Glucose Low

If you scored high in the ‘Glucose Low’ section of the Health Score Quiz, please read this article as it contains some useful information and resources to help you.

The questions or statements posed in this section help to determine if you are prone to periods of low blood glucose or sensitive to the body’s response to glucose levels dropping low. Please note this is not a diagnosis for clinical hypoglycaemia.

On this page we are going to look at:

1. What is blood glucose and why do we need it?
2. Why our body needs to prevent low glucose?
3. Why do I experience low glucose symptoms?
4. What are the causes of hypoglycaemia?
5. How our gut might impact low blood glucose
6. Useful assessments for those with low glucose related symptoms
7. Foundation interventions for low glucose tendencies

What is blood glucose and why do we need it?

Blood glucose is essentially the main sugar that the body utilises to help make energy. Our brain needs a constant supply of glucose and uses various hormones to try and keep your blood glucose within a fairly tight range. If the glucose levels go too high or too low this can cause a number of symptoms, some of which can cause significant acute issues whilst other issues can arise over time from poor management of glucose, or chronically elevated levels of glucose, as seen with type 2 diabetics.

The body can absorb glucose from the foods we eat and also from its own stores, such as the storage form of glucose known as glycogen. Because of the importance of blood glucose, we can also make it from fats and proteins, in a process known as gluconeogenesis.

Glycogen, the storage form of glucose, can be found predominantly in the liver and in muscle tissue. In muscle tissue we store it there, so the muscles have immediate access for it if we need to move, particularly with intense activity. The liver provides a storage point so that glucose can be released as required by the rest of the body, especially in times of stress/demand.

Why our body needs to prevent low blood glucose?

Reduced levels of glucose, especially when they go very low can be life threatening, sometimes even resulting in loss of consciousness, seizures and neurological problems. For this reason, we have 4 hormones that help to maintain normal blood glucose levels, these include:

1. Glucagon
2. Growth Hormone
3. Cortisol
4. Adrenaline

These hormones help to release glucose from the liver as well as make glucose from fats or proteins.

If these hormones are not adequately available, or perhaps there is an excess of insulin, a hormone that helps to lower blood glucose, this can result in low glucose levels.

According to the Whipple’s Triad criteria, hypoglycaemia (clinically low blood glucose) is seen as a drop below 50mg/dl or 2.8mmol/l, coupled with low glucose related symptoms and relief of those symptoms with the ingestion of glucose orally or via an injection.

As you may be aware, the low glucose related symptoms include:

• Feeling shaky
• Irritability or impatience
• Sweating, chills
• Feeling anxious
• Sweet food cravings & hunger
• Confusion / loss of cognitive function
• Feeling lightheaded or dizzy
• Elevated heart rate
• Blurred vision

The large majority of people will never have issues with clinically low levels of glucose leading to a hypoglycaemia diagnosis. Even those experiencing low glucose related symptoms, like those listed above or in your questionnaire, never actually get to that point. If someone is getting to that point, then levels of insulin should be assessed or anyone using insulin to manage their glucose should review the dosages they are using, along with ruling out other red flags.

Likewise, there may also be insufficiencies in the counterregulatory hormones, glucagon, growth hormone, cortisol and adrenaline. These are the hormones that can help to increase glucose levels in the blood.

What is interesting is that we don’t need levels of glucose as low as the criteria suggests to experience low glucose related symptoms. Some people will experience the symptoms at what would be deemed normal physiological levels which creates a bit of a grey area, because low glucose symptom levels may be significantly different from one person to the next.

Why do I experience low glucose related symptoms?

Different people experience lower blood glucose symptoms, not only because of the effect of low glucose itself, but also to show how that individual responds to the hormones that help us prevent really low levels of glucose, especially cortisol and adrenaline.

Counter-regulatory hormones (glucagon, cortisol, adrenaline, growth hormone) get released when the glucose levels are falling too low or perhaps falling too rapidly, but are yet to be low.

With two of the four hormones being stress related hormones (cortisol and adrenaline), the increase in these hormones can often cause symptoms of their own, independent from actual low blood glucose. For example, elevations in these hormones may be the cause of:

• Irritability or impatience
• Feeling hangry (hungry and angry at the same time)
• Elevated heart rate
• Sweet food cravings
• Anxiety
• Sweating

You can see just from this that there is a significant carry over between what is listed as actual low glucose related symptoms, and elevated stress hormone related symptoms.

Interestingly, as levels of glucose drop to around 3.5 mmol/l glands are stimulated to release cortisol, adrenaline and growth hormone. Therefore, one can experience low glucose “related” symptoms, but it may not have anything to do with physiologically low glucose, it may be more to do with how that person responds to stress hormones like cortisol and adrenaline.

This is how I look at actual low glucose symptoms vs responses to counter-regulatory hormones like adrenaline and cortisol:

1. Sympathetic/Adrenergic (Those sensitive to stress hormones) – anxiety, irritability, sweating, palpitations.
2. Neuroglycopenic (lack of glucose availability for the neurons of the brain/actual low blood glucose) – hunger, dizziness, tingling, blurred vision.

Studies have shown that certain individuals are more sensitive to adrenaline, also known as beta adrenergic sensitivity. Therefore, when adrenaline is called into action to help increase or stabilise glucose levels, they will experience the stress hormone related symptoms that are often considered low glucose related symptoms as well. These people often find themselves sensitive to stress and stimulants as well.

What are the causes of hypoglycaemia?

As mentioned previously, low glucose is often termed hypoglycaemia. Whilst most people will not be experiencing clinical hypoglycaemia according to the criteria laid out above, some might. Below outlines some of the causes of true hypoglycaemia.

Reactive hypoglycaemia

This is the most common cause of low glucose symptoms, even without true hypoglycaemia. This occurs usually within a couple of hours of eating, driven by an over-production of insulin. This can actually be one of the very earliest signs of type 2 diabetes development and may be something that contributes to the development of insulin resistance, PCOS and more.

Non-reactive hypoglycaemia

This is where it is not related to a meal and may be due to an underlying disease or imbalance causing non-reactive or fasting hypoglycaemia.

• Certain medications
• Excessive alcohol, leading to liver dysfunction and poor production of glucose from the liver, therefore less in systemic circulation
• Excessive insulin production, although rare, sometimes can be caused by a pancreatic tumour
• Disordered eating habits
• Pregnancy
• Liver, heart or kidney dysfunction

How our gut might impact low glucose

GLP-1 is a hormone secreted by something called enteroendocrine cells found in the gut. It does so in response to the consumption of food, in particular carbohydrates. GLP-1’s job is to stimulate the pancreas to release a large dose of insulin, even before glucose enters the blood stream, known as the first phase insulin response. As insulin levels increase, it suppresses the production of glucagon, shutting down the release of glucose from the liver into the blood stream. This makes sense because after a meal we want to be able to move sugar from the blood into cells and not continue to release glucose into the blood stream from the liver while we are absorbing it from food.

Studies have shown that increase GLP-1 can play a role in inducing reactive hypoglycaemia (low blood glucose following meals).

The challenge for some people is that overstimulation of GLP-1 resulting in excessive stimulation of insulin, thus suppression of glucagon can increase speed at which glucose is disposed from the blood into the cells (increased insulin sensitivity), increasing the likelihood of a sharp decline in glucose levels after a meal, and thus low glucose symptoms or increased adrenergic activity such as adrenaline/cortisol response.

People most prone to excessive production of GLP-1 are those who have what is known as increased gastric emptying, simply put it is an increase in the clearing of contents from the stomach into the small intestine. Following certain surgeries on the gut this can also result in something known as dumping syndrome, thus past surgeries should be reviewed if hypoglycaemia has suddenly developed.

In this situation you are most likely to experience low glucose ‘like’ symptoms. If that is the case, then focusing on addressing the underlying digestive issue should be a priority in addressing your glucose regulation. Review your digestive health scores from your questionnaire to get an idea on any digestion or other related imbalances.

Useful Assessments for those with low glucose symptoms

Unlike high blood glucose levels, such as that seen in type 2 diabetes, low glucose is rarely a chronic issue, it tends to be something that occurs acutely, and our body responds by releasing hormones that elevate glucose levels. For this reason, it can be quite hard to assess and track.

If someone seems to get low blood glucose a lot, especially following nutrition and lifestyle changes that would typically help, I would consider the following assessments and have them see their GP for further analysis:

• Continuous glucose tracker – e.g. freestyle libre device where it tracks glucose levels in real time for 2 weeks whilst keeping a detailed nutrition, lifestyle and symptom diary.
• Glucose tracking. If not wearing a continuous tracker then keeping a food diary and glucose diary using a blood glucometer can be useful, especially when experiencing low glucose symptoms.
• Fasting Insulin levels.
• Urine or salivary adrenal hormone assessment.
• Blood chemistry looking at basic haematology and biochemistry markers, kidney function, liver etc, adding on mineral assessments such as magnesium and chromium, because of their role in managing glucose levels.

Foundation interventions for low glucose tendencies

Nutrition

• With each meal ensure that you:
1. Minimise the consumption of refined/processed carbohydrates
2. Increase the consumption of fibre in the diet, eating good portions of colourful vegetables with your meal
3. Eat a good source of protein with most of your meals
4. Add some healthy fats to your meal
5. Try to avoid meals where the dominating macronutrient is carbohydrates
• Eat at regular times of the day. For some people it is beneficial to eat more often, however for many it is about changing what you eat within a meal and also getting the body better at fasting between meals
• Minimise the intake of stimulants like caffeine
• Minimise all alcohol intake as this can contribute to poorly managed glucose and food choices that further exacerbate imbalances in glucose.

Sleep

Sleep can have significant effects on the food choices that we make and often these food choices can lead to more imbalanced glucose levels. By improving sleep, you can often improve choices, reducing reliance on stimulants and sugary foods.

Movement

When we exercise this can cause an increase in blood glucose, however after exercise or if we are doing particularly intensive exercise there is a risk that glucose levels can fall suddenly. For this reason, it is worth having some food with you, like fruit or a sugary snack in case you feel you need to increase your glucose levels suddenly.

For anyone training regularly experiencing low glucose symptoms then I recommend working with us to help you create a pre, during and post training protocol.

Stress

For those that are sensitive to hormones like cortisol and adrenaline then I recommend prioritising how you manage stress and minimising intake of stimulants.

Practicing periods of mindfulness in the day or perhaps even before meals is a nice practice to get into. This can be as little as 3-5 minutes. Bringing awareness to your breath and how you are at that moment in time can be a useful practice not only to help prevent the onset, but also when you are experiencing hangry symptoms, a tool you can fall back on to help guide your mind.

We all have different things that create a mindful state, so for one person it might be meditation, another taking a walk, someone else listening to music or being with certain friends. Find what or who helps you create a relaxed and mindful state and prioritise this in your day to day existence.

Additional Resourses

Articles

• Why people get hangry and what to do about it
• Understanding carbohydrates
• Understanding fibre
• Understanding Caffeine
• Understanding Alcohol
• Calorie and macro breakdown of common foods