What is hypoglycemia? Definitions [1].

Reactive hypoglycemia: type of low-blood sugar levels, that occurs after meals.

Fasting hypoglycemia: low-blood sugar that occurs in the post-absorptive state at 6-12 hours after the last meal. In adults, fasting hypoglycemia is related to a serious condition such as an insulinoma, extrapancreatic tumor, liver or kidney failure, or hormonal deficiencies.

Drug-induced hypoglycemia: low-blood sugar usually resulting from taking insulin, oral hypoglycemic agents, alcohol, or other drugs or combinations of these.

Symptoms of reactive hypoglyemia

Symptoms of hypoglycemia relate to either activation of the sympathetic nervous system or impairment of brain function. A rapid fall in blood glucose levels stimulates release of catecholamines producing sweating, weakness, hunger, tachycardia, anxiety, numbness or tingling. A slow reduction in blood glucose levels produces neuroglycopenia with irritability, headache, mental confusion, slurred speech, stupor, coma or seizures. Rarely, alimentary hypoglycemia produces severe neurologic symptoms such as seizures; this occurs in some individuals with prior removal of more than half of their stomachs. Fortunately, reactive hypoglycemia is usually self-limited and associated with only mild to moderate symptoms related to catecholamines.

Types of reactive hypoglycemia

Alimentary type. Hypoglycemia occurs between 60-150 minutes after food or glucose intake. The rapid absorption of glucose produces an early and excessive serum insulin response. Alimentary type hypoglycemia has two subgroups:

1.	those without prior gastric surgery
2.	those with prior gastric surgery- either gastric resection or vagotomy.

Nutrition management of reactive hypoglycemia