This leaflet is to provide you with guidance and information to help support your decisions.
What is reactive hypoglycaemia?
Reactive hypoglycaemia is a condition where the level of glucose in the blood drops too low (below 4.0mmol/l) after eating.
It usually occurs around 2-4 hours post meal and is thought to happen due to an over-production of the hormone insulin following a high carbohydrate meal.
What are the symptoms?
Symptoms may vary between individuals but common ones include:
- Shaking
- Sweating
- Irritability or anxiety
- Hunger
- Rapid heart rate
- Dizziness or light-headedness
- Fatigue
- Tingling around the mouth
How to treat an episode of reactive hypoglycaemia
If you have blood glucose levels of less than 4.0mmol/l this should be treated immediately with 15-20g of rapid acting carbohydrate such as:
-
4 to 5 Glucose tablets
-
150 to 200ml Full sugar fizzy drinks
-
3 to 4 Jelly babies
-
200ml Fruit juice
This should then be followed up with a snack containing 15 to 20g of slower acting carbohydrate or your next meal (if it is due). Examples of 15 to 20g carbohydrate snacks include:
- A slice of toast with margarine
- A piece of fruit
- 1 to 2 Plain biscuits and milk
How to prevent episodes of reactive hypoglycaemia
The dietary changes below may help to reduce episodes of reactive hypoglycaemia.
Limit portions of starchy carbohydrates – such as bread, pasta, potatoes and rice (aiming for no more than ¼ to â…“ of the plate). Having these in large quantities may lead to a spike in insulin levels resulting in hypoglycaemia. They are better eaten evenly spread throughout the day. If you feel hungry when having reduced carbohydrate portions then top up meals with extra vegetables and salad or consider using carbohydrate
free alternatives such as courgette spaghetti, cauliflower rice, butternut squash wedges and carrot and swede mash.Choose low glycaemic index (GI) foods – the glycaemic index is a rating system for carbohydrate containing foods and tells us if a food affects blood glucose levels rapidly, moderately or slowly. Foods with a lower GI take longer to digest and therefore glucose is released at a slower rate (examples include higher fibre options such as oats, fruit, pulses and whole grains). It is important to note that not all low GI foods are healthy. Please see attached table for more information on the GI of foods.
Include a source of lean protein with each meal or snack (food pairing) – combining carbohydrates with proteins can slow down the rate at which they are digested. This can help you to feel fuller for longer and also reduce the risk of a reactive hypoglycaemia episode.
Choose healthy fats – monounsaturated fats work the same as protein in slowing down the absorption of carbohydrates (examples include: nuts, olive and rapeseed oil, and avocado).
Avoid sugary food and drinks – these will cause a rapid rise in blood glucose levels which may in turn cause an excessive increase in insulin production, possibly resulting in an episode of reactive hypoglycaemia.
Eat little and often – having 5 to 6 small meals and snacks per day may help to regulate the glucose levels in your blood, especially if physically active. It can also help to prevent hunger.
Follow a healthy balanced diet – aim for five-a-day fruit and vegetables (ideally two fruit and three vegetable portions). Eat only one portion of fruit at a time (for example, one medium fruit such as an apple, orange, pear or two smaller fruits like kiwis, tangerines, plums) and avoid fruit juices and smoothies as these will have a significant effect on blood glucose levels. Try to include plenty of whole grains.
Examples of suitable meals and snacks
Meals
- Porridge with nuts and berries
- Wholegrain (granary or seeded) toast with poached egg, grilled bacon, peanut butter or avocado
- Sandwich with seeded or granary bread or pitta
- Lentil soup with sourdough bread
- Avocado and tomato on rye bread
- Baked sweet potato with reduced sugar beans
- Wholegrain pasta in tomato sauce with chicken and cheese
- Stir-fry with meat, fish or vegetarian alternative, vegetables and wholegrain noodles
- Grilled meat or fish with new potatoes and vegetables
- Chilli con carne with kidney beans and basmati rice
- Shepherd’s pie with sweet potato topping and vegetables
Snacks
- An apple and peanut butter
- Pear and handful of almonds
- 2 to 3 wholegrain crackers and cheese
- Strawberries and a drizzle of double cream
- Full fat Greek yoghurt with a handful or nuts, seeds and berries
- 2 to 3 oatcakes with houmous and vegetable sticks
- 125g pot yoghurt (or 150 to 200g pot high protein yoghurt)
- 2 squares dark chocolate and handful walnuts
- Pickled onions
- Hard-boiled egg
- Cherry tomatoes
- Cold meats and olives
Glycaemic Index
| Low GI Low GI ≤ 55 | Medium GI Medium GI = 56-69 | High GI High ≥ 70 |
|---|---|---|
| Cereals | ||
| All Bran Muesli Porridge (Rolled oats) Special K | Shreddies Cheerios Instant porridge | Cornflakes Coco Pops Rice Krispies Weetabix Shredded Wheat Branflakes |
| Bread | ||
| Mixed grain bread (for example, granary, multigrain, seeded) Pitta bread Pumpernickel bread Sourdough bread Fruit loaf Corn tortilla Rye bread | White bread with added fibre Croissant Crumpet Wholemeal bread Hamburger bun Chapatti | Brown bread White bread Baguette Bagel Gluten free bread Melba toast |
| Potatoes, rice, pasta and grains | ||
| Yam Basmati rice Noodles Pasta (most types) Buckwheat Bulgar Wheat Pearl Barley | Chips Brown rrice New potatoes Boiled potatoes Sweet potato Couscous Gnocchi Long Grain rice Risotto rice Pastry Polenta Rice vermicelli Semolina | Instant potato Mashed potato Jacket potatoes Potato products (for example, waffles, croquettes, etc) Instant rice White rice Millet Pasta made from corn or rice (gluten free) Tapioca |
| Legumes | ||
| Baked beans Barley Black-eyed beans Chickpeas Haricot beans Kidney beans Lentils Soya beans Split peas (yellow and green) | Broad beans | |
| Fruit and vegetables | ||
| Apples Apricots (fresh & dried) Blueberries Cherries Grapefruit Grapes Kiwi Mango Orange Peach (canned & fresh) Pear Plum Prunes Fruit cocktail Carrots Peas Sweetcorn | Canned apricots Pineapple Papaya Sultanas Raisins Melon Banana Squash Beetroot | Watermelon Dried dates Parsnips Swede Pumpkin |
| Dairy foods | ||
| Milk Yoghurt Flavoured milk drinks Custard Mousse Pudding Smoothies Soya Milk Yakult™ | Ice-cream Frozen yoghurt | |
| Biscuits, cakes and chocolate | ||
| Sponge cake Banana cake Chocolate cake | Shortbread Oatmeal biscuits Digestive biscuits Muesli bar Flapjack Mars bar Pancakes Sorbet | Morning coffee biscuits Doughnut Jelly sweets Waffles (sweet) |
| Savoury snacks | ||
| Popcorn Crisps Peanuts Nuts (unroasted, unsalted) Peanut butter Oatcakes Pizza Corn chips | Taco shells Ryvitas | Water biscuits Rice cakes |
Contact us
If you require further information, please contact us on:
- Dietetics and Nutrition Dept – James Cook University, Middlesbrough, TS4 3BW
Telephone: 01642 854777 or Email: [email protected] - Community Dietetics – Langbaurgh House, Guisborough, TS14 7AA
Telephone: 01642 944 455 or Email: [email protected] - Dietetics and Nutrition Dept – Friarage Hospital, Northallerton, DL6 1JG
Telephone: 01609 762012 or Email: [email protected]
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