Select Page

Hypoglycemia and Low-Carb

Many people know that low blood sugar or hypoglycemia (HG) is usually associated with persons with type-1 diabetes. Their blood sugars are often very labile –going too high and dropping too low. In this situation HG not only causes severe symptoms that diminish one’s quality of life but can be lethal. One of the benefits of carbohydrate restriction in a person with type-1 is that blood-sugar swings even out with more moderate highs and far less hypoglycemic reactions.

One reason why this happens is because we are able to decrease medications including insulin that a person with type-1 diabetes must take.

Reactive Hypoglycemia: Lots of People Have It

The purpose of this article is to talk about reactive hypoglycemia (RHG), a far more common occurrence. It is often unrecognized and undiagnosed. It is not likely to cause death but is associated with a long list of symptoms that can interfere with everyday life. Symptoms of RHG are often treated with prescription drugs but because it is the result of lifestyle it should be treated with lifestyle changes. Reactive hypoglycemia or low blood sugar is not the opposite of diabetes (high blood sugar). It is the same condition just an earlier phase.

When one eats too many carbs, especially simple sugars and starches, glucose is digested and dumps in the blood quickly. The body responds by making insulin to carry glucose into the cells for energy. Any excess glucose is stored as glycogen and when the glycogen store is full, the glucose gets stored as fat in fat cells.

There are a number of factors than can lead to diabetes. If a person has a genetic risk for diabetes they are likely to be carbohydrate intolerant to some degree. This means their cells may be resistant to the effects of insulin requiring more and more to be produced in order to deal with the carbs in the diet. Excess insulin also promotes fat storage. As weight increases, cells become more insulin resistant. Over time this mechanism breaks down and blood sugars rise to unsafe diabetic levels. Diabetes is far more complicated than this as there are other metabolic defects that occur. But for our purposes this is the important piece to understand.

The Path to Diabetes

People don’t suddenly develop type-2 diabetes after having perfectly normal blood sugars. In my opinion, it’s a nutritional wear and tear disease. In the past it took years to develop full blown type-2; unfortunately with our dietary culture, we now see kids and teens diagnosed with it.

Reactive hypoglycemia is one stage on the way to type-2. At any stage during the breakdown of insulin regulation one can intervene by changing diet to limit carbs and lose the excess weight and probably avoid diabetes. I did; more on that later. The key is to recognize that you are already on the path to diabetes.

Once you have insulin resistance and high insulin levels it is common to get a delayed insulin response causing your blood sugar to drop too fast and /or too low. Know that the body works best when your blood sugar is kept in a narrow range. Your brain especially does not like blood sugars that are too high, too low or drop too fast.

To cope with a sudden drop in blood sugar your body takes steps to restore blood sugar levels. One of these mechanisms is a stress hormone response from the adrenal gland. You produce epinephrine which is thought to be the main cause of the RHG symptoms.

In my clinical experience in working with thousands of patients undergoing glucose and insulin tolerance tests, the most common time for a drop in blood sugar was about 3 hours after the glucose challenge. Our patients logged the symptoms they experienced during the test allowing us to correlate these with blood sugar changes.

The-Cycle-of-HypoglycemiaThe more common symptoms were: shakiness, tremors, sweating, headache, irritability, short temper, mental confusion, decreased coordination, insomnia, mood changes such as depression and anxiety, skipped heart beats, palpitations, blurred vision, fatigue, lightheaded-ness, hunger, and cravings. In susceptible people migraine headaches, a re-occurrence of atrial fibrillation, panic attacks, or even seizures occurred.

Stabilizing blood sugar requires a dietary change to restrict the kinds of carbohydrates that have the most negative effect on blood sugar. Adopting this kind of lifestyle can decrease your chances of developing type-2 diabetes and normalizing your weight. It has worked for me since 1974.


My Story

I have a family history of diabetes on my Dad’s side and morbid obesity on my Mom’s. We were brought up on plenty of bread and potatoes. I always loved and craved carbs including flour containing foods. I rarely ate fruit unless it was in a pie.

I was a normal skinny kid until puberty. As my body began to change cravings increased and I gained weight. I know now that with hormone changes insulin resistance increases and blood sugar regulation can worsen. I wish I knew it then.

I began dieting off and on in my teens by stopping bread and sugary desserts and decreasing calories. I gained and lost the same few pounds. As a nurse I knew better than to let myself gain too much given my genetic proclivity to obesity and diabetes.

In my early twenties I began having strange symptoms. I would wake up after a few hours sleep with a racing heart, skipping beats and palpitations. In the morning if I hadn’t eaten breakfast or had a sugary breakfast item I would get irritable, internal shakiness, tremors of my hands, difficulty concentrating, decreased coordination, intense hunger, and cravings for sugar. I would feel better after I ate.

These symptoms would come and go. It was only later that I realized that my symptoms got better when I was trying to lose weight and got worse when I resumed my favorite carbs.

Finally I knew I needed to see a doctor especially since the cardiac symptoms were quite uncomfortable. I didn’t think it was my heart but I couldn’t explain why I felt like this.

I saw an internist and endocrinologist. I was worked up for an adrenal tumor and hyperthyroidism (overactive thyroid). All tests were negative. So I was given cardiac meds to deal with my symptoms and a prescription for valium. I was told if I didn’t feel better to see a psychiatrist.

I knew I didn’t have heart disease so after a few months I stopped the meds.

To make a long story short, it was several months after I began to work with Dr. Robert Atkins that he diagnosed me with severe reactive hypoglycemia. After a review of my history Dr. Atkins knew exactly what I had. It was confirmed with a 4 hr. glucose tolerance test. At the third hour, when my blood sugar dropped precipitously, I passed out. I was surprised because I was taught that reactive hypoglycemia was rare.

Because Dr Atkins understood the progression of blood sugar and insulin dysregulation that could ultimately lead to type-2 diabetes, he knew how effective the proper level of carb restriction was to reverse this process. Not only could people lose excess weight but blood sugar and insulin regulation could ne normalized.

Since 1974 I followed Dr. Atkins advice and still do. I have him to thank for showing me the way to avoid type-2 diabetes and keep my weight normal.

It is never too late to improve your health. At any stage of carbohydrate intolerance from hypoglycemia to metabolic syndrome to type-2 diabetes, The HEAL Protocol can help you get healthier and stay healthier too.


Learn more about our HEALcare program here.


If you have a question that needs a response from a member of our team, please CONTACT US. Messages left in the comment box below may not be answered directly.


  1. Avatar

    Thanks for the great, helpful article!

  2. Avatar

    This could have been my story! Ever since I was little, I’ve had this (undiagnosed of course).After dating a type 1 diabetic who took my blood sugar levels during an episode, I finally put two and two together. I haven’t been officially diagnosed because no doctor has been able to recreate symptoms, but I feel SO much better on a low carb diet. No symptoms, high energy, even moods, etc. I have no experience in the medical field, but came to the conclusion of an overdose of insulin on my own. I’m pleased to know that’s pretty accurate. Thanks for your story! It’s very encouraging!

  3. Avatar

    Dear Jacqueline,

    Thank you very much, I have been having all the symptoms of Reactive Hypoglycemia for years now and it almost ruined my life!!! My naturopath had me start the low carb high fat diet and I am feeling better but i still have sypmtoms just much less. I think that I need to do the ketogenic diet, however I am vegetarian. I eat Milk, cheese, all dairy, but i do not eat meat fist or eggs. Do you have any recommendations of a dietary nutritionalist that can help guide me safely with a ketogenic diet, or diet that will relieve all the symptoms. I have strong diabetes genes on both sides of my family. Thaks for the help and information

    • Jacqueline Eberstein RN


      I have several comments:

      Schedule an appointment for a medical visit with Dr. Westman through HEAL, by emailing us. I don’t have any other referral for you at this time.

      Dr. Westman’s book The New Atkins for a New You has a few pages on this topic. You can get some ideas from there.

      The best plan for your health is a low carb plan to decrease your risk of diabetes. All symptoms may not disappear immediately, give it time.

      Hope that helps.

  4. Avatar

    Hi Jacqueline,
    Thank you for writing this post. I would like to ask you if there are any specific instructions or adaptions to the low carb diet that someone with reactive hypoglycemia should follow? For example, it is often advised to eat every 2-3 hours (and usually given a low GI carbohydrate-rich diet!). There is very little information about this around. I would be grateful of any advice.
    Kind Regards,

    • Jacqueline Eberstein RN


      I had undiagnosed reactive hypoglycemia all of my life until Dr. Atkins made the diagnosis.
      I follow a ketogenic low carb diet usually around 20 to 25 grams daily. In my experience a low glycemic index diet is still too high for most of us to stabilize blood sugar levels and avoid RHG reactions. Ketones will supply a steady fuel source and is low enough in carbs to improve blood sugar and insulin.
      I eat 3 meals a day and do very well without additional feedings. Occasionally if I get hungry I’ll have a small protein/fat snack.

      Hope this helps you.

      • Avatar

        Thank you for taking the time to reply. It is very helpful to know from personal experience what has worked for people with RHG.
        Best wishes

      • Avatar

        Wait.. I’m confused.. I thought that if you consume foods that have a low glycemic index as well as a low glycemic load, that is supposed to help control blood sugar spikes??.. Are you saying that doesn’t help?

        • Jacqueline Eberstein RN

          Reactive hypoglycemia that I was discussing in the article is a step to type 2 diabetes when on the typical high carb Western diet.
          To lower your risks of developing type 2 it is important to be aware of it and follow a low carb diet.

  5. Avatar

    This is EXACTLY why I went to endo 30 years ago. I also had debilitating fatigue and depression. He did a 6 hour glucose tolerance test, and he told me that every time I eat carbs, my insulin overdosed me. It felt like sleeping pill every time I ate, but I had felt that way my whole life, so I had nothing to compare it to. He said, “No more carbs for you” and gave me a list of dos and don’ts.

    I cried to give up all my favorite foods, and I said I would rather be blind and deaf than give up bread and milk. But I did it. After one week of huge whiny pity-party, ketosis kicked in and I had ENERGY, MENTAL CLARITY and no more depression.

    I have stayed on it for 30 years. It has kept me thin and healthy, while all my friends turned into fat, lethargic, unhealthy grandmas. I am 56 and fell better than when I was a teenager. I think this is the Fountain of Youth and I now I could kiss that doctor’s feet for telling me to eat meat, fat and leafy greens instead of carbs.

    • Jacqueline Eberstein RN

      Carolyn, thanks for sharing your experience. You were very lucky to have such a knowledgeable endocrinologist decades ago.
      Even now this is just not recognized as it should be.


Leave a Reply to Jacqueline Eberstein RN Cancel reply

Your email address will not be published. Required fields are marked *

Disclaimer: This website does not provide medical advice or treatment. Follow the guidance of a physician before embarking on any diabetes-management or weight-loss program, especially if you are on dialysis, pregnant, nursing or under the age of 18. If you are taking medications, changing your diet under the HEALcare® program may require a change in their dosages. Follow your doctor’s orders on all medications, especially if you are taking diuretics or medication for blood pressure or diabetes. Individual results may vary. The testimonials referenced in this website are not promises or guarantees that you will achieve similar results.

Pin It on Pinterest