Thyroid Thursday #90: Reactive Hypoglycemia: Part 3

We’re back for part three of our Thyroid Thursday series on reactive hypoglycemia. If you didn’t watch the other videos, go back and watch video one and two. I want to give you a recap. We talked about reactive hypoglycemia being this state where your blood sugar actually drops too low about one to four hours after a meal.

How do you know if you have reactive hypoglycemia?

You’re going to have symptoms like anxiety, irritability, something we call “hangry”, blurred vision, dizziness or lightheadedness. You may actually feel like you’re going to pass out. You may get confusion or brain fog. The scenario goes something like this. You eat your meal. You come back to work. You sit down at your desk. You just can’t think. You just can’t focus. You get this sense of fatigue or weakness. You can get sweaty. You can get headaches and heart palpitations. You may get hungry, pretty quickly after your meal. And, you can have disturbed sleep if your blood glucose drops too low at night.

First-Phase Insulin Response

What we want to talk about today is this thing called the First-Phase Insulin Response. This is really important to understand. Within the first two to fifteen minutes of eating, your GI tract should get signals that food is coming into the system, and should make a hormone called GLP-1. The GLP-1 gets into the bloodstream and stimulates the pancreas to release preformed insulin.

When we eat, and blood sugar starts to rise, there’s insulin there to match the glucose and bring the glucose, or the blood sugar, back down to our baseline. The optimal baseline for fasting blood sugar is between 82 and 88. But, if there’s problems in the GI tract, we could have either an increased GLP-1, a delayed, or decreased GLP-1 response. All of these situations, can result in causing reactive hypoglycemia.

In a state where you have fast GI motility, you eat and have to go to the bathroom right away because your bowels move really quickly. You may be moving food through the stomach, into the intestine, too fast. In this situation, you’re going to get increased GLP-1 production. What’s going to happen is as your blood sugar is rising, you’re getting too much preformed insulin released, and it’s going to cause your blood sugar to drop below baseline too quickly, and you’re going to get those reactive hypoglycemic symptoms.

In the other situation, if you have really slowed bowel motility, and you may have a delayed or a slowed GLP-1 response. If you have dysbiosis, and you could have a decreased GLP-1 production. Without sufficient GLP-1, you’re not going to get an appropriate first-phase insulin response. What’s going to happen is, your blood sugar is going to start to rise. It’s going to slowly start to decrease over time. But your insulin is going to actually spike too late, as the blood sugar’s actually starting to decline, and that’s going to rapidly drop your blood sugar and put you in that reactive hypoglycemic state.

GLP-1 is this critical enzyme to support first-phase insulin response, and it’s really one of the earliest indicators of blood glucose dysregulation and risk for developing diabetes.

What do you do in this situation?

If you have blood sugar issues, reactive hypoglycemic issues, know or believe you have hypothyroidism (whether you’re being treated or not), and you have GI issues, irritable bowel syndrome (whether it’s IBS or IBC or IBS mixed), seek out a functional medicine practitioner. A practitioner like myself who understands blood sugar physiology and the first-phase insulin response. This isn’t something you’re going to fix by eating every two hours. That doesn’t fix the problem you may have going on in the GI tract. Many times, it’s hypothyroidism or this first-phase insulin response problem due to some type of dysbiosis in the GI tract. If we can fix this, you can start to regulate blood sugar properly.