Hypoglycemia Without Diabetes: Symptoms & Treatment

Instructor: Alexandra Unfried

Alexandra earned her master's degree in nursing education and is currently a hospital supervisor/administrator.

Hypoglycemia is also known as low blood sugar. It can occur in those with our without diabetes. This lesson will discuss the symptoms and treatment of hypoglycemia without diabetes.


Rick is a forty-five year old male with a history of obesity and pancreatitis. He has been working at a busy factory and does not have time to take breaks until lunch time. He has been noticing that he often feels shaky, dizzy, and sweaty about three hours after he eats his breakfast consisting of pancakes with syrup and fruit. Rick thinks that he is just tired from working hard, but mentions it to his doctor. Rick's doctor wants to test him for hypoglycemia.

What is Hypoglycemia?

Hypoglycemia occurs when sugar levels in the blood are low. This is mainly seen in those with diabetes when treatment is not optimal, but can also occur in those without diabetes. This occurrence is related to having too much insulin in the blood, which leads to low glucose levels in the blood. There are two types of hypoglycemia that can happen with non-diabetic hypoglycemia. They are called reactive hypoglycemia and non-reactive or fasting hypoglycemia.

Reactive Hypoglycemia:

  • Happens when there is low blood sugar that occurs several hours after a meal
  • May be at risk for developing diabetes
  • Affects those with stomach surgery where food can pass too quickly to the intestines
  • May have insufficient enzymes, making it hard to break down food

Non-reactive Hypoglycemia:

  • May be caused by an underlying disease
  • Can happen when on certain medications including salicylates (ex. aspirin), sulfa drugs (ex. antibiotics), pentamidine (treatment for pneumonia), or quinine (treatment for malaria)
  • Increased risk with consuming excess amounts of alcohol which slows the liver from producing glucose
  • Seen in illnesses that affect the liver, kidneys, or heart
  • Seen with pancreatic tumors
  • Can happen during pregnancy

Rick has some blood work done at the doctor's office to check the level of sugar in his blood. Unfortunately the test shows that he is at risk for pre-diabetes. After several more tests, Rick is diagnosed with reactive hypoglycemia. This is because his blood sugar runs low several hours after he has eaten. Rick's body does not know how to react to food, specifically carbohydrates. Complex carbohydrates are more beneficial than refined carbohydrates because they help maintain a more steady blood sugar over time. Examples of complex carbohydrates include:

  • Brown rice
  • Whole grain bread
  • Oats
  • Pasta
  • Potatoes

Complex carbohydrates

Examples of refined carbohydrates include:

  • White bread
  • White rice
  • Granulated sugar
  • Brown sugar
  • Syrup
  • Honey

Refined sugars to avoid

When Rick eats carbohydrates his blood sugar rises, causing an increase in insulin. However, the excess insulin is too much and then causes the blood sugar to drop to low levels several hours after he has eaten. Now that Rick knows what is going on in his body, he wants to know what symptoms he needs to be aware of.

Symptoms of Non-diabetic Hypoglycemia

Rick is told to report any symptoms of hypoglycemia to his doctor, even if there is only one episode. Each person's reaction to low blood sugar is different and some people may not even have any symptoms. They may happen frequently or inconsistently. Common symptoms of hypoglycemia include:

  • Dizziness
  • Hunger
  • Shakiness
  • Headache
  • Sleepiness
  • Anxiety
  • Confusion
  • Sweating
  • Blurred vision
  • Irritability
  • Weakness

Rick makes sure to tell his doctor that he has had periods of dizziness, shaking, and sweating. His doctor tells him to keep a journal of what he eats and how he feels throughout the day. This way they can work together towards a treatment plan and learn how to avoid hypoglycemia.

Treatment of Non-diabetic Hypoglycemia

Treatment for acute hypoglycemia involves increasing the glucose in the body. This is done by eating or drinking a recommended fifteen grams of carbohydrates. For a quick rise in blood sugar the treatment is orange juice or other fruit juices, glucose tablets, or hard candy. However, the blood sugar will not stay increased for long so complex carbohydrates should also be consumed to keep blood sugar levels stable.

Long-term treatment of hypoglycemia is dependent on the cause. For example, in reference to non-reactive hypoglycemia, if it is caused by medications then the medication should be changed. If it is caused by a tumor, the tumor may need to be removed.

Other treatments are based on diet and eating schedule in order to stabilize the glucose in the blood throughout the day. Recommendations for diet include:

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