Nutrition Therapy for

Patient with Reactive

Hypoglycemia

By Hachi Wilkinson
Dietetic Intern 2015

OUTLINE
Objective
Patient profile
Patient medical history
Reactive Hypoglycemia
Nutrition Assessment
Nutrition Diagnosis
Nutrition Intervention
Conclusion

OBJECTIVE
List the nutritional therapy for an
individual with reactive hypoglycemia

PATIENT PROFILE
40 y.o.
African American
Female
Ht: 53 (160 cm)
Wt: 177.4 lb (80.6 kg)
BMI: 31.4

PATIENT MEDICAL HISTORY

Reactive Hypoglycemia
Multiple food allergies/sensitivities
Gluten intolerance
GERD
IBS
Endometrial CA
Depression
Pancreatitis

FINDINGS FROM INITIAL NUTRITION

ASSESSMENT
Pt visited HDC to see dietitian for weight
management/ nutritional advice for
reactive hypoglycemia and multiple food
allergies/ intolerance
Pt following High protein/low carbohydrate
(CHO) diet for hypoglycemia
Recently diagnosed with stage 1
endometrial CA
Allergy skin testing planned in 2 weeks
Awaiting for test result for autoimmune
disease

NUTRITION DIAGNOSIS
Inadequate CHO intake related to need for
nutrition counseling as AEB 24 hr recall
Food and nutrition-related knowledge deficit
related to need for nutrition counseling AEB pt
report
Overweight/obesity related to energy imbalance
AEB BMI of 31.4

REACTIVE HYPOGLYCEMIA
Hypoglycemia that happens to non-diabetic adults
Occurs postprandial
May occur in fasting state as well
Related to hyperinsulinemia
Symptoms are often felt when plasma glucose
levels are 60-65 mg/dL

SYMPTOMS OF HYPOGLYCEMIA

NUTRITION THERAPY FOR REACTIVE

HYPOGLYCEMIA
The goal is to eliminate the symptoms and
hypoglycemia
5-6 small meals/snacks spreading CHO
intake throughout the day
Instruction on CHO counting to control
CHO intake
The goal of nutrition therapy is to provide
meal planning and help patient to adapt
eating habits

NUTRITION THERAPY FOR REACTIVE

HYPOGLYCEMIA CONTINUED
Avoid:
Foods that contain large amount of sugar and
CHO
- regular soft drinks, juice, candy, sweet baked
goods
Caffeine can cause similar symptom to
hypoglycemia
Alcohol beverages should be limited
- Drinking alcohol on empty stomach can cause
hypoglycemia
- CHO food should always be eaten along with

NUTRITION INTERVENTION I
Instructed on adequate CHO intake using meal
plan with CHO counting
- 2 CHOs (30 gm) every 2 hours + Protein/Fat
- 1400 kcal diet
Provided patient with information about Celiac
Disease Foundation and Food Allergy Network
websites
Continue with regular exercise
- Aim for 3-5x/week

FINDINGS FROM SECOND VISIT

Has been focusing on eating plain past 1 wk
- Significant food allergy s/s with consuming
chocolate and soy
BS crash when consuming plain brown rice
Episode of hypoglycemia after eating Chinese
food
Increased CHO intake but not following the meal
plan

NUTRITION INTERVENTION II

Reinforced importance of consistent CHO intake following

2 CHO + protein/fat Q2h meal plan
Reviewed CHO counting
Taught label reading to help counting CHO
Planned several sample small meals with patient

FINDINGS FROM THIRD VISIT

Has not followed meal plan consistently
Reports 2 episodes of hypoglycemia when meal
was delayed
Life/other medical issues (CA, family, allergies,
depression) preventing her from focusing on
following the meal plan
Abdominal pain IBS/constipation
- Pt reports decreased water intake
Satiety issue

NUTRITION INTERVENTION III

Reviewed meal plan eat with in 1 to 1-1/2 hrs of waking

up and every 2 hrs thereafter
Encouraged to eat CHO + protein when hungry and not
to delay when pt notices hunger -- means of self care
and prevent overeating
Advised to drink water to prevent constipation, as well as
to control hunger and satiety
If pt feels hungry shortly after eating, drink water, eat
vegetables, CHO or fat

CONCLUSION
Pt continues to require further nutrition
counseling at this point
- With support for surrounding life/medical
issues
- Ongoing process of figuring out food allergies
and eat
according to schedule
There is no research to determine
what kind of food-related treatment is
best to prevent reactive hypoglycemia

REFERENCES
Douillard, C et al. Hypoglycemia Related to Inherited
Metabolic Diseases in Adults. Orphanet Journal of
Rare Diseases. 2012; 7(26)
International Diabetes Center. Reactive and Fasting
Hypoglycemia. 4th ed. Minneapolis, MN: International
Diabetes Center, Park Nicollet Institute; 2013
Academy of Nutrition and Dietetics. Hypoglycemia
(nondiabetic)