What Is Reactive Hypoglycemia?

reactive hypoglycemia

How RH makes me feel

Over the past two months, I’ve begun experiencing one of the dreaded after-effects of gastric bypass surgery: reactive hypoglycemia. Most people who are familiar with gastric bypass know about dumping syndrome, but reactive hypoglycemia can be just as painful and uncomfortable.

Reactive Hypoglycemia (RH) is a condition indicating recurrent episodes of hypoglycemia in people who do not have diabetes. Scientists and nutritionists think that RH is a consequence of excessive insulin release triggered by intake of carbohydrates, but the insulin release continues past the digestion phase, and and beyond the disposal of the glucose derived from the meal. According to the NIH, a blood glucose level below 70mg/dL at the time of symptoms, followed by relief after eating, confirms a diagnosis for reactive hypoglycemia.

Reactive Hypoglycemia symptoms include:

  • Double vision or blurry vision
  • Unclear thinking
  • Sleeping Trouble
  • heart palpitation or fibrillation
  • fatigue, depression
  • dizziness, lightheadedness, confusion
  • sweating
  • headaches, tremors, flushing
  • nervousness, irritability, panic attack
  • increased appetite, craving sweets
  • numbness/coldness in the extremities

In severe untreated cases, coma can be a result from RH. It’s serious stuff.

How do you treat RH? By eating. The quickest way to feel better is to eat something that will get your blood sugar up quickly, so sugars and carbohydrates seems to work the best. But having protein and fat will help sustain you so you don’t have another RH episode.

Now, I leave a disclaimer that this is NOT to be taken as medical advice, but I’m sharing what I’ve come up with after tracking my RH episodes and talking to my doctor. I will often have peanut butter and crackers, or some popcorn. Fruit juice usually makes me dump, but a sip or two seems to help me get out of an RH episode. I’ll admit, sometimes I’ll eat junk food when I sense the first symptoms of RH, and being timely is much more important than choosing the exact perfect thing to eat.

I had my first experience with RH in November in England. I was meeting up with a friend in Liverpool one morning, and the restaurant we planned to eat at wasn’t open yet. I nibbled on some turkey jerky, then we walked around Albert Dock for a few hours, then I went to the Beatles Story museum. As soon as I got back in the car, I started getting confused, shaky, weak, and had blurred vision. I knew it was because I hadn’t eaten and I actually blacked out for a few seconds. Eating made me feel better very quickly.
The next RH episode was on Thanksgiving. I had a fairly surgery-friendly dinner (turkey, salad, veggies, sf jello) with one exception – I had a little bit of mashed potatoes and gravy. I’ve been having powdered mashed potatoes for a few months, but mashed real potatoes took me over the edge. I went into dumping mode for about 20 minutes. As soon as the dumping subsided, I laid down and fell asleep immediately. When I woke up, I felt disoriented, my arms and legs were completely numb, and had double vision. When I tried to stand up, I collapsed and started shaking uncontrollably. I got on BBGC and left a message with my symptoms, and everyone agreed it was an RH episode.

I started tracking the symptoms through the next 10 or so episodes, and I realized that there were two common items : I had done a rigorous workout within the past 24 hours, and it had been more than 3 hours since I’d eaten anything. To date, I’ve completely passed out 3 times from RH. Every Sunday in the 3rd hour of church, I’d have RH symptoms, so I began packing crackers, granola bars, and other portable items to eat between classes.

I met with my doctor, showed him my log of RH episodes, and he agreed that it was something I needed to take very proactive control over. His main advice to me, which is not what is part of the typical gastric bypass diet, is to eat more carbs. Eat something a little carby with every meal. Eat carbs and protein before and after working out. Stop exercise at the first sign of fatigue. Be intuitive and listen to my body’s signals.

My weight loss has been slow the past 2 months, but my body is shrinking. I’m down a dress size, but only about 5 pounds from the beginning of January. I’m exercising hard, my muscles are getting more lean and toned, and I am enjoying an active lifestyle. My body is no longer in ketosis, but I’m okay with that. I’d rather have energy, exercise, and eat more carbs, than be lethargic with a carb and exercise restriction.

Now, if I can only get this reactive hypoglycemia under control!


  1. I’d never heard of that. I’m glad you are going for a proactive solution.

  2. That sounds incredibly scary. So glad you have figured out a way to deal with this. Is this something you will have to worry about once you achieve your weight goal?

  3. omg. I had heard of it but never knew what it was called. I’m sorry, that stinks and must be pretty scary. But I am glad you’re taking measures to address it. (hugs)

  4. That sounds crazy scary, but your proactive approach probably saved you from a bunch hassle and made it easier for your dr. to tell you the next best step. Thanks for sharing.

  5. Came here via Robyn’s Online World. That sounds very scary, but at least you are very aware of what triggers it, and I think that’s most of the battle right there. BTW, I want to say that you are doing great and look good, too. 🙂

    • Thanks, Pam! It’s been a tough few months trying to figure out the triggers and solutions to get the RH under control. It’s one of the things I signed up for with weight loss surgery, and I know it’ll get better with time.

  6. I recently heard about RH. I’m 8 yrs out from RNY and the last few years I’ve had some mild episodes that have at least some of the symptoms. The shakiness, sweating, confusion are definitely awful. I like your idea of tracking your episodes to see the what’s and whens. I may do that! Glad you’ve gotten on the right track! Thanks for sharing!

  7. Thanks for sharing this. I’ve had a few episodes of RH now, and it wasn’t until an episode in mid-December (I have a glucose monitor and my number was 63) that I figured out what it was. For me, eating, grossly/ironically enough, about a tablespoon of frosting (I keep the canned, colored ones around for decorating cupcakes and such for my children) and then following up with some protein (a piece of cheese, a couple slices of pepperoni) and laying down for a nap is enough to get things back in order.

    Go figure that we’re so conscious and careful with limiting carbs and sugar and focusing only on protein that we wind up going in the other direction and not taking in enough to keep from dipping too low!

    I wrote a blog post about it, too, and it was a commenter that pointed me to your very insightful post.

  8. Debbie Adams says:

    2 years after GB I began having RH. First episode landed me in the ER, however, NO ONE knew anything about it and I got no help from the GB doctor. Even a recent trip to a gastroenterologist resulted in a “well that rarely ever happens” comment. So, I have been going at it on my own. The thing that works best for me is glucose tablets made for diabetics. They come in easy to carry around tubes. After I eat one I eat some protein -cheese or peanut butter and Greek yogurt-and it seems to help but it has been lonely trying to deal with this ESP with no knowledge/support from doctors.

  9. There is alot the doctors do not know about why Reactive Hypogycemia happen after Gastric Bypass. I am 11 years out since I had the procedure and my doctors are reversing the procedure due to the Reactive Hypogycemia control your life I can not drive, lost my job, my family is scared everyday, I black out everyday I eat, I have sugar levels of 40, I do not have a bad case of Reactive Hypogycemia people I have the condition. I will be glad when the world open there eyes and see this condition is just as bad as diabeties. I can go in a coma and die too.

  10. Thank you for your article, it’s very helpful. I’m actually experiencing an episode right now. My surgery was Feb. 2012, I began having symptoms last summer, but had no clue what it was. My primary doc brushed it off as me just being tired and recovering from surgery. The more research I did the more I realized that my symptoms were that of hypoglycemia.

    The episodes have ceased over the past few months but today they came back with a vengeance! I’m 5’9 went from 284 – 149, I notice when I don’t eat atleast 3 full meals per day I tend to lose a few pounds. In the past week I’ve gone from 153 – 149.

    I decided to increase my food intake, had turkey breast on a 4 inch piece of wheat bread (1 slice). 2 hours later it hit me like a ton of bricks, I rushed to the nearest store for hard candy, orange juice to mix with water, and saltine crackers. I was jittery, dizzy, anxious… Although we aren’t supposed to, I ate and drank at the same time…now an hour later I feel like I’m slowly coming off of the sugar drop. I’m not as lethargic anymore, I can keep my eyes open, and feel like myself again. I think my trigger in this case was the bread. I know that previously it has been foods high in sugar, certain yogurts, protein bars, and dry cereals. I have an appt next week to be officially diagnosed and I can’t wait!!! I’m ready for answers 🙂

  11. Kristin says:

    Stumbled on your blog post while researching RH! I’m 6.5 years post-RNY and have had a number of scary episodes lately that have come up out of nowhere. I’ve only had a handful of episodes in my entire post-surgical life but it seems to have gotten worse since the birth of my second child last October.

    I really enjoyed reading your post (and blog). It’s given me great insight into my own RH and some helpful suggestions for how to deal with it. My doctors haven’t been super helpful so this has helped me be more proactive for myself. Thanks!!

  12. Cindy Hayes says:

    I have RH. I struggle with it every day. I have been unable to work or drive since May 22nd. Nothing that I have done has helped – adding carbs, taking them away, several different medications – none of my doctors can help me. I am so glad you were able to get yours under control. This is awful!

  13. Wow! I had bypass in May 2014, so I’m not even a year out, but I noticed a few months ago some episodes after I drank a few sips of OJ. Sweating, shaking, and an overwhelming sense of panic, or impending doom. I will also start thinking about eating juice or candy, a few minutes before the anxiety feeling. I am a nurse, so I knew the symptoms of hypoglycemia, so I would drink juice and within 10 minutes feel ok again. I had an episode yesterday where I ate a handful of my daughters cereal and about an hour later it started. My husband got me a Glucose monitor so I checked as soon as the feeling came and it was 51. My hands hadn’t even started shaking, so I wonder what it’s been when I have really felt bad. I have never blacked out or had a seizure, but my question is this. Will it get worse as time goes on? I feel like the episodes have increased these last couple months. I have discovered if I eat any carb without following it with protein or accidentally eat something high in hidden sugar ( I ate a half a pop tart once and spent 30 minutes trying to get my sugar up) that it happens. It’s becoming an everyday thing. I actually do better if I don’t eat because my body is pretty good at stabilizing until the food gets there. I’m Going to keep a log, but I have read that Diazide helps some people, as well as a low carb diet. As long as it doesn’t get worse, I think I will be ok.

  14. My dr and I have found that if I will eat less carbs (and definetly avoid drinking while I eat) I have less RH episodes. However, when I do have an episode, I CAN NOT do the quick fix OJ or candy. I have to do something like peanut butter that has a lot of protein to prevent a wild rollercoaster of highs and lows. I had an episode last night that scared me pretty bad. My BS was down to 44 and wouldn’t go up much over 70 for most of the evening no matter what I ate. It is hard to get paramedics and EMT’s to understand the complexities of gastric bypass and RH. They always want to force that D50 down my throat even with me telling them it will make it worse later. Today, I feel horrible even though I am showing normal (108) BS levels. I am still in a fog and feel disoriented and “wobbly”.

  15. I think I also have this reactive hypoglycemia everytime I eat bread or sugars, I fall as sleep within a few minutes, is so scary that i remeber one time I when to eat with my family and wile driving back home I felt as sleep while driving my mother scream I open my eyes and swerled out the way of an incoming truck after that day when I eat out i wait for an hour before jumping back in the car.

  16. This answers so many questions and episodes for me; one real bad one down to the 40 shaking unable to focus thank God my boss had a meter and a Pepsi. I’ve quickly learned my symptoms but never knew what it what was as diabetes runs in my family both high and low. Thank you for this useful information and answers to many questions.

  17. I suffer from this too, and have for the laat 14yrs since WLS. I find peanut butter works best for me for stability, especially if I haven’t eaten lately.

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