non diabetic hypoglycaemia?
What is reactive hypoglycaemia and what causes reactive hypoglycaemia?

What causes non-reactive (fasting) hypoglycaemia?
How do you feel when your blood sugar is low?
How to test for non-diabetic hypoglycaemia?
Do I have non-reactive (fasting) hypoglycaemia?
How to treat non diabetic hypoglycemia?

Do non-diabetics get hypoglycemia?

Yes, non diabetics may develop hypoglycemia (low blood sugar). It is often thought that hypoglycemia which is the medical terminology for low blood sugar, happens only in diabetic individuals. That’s not entirely true.

It is true that when it comes to neuro-linguistic programming, you hear the word, hypoglycemia and automatically, your mind flashes to a diabetic individual. At least that’s how the mind of a medical personnel works anyway.

But low blood sugar events are not exclusive to diabetics. Non diabetics also suffer from hypoglycemia although it is a less common occurrence, but beware.

A mis-match between the interaction of blood glucose levels and insulin, the hormone responsible for stabilising your blood sugar levels, is the origin of the non diabetic hypoglycaemia phenomenon.

Non-diabetic low blood sugar can be caused by a variety of conditions which I will discuss further along this page but the point here is that, both diabetics and non-diabetics can develop hypoglycemia.

Do non diabetics experience dawn phenomenon?

Non-diabetic hypoglycemia should not be confused with the dawn phenomenon in non-diabetics. The dawn phenomenon is a condition where there is a rise in blood glucose levels in the early hours of the morning between 2am and 8am.

The dawn phenomenon is more likely to occur in a diabetic than in a non-diabetic.

The dawn phenomenon is a consequence of the diurnal variation of the stress hormone called cortisol. Cortisol causes the release of glucose from the liver by breaking down the storage form of glucose called, glycogen.

A breakdown of glycogen usually stored in the liver leads to elevation of blood glucose level. This glycogen breakdown is induced by cortisol hormone. Cortisol hormone usually rises in the early hours of the morning. This unwelcome but inevitable action by cortisol in the early hours of the morning is what causes the dawn phenomenon.

The non-diabetic dawn phenomenon is the direct opposite of non-diabetic hypoglycaemia. The similarity between the two conditions (if you call it that) is that they are both rare in non diabetics compared to diabetics.

In fact, the dawn phenomenon is so rare in a non diabetic, that should you experience it, then there is a good chance you are insulin resistant. You are probably either prediabetic or have full blown type 2 diabetes. Get checked as soon as you can!

A small rise of blood glucose in the early hours of the morning on account of the cortisol rise can be expected in a non-diabetic. But this rise should be so small that it’s best considered an academic event really. If you are not diabetic, your blood sugar levels should still remain within normal limits in the so-called non-diabetic dawn phenomenon.

So in essence, it’s not really a non-diabetic dawn phenomenon strictly speaking. The message here being; non diabetics don’t usually exeperience the dawn phenomenon.

If your blood sugars show a significant rise in the early hours of the morning i.e the dawn phenomenon, and you are not a diabetic, you need to see your doctor to be screened for type 2 diabetes.

What is normal blood sugar levels for a non diabetic?

If we are going to be talking about low blood sugar in non diabetics, it makes sense to know what normal blood sugar ranges are for non-diabetics.

You’ve got to know what is normal before veering into what is not normal.

Indeed normal blood sugar should apply to everybody. Diabetics and non diabetics should be striving to achieve the same normal blood sugar levels. Achieving normal blood glucose is just a little more challenging for diabetics in comparison.

On this account, here is what the American College of Clinical Endocrinologists recommend as normal blood sugar levels for both non-diabetic and diabetics too.

• Fasting blood sugar should be 99 mg/dl (5.5 mmol/L) or less
• 1-hour blood sugar after meals should be 140 mg/dl (7.8 mmol/L) or less
• 2-hour blood sugar after meals should be 120 mg/dl (6.6 mmol/L) or less

This is what every individual regardless of whether diabetic or otherwise should be aiming for every day.

For instance, a non-diabetic fasting blood sugar levels should be kept between 4.0 mmol/l (72 mg/dl) and 5.5 mmol/l (99 mg/dl).

Indeed, so should diabetics too, because fasting blood sugar levels within that range implies a very good blood glucose control if you are diabetic.

Keeping your blood glucose within this range is good for the optimal metabolic health of everybody.

Maintaining your blood glucose within this range, both for fasting and after meals, is an important step in taking control of your health.

With that in mind, it begs the next question:

What is low blood sugar?

The definition of low blood sugar is somewhat fluid as symptoms of low blood glucose may appear at different levels in different individuals.

Strictly speaking, low blood glucose (hypoglycemia) is blood glucose below 4.0 mmol/l (72 mg/dl). For somebody like me, I don’t experience any symptoms of hypoglycaemia at blood glucose levels of 3.5 mmol/l (63 mg/dl) but you might be different.

Some literature use a blood glucose cut-off point of 2.5 mmol/l (45 mg/dl) as hypoglycemia. Practically everyone will have symptoms suggestive of hypoglycaemia at and below 2.5 mmol/l (45 mg/dl).

At the end of the day, it really doesn’t matter whether your blood glucose level is 3.7 mmol/l (66.6 mg/dl) or 2.2 mmol/l (39.6 mg/dl), if you are experiencing the typical symptoms of low blood sugar, or you checked a friend’s blood sugar if they are feeling queasy or out of sorts and the sugar level is below 4 mmol/l (72 mg/dl), you might as well take necessary steps urgently to correct the problem.

The level becomes academic in the end if you have symptoms. It only becomes a question of severity rather than the matter of the presence of it.

Should non diabetics check blood sugar?

This is an interesting question for me. I firmly believe that non-diabetics should check their blood glucose levels. You don’t necessarily have to obsess over it but every person above the age of 40, certainly over 45 years of age should own a blood glucose monitoring device (glucometer) at home. That’s my opinion.

Diabetes is tearing through populations globally. We used to think type 2 diabetes was more common in the Western hemisphere but the developing world like the Pacific Islands are catching up and catching up fast.

Who would have thought smaller nations in the far east and the pacific, would be heading the type 2 diabetes League tables?

Diagnosing type 2 diabetes early is the way to go and one way of detecting prediabetes is to test your blood sugar following meals. Once you suspect you may be diabetic, using the values above, you go to your doctor to confirm or refute the condition.

Of course, your results would also be highly dependent on what food you ate. Refined carbs will definitely spike your blood sugars.

If you have a glucometer at home, you are in luck. With a glucometer you can easily test your blood sugar or that of the relative with a little finger prick test and call for help straightaway, if the reading is low. I will talk about what you can do to resolve the problem very quickly in the later part of this article.

What can cause non diabetic hypoglycemia?

What causes low blood sugar without diabetes is another way paraphrasing the question and here is your answer.

I have already mentioned that you can have low blood sugar without having diabetes but I need to stress a further point. In most normal individuals without diabetes, hypoglycaemia is not something they should go to bed worrying about.

You have got enough stuff to worry about in your day to day life. Why add low blood glucose to your list of worries if you are non diabetic.

Low blood sugar in non diabetics is a rare event, but it can happen in certain circumstances. The culprit for hypoglycemia (low blood sugar) is insulin. Insulin is the main driver for blood glucose. If you have too much of insulin in circulation at any one time and you are not insulin resistant, your blood sugar will plummet.

That said, there are 2 broad classifications for hypoglycemia.

• Reactive
• Non-reactive (fasting)

What is reactive hypoglycemia and what causes reactive hypoglycemia?

Reactive hypoglycaemia typically is an event that occurs secondary to having a meal. It happens within a few hours of having a meal, typically a refined carbohydrate-laden meal.

The affected individual has a meal, a huge surge of insulin occurs in response to the meal.

This huge insulin surge results in an overzealous blood glucose clearance from the circulation into the cells, blood sugar levels drop like a stone. That in essence is reactive hypoglycaemia.

The insulin over-secretion can be detected by a blood test several hours after the initial episode of reactive hypoglycaemia.

Current thinking is that reactive hypoglycaemia is a forerunner to type 2 diabetes. So get yourself screened for diabetes if you ever experience an episode of reactive hypoglycaemia.

The following are causes of reactive hypoglycaemia:

• Prediabetes
• Being overweight or frankly obese
• Surgery of the stomach making consumed food hasten its journey from the stomach to the small intestine
• A heavy meal of refined carbohydrates

What causes non-reactive (fasting) hypoglycaemia?

Non-reactive hypoglycaemia is low blood sugar that is unrelated to an eating episode. Some people refer to non-reactive hypoglycaemia as fasting hypoglycaemia.

The following may cause non-reactive hypoglycaemia.

• • Insulin secreting tumours of the pancreas
  • Alcohol when it interferes with liver function.
  • Fasting
  • Eating disorders like anorexia, bulimia.
  • Medications that affect liver function like salicylates for pain relief, quinine used to treat malaria, sulphonamide antibiotics, pentamidine.

• Diseases that affect the liver and the kidneys.
• Pregnancy
• Hormonal problems that affect the level of hormones such as cortisol, glucagon, growth hormone negatively. Adrenal gland problems are particularly noteworthy.
• Accidental administration of insulin injection or taking of some other anti-diabetic medications.

Low Blood Sugar in Non-Diabetics: How does it feel?

You feel awful and unwell when your blood sugar is low. One thing with the symptoms of low blood sugar in non diabetics and diabetics is that they overlap with so many other conditions in medical practice.

Obviously if you experience any of the typical symptoms below, you should either quickly check your blood glucose level or call for help for someone else to assist you and act accordingly.

The feeling of low blood sugar is unpleasant and it includes the following:

• • You feel weak
  • You begin to tremble
  • You become nervous
  • You sweat
  • You feel your heart beating through your chest
  • You feel agitated
  • You may have a headache
  • You may have a feeling of nausea
  • You may feel dizzy or light-headed
  • You will have hunger pangs

• You heart rate quickens
• You look pale-skinned
• You become confused
• You become short-fused and temperamental
• Your vision is impaired
• You may become unconscious
• You may have seizures

That list is by no means exhaustive, but if you have had low blood sugar, you will identify with some of those symptoms.

Do I have non diabetic hypoglycaemia? | How to test for non-diabetic hypoglycemia?

How do you know you have non-diabetic hypoglycemia or how is non-diabetic hypoglycaemia diagnosed or tested for?

The simplest way to diagnose hypoglycaemia under any circumstances is to check blood sugar levels when the person is experiencing symptoms.

If your blood glucose reading is below 4 mmol/l (72 mg/dl) in the presence of symptoms, that is hypoglycemia by definition regardless of whether you have diabetes or not. That is an on-the-spot diagnosis for that hypoglycaemic event.

Now if you want to specifically answer the question: do I have non-diabetic hypoglycemia, you may want to have tests done to pinpoint the exact cause of the problem.

And the tests would vary depending on the type of non-diabetic hypoglycaemia.

Do I have reactive hypoglycaemia? | How to test for reactive hypoglycaemia?

To diagnose the reactive hypoglycaemia, you will need to be tested on your response to food or have the standard oral glucose tolerance test (OGTT).

Some practices use the Mixed Meal Tolerance Test (MMTT) where you are given a drink consisting of refined carbs, protein and fat. The Mixed Meal will provoke an insulin response from your pancreas.

With a load of insulin in in your blood circulation, your blood glucose level is tested to see how your body responds every hour for about 5 hours.

To do this test for reactive hypoglycemia, a fasting period of 10 – 12 hours prior to the test is necessary for validity of the test.

Another test for reactive hypoglycemia instead of the Mixed-Meal Tolerance Test, is the Standard Oral Glucose Tolerance Test (OGTT). Your medical facility will perform a concentrated glucose test using a 75 gms glucose drink. Hmmm, tasty, if you have a sweet tooth. But not so nice, if you don’t.

Even though your blood glucose is drawn hourly for up to 5 hours during the test for reactive hypoglycemia, in truth the result of the first 2 hours makes more sense.

Most individuals with reactive hypoglycaemia will show a significant drop of blood glucose to hypoglycaemic levels within 2 hours and you will experience the feeling of low blood sugar within that time frame.

Having said that, it makes sense to extend the test beyond 2 hours to be thorough.

Do I have non-reactive (fasting) hypoglycaemia?

How the test for non-reactive or fasting hypoglycaemia is done is a lot more involving. It may require you fasting for up to 72 hours. Now you see what I mean.

During the 72-hour fast period, your blood is drawn several times for blood glucose levels.

In general, fasting hypoglycaemia test tends to revolve around the suspected cause of the problem. Sometimes, it may be necessary to test for your blood levels of insulin. The insulin test is done at the point where the blood glucose reading is low, if insulin secreting tumour of the pancreas or diabetes is suspected.

Very high levels of insulin in the blood circulation will suggest insulin-secreting tumour of the pancreas. A further scan of the abdomen will throw more light on the issue as the tumour should be seen on CT Scan.

If other causes of non-reactive hypoglycaemia are suspected, like problems related to the adrenal gland, investigations will be tailored in that direction.

How to treat non diabetic hypoglycemia – The non diabetic hypoglycaemia diet

Going on from the last point, controlling non-diabetic hypoglycemia is very much dependent on the cause of the problem.

However, a few generic rules apply in the control of non-diabetic hypoglycemia. If you do undertake these measures, you will have few (if any) episodes of non-diabetic hypoglycaemia, unless there is an identified cause in which case, the treatment has to be directed at the cause.

For instance, if an insulin producing tumour of the pancreas is the cause, then surgery to remove the tumour will be essential and really should fix the problem.

If the cause is that of the adrenal glands, then obviously, this will have to be dealt with too by directing treatment accordingly.

What generic measures can you use to control non-diabetic hypoglycemia?

These measures are sometimes described as non-diabetic hypoglycemia diet but they are to all intents and purposes a re-structuring of how you eat and what you eat.

>> You need to eat a lot more vegetables especially leafy green vegetables. Root vegetables are fine as well, so long as they are prepared in a way as not to alter their glycaemic index to a high one.

>> Which brings me to next point. Eat starchy foods that are complex in nature. That means whole grain foods. Whole grain foods like oatmeal, brown rice, quinoa, bulgur wheat, millet, triticale, usually have a high fibre content. This makes for a slow release of glucose into the blood.

>> A non-diabetic hypoglycemic diet is enabled by a slow digestive process. This leads to a gradual breakdown of the carbohydrate leading further to a gentler rise in blood glucose following your meal.

>> Another non-diabetic hypoglycemic diet tip is to include protein in your diet. I will encourage more plant proteins like you find in legumes – beans, peas and lentils, in preference to animal protein.

>> Of course, having animal protein in your non-diabetic hypoglycemic diet is still allowed but keep the red meat to a minimum. White meat would be a better choice as would eggs if that’s your thing.

>> Dairy products can be part of your non-diabetic hypoglycaemic diet but low fat dairy is better unless you are on a low carb high fat diet.

>> Of course, a low carb high fat diet is another approach to treating hypoglycemia without diabetes. Low carb high fat diet typically does not lead to insulin spikes as blood sugar levels are usually steady with this type of diet.

>> If you are someone with hypoglycemia without diabetes, it would make sense to limit or avoid altogether refined carbs. Refined carbs like white rice, rice cakes, white bread, cup cakes, sodas, typically cause blood sugar spikes and insulin spikes as a consequence, so best avoided.

>> Some doctors and nutritionists will recommend frequent small meals as a way of dealing with non-diabetic hypoglycemia. This approach is worth a try.

>> The frequent small meals approach may help so long as you keep an eye on your calories because the danger of eating small meals frequently is that the “small” is open to misinterpretation and you could suddenly be facing obesity with this advice.

>> What you eat with this method of eating is also important. Remember complex carbs.

>> Be careful with dried fruits. Dried fruits are devoid of moisture which means they are packed with lots of natural simple sugars. Even though they are fruits and are supposed to be healthy, these dried fruits can spike your blood sugar very quickly causing a subsequent crash of blood sugar afterwards.

I’m talking about dried fruits like dried apricots, raisings, dates, apples – not your best friend, if you have non-diabetic low blood sugar issues.

>> With non diabetic hypoglycemia diet, you need to be careful with white potatoes especially when baked. Sweet potatoes are preferred for non diabetic people who have low blow blood sugar problems. Better boiled than baked though.

>> If you don’t have diabetes and have low blood sugar problems, it would be a good idea to avoid coffee, be it regular coffee or worse still Starbucks coffee, Costa coffee. Not a good idea.

Whatever you do, if you experience an episode of non-diabetic hypoglycaemia, your immediate action should be to correct the hypoglycemia first by having a sweet drink, sugar tablet or intravenous glucose injection depending on the severity of the hypoglycemia.

For instance, if someone is unconscious, an intravenous glucose administration will be the way to go.

If you are going to have any of these dried fruits (preferably not an emergency situation by the way because that would be the wrong approach), please have them with cruciferous vegetables or leafy green vegetables.

Take care of the emergency situation first. If you need to call for help, do so, even if it means calling the emergency services. What you do in the medium to long term would be different but deal with the immediacy that situation demands in the first instance.

Suggested further reading:
The #1 WORST food for your skin, joints & blood sugar?

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