The man on the phone told a familiar story. He had eaten lunch at approximately 11:30 the day before. He went to a movie at 4:30 and while there had some candy. After the movie he and his wife went out to eat. At 7:30, while waiting for his meal, he broke out in a sweat, had blurred vision, and was not coherent for approximately five minutes.

He was taken to the nearest hospital emergency room where his examination and lab tests were completely normal. The emergency physician told him that he had suffered a mini-stroke and prescribed a drug to poison his platelets. The man was calling me for advice on how to avoid a full-blown stroke.

I informed him that I believed the emergency room physician’s diagnosis was in error. Mini-strokes resolve over a matter of hours, not minutes. What he had experienced was not a mini-stroke, but a hypoglycemic reaction. A much different strategy than prescribed in the emergency room will be required to prevent subsequent hypoglycemic episodes.

It’s not uncommon to hear someone announce, “I’m hypoglycemic.” or “I have hypoglycemia.” Neither statement is quite accurate. Individuals may experience hypoglycemic episodes, but rarely is a person continuously hypoglycemic. Hypoglycemia is a temporary condition, it is not a disease. Hypoglycemia simply means “low blood sugar”. A hypoglycemic episode is a period during which an individual’s blood sugar has fallen below the level the body needs to continue to function normally.

Blood sugar levels rise for a short time following a meal, but are generally maintained between 70 mg/dl and 110 mg/dl. A very small amount of glucose is present in the blood stream at any time. The amount of sugar required to produce a blood sugar level of 100 mg/dl is equivalent to the amount of sugar found in one of the packets found on restaurant tables. Most dietary sugar is quickly converted to glycogen, which is used to produce energy quickly, or stored as fat for use at a later time. Blood sugar balance is maintained primarily by insulin, which lowers the amount of sugar present, and glucagon, which raises the sugar level. Other hormones also play a role.

When fasting blood sugar levels are above 125 mg/dl an individual is said to have diabetes. When blood sugar falls below 70 mg/dl hypoglycemia is said to be present, although some people may not experience symptoms until the level falls to 60 mg/dl or lower.

Hypoglycemic reactions are quite common. Signs of hypoglycemia include breaking out in a cold sweat, turning pale, shaking or losing coordination, becoming irritable or otherwise behaving poorly, feeling nervous, experiencing sudden hunger, nausea, a rapidly developing headache, blurring of vision, and loss of consciousness.

A rare cause of hypoglycemia is an insulinoma, which is a pancreatic tumor that produces insulin. An insulinoma is the only condition in which hypoglycemia can exist for prolonged periods of time. Persistent hypoglycemia can cause dizziness, disorientation and weight gain. The weight gain occurs because individuals with insulinomas feel better for a short time after they eat and thus eat more frequently. Most complain of blurred vision, fast or skipped heartbeats, sweating and weakness. Depression and lethargy can occur. As the condition progresses seizures and loss of consciousness can occur.

Drug-induced hypoglycemia, which occurs when diabetic treatment causes the blood sugar to fall to low levels, is much more common. Drug-induced hypoglycemia can be quite severe, as a drug does not stop working when the blood sugar falls below a safe level. Drug-induced hypoglycemic reactions occur so often that emergency personnel have been advised to consider anyone who arrives at the hospital in an unconscious state hypoglycemic until proven otherwise.

Anyone who is being treated for diabetes should be aware of the signs of hypoglycemia. It is just as important - perhaps more important - that close friends and family members be able to recognize the condition. An individual whose blood sugar is dropping out of the functional range may be unable to recognize what is happening or be unable to call for help when it occurs.

Management of drug-induced hypoglycemia requires the administration of sugar in some form. Juices are ideal because they can be swallowed and absorbed quickly. Severe episodes may require an injection of glucagon, a hormone that opposes insulin and causes blood sugar to rise. I believe that all insulin-dependent diabetics should have a glucagon kit available for use if a severe hypoglycemic episode occurs. Family members should be instructed about how to recognize the need for glucagon and understand how to inject it if the need arises.

The vast majority of hypoglycemic reactions occur in people who do not have an insulinoma and who are not taking insulin or drugs to control blood sugar. Fortunately, these episodes are rarely as severe as drug-induced reactions. In nearly all cases the blood sugar returns to the normal range within a few minutes without any specific treatment. These incidents can be alarming, however, and if they occur frequently they can significantly disrupt one’s daily routine.

Nearly all cases of non-drug induced hypoglycemia are due to poor dietary choices. If a meal or snack consists primarily of refined carbohydrates (white sugars, white flours, & white grains) the body may release more insulin than is necessary to handle the load. The excess insulin continues to lower the blood sugar until it drops into the hypoglycemic range, at which time glucagon and other chemicals such as epinephrine and norepinephrine are released to restore normal blood sugar levels.

Food-induced hypoglycemic episodes usually occur within 1 ½ to 4 hours after eating. They can be characterized solely by trembling and irritability, but can be dramatic enough to cause fainting. Any of the signs of hypoglycemia can occur.

Two groups of individuals are at risk for having a hypoglycemic reaction due to a poor dietary choice. The first are young, healthy individuals who are capable of absorbing and metabolizing sugar very quickly. Teenage girls and young women in their twenties are the most likely to experience food related hypoglycemia on this basis, but the phenomenon can occur in males as well.

The second are individuals who have hyperinsulinemia (higher than average levels of circulating insulin). Hyperinsulinemia is found in two conditions, polycystic ovarian syndrome and the metabolic syndrome.

Polycystic ovarian syndrome (PCOS) is characterized by a variety of symptoms including menstrual irregularity, weight gain, increased hair growth, reduced fertility, and darkening of the skin. At least half of women with PCOS have higher than normal insulin levels, and many will go on to develop type II diabetes.

Metabolic syndrome is a pre-diabetic condition. Individuals with metabolic syndrome have high insulin levels and also tend to be overweight, especially around the waist. A waist size in excess of 40 inches in a man and 35 inches in a woman is consistent with metabolic syndrome. Levels of triglycerides tend to be greater than 150 mg/dl. HDL cholesterol levels less than 40 in a man and 50 in a woman are a sign of metabolic syndrome, as is a blood pressure greater than 130/80.

Young, healthy individuals can prevent hypoglycemic episodes by adjusting their eating habits. These people generally feel better eating six small meals or snacks daily rather than 1 to 3 large meals daily. Refined foods should be limited and should only be eaten as a small dessert following a full meal. Each meal or snack should include foods that contain significant amounts of fat or protein. For example, apple slices with cheese would be preferred to an apple alone. Crackers with peanut butter would be a better choice than pretzels or crackers alone. In my experience, individuals who make wise choices on a regular basis are less likely to experience hypoglycemia if they skip a meal or make a poor choice than those who routinely make poor choices.

It is important to remember that many beverages contain large amounts of refined sugar. Many people have come to me for evaluation after experiencing a hypoglycemic reaction that followed the consumption of a soft drink, juice, or sweetened tea. Low calorie or sugar-free drinks can also trigger hypoglycemic episodes as many artificial sweeteners trigger the release of insulin.

Individuals who have PCOS or metabolic syndrome should follow the same dietary recommendations as young, healthy individuals who are prone to hypoglycemia. These people generally need to take additional measures to control their hyperinsulinemia, however. They should walk or perform a similar physical activity for 30 minutes daily. This is because doing so improves insulin resistance and reduces insulin production for the next 24 hours.

Mineral supplementation is helpful. The most critical minerals for maintaining a normal blood sugar are chromium, magnesium, and vanadium. Herbs such as gymnema, momorica, and cinnamon can provide additional stabilizing benefits.

Combination products such as Chromium Plus, which I formulated specifically to address the challenge of hyperinsulinemia, are particularly helpful in maintaining normal blood sugar levels. Unlike insulin or diabetic drugs, which continue to drive the blood sugar lower when hypoglycemia occurs, formulations like Chromium Plus support the body’s ability to maintain the blood sugar in a normal range. One or two capsules twice daily are generally effective in eliminating hypoglycemic episodes.

The gentlemen who called me met the criteria for metabolic syndrome. His experience was predictable. He had not eaten for 5 or 6 hours before he ate the candy at the movie. He had nothing else until his episode of blurred vision and confusion 2 or 3 hours later.

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