Hypoglycemic Health Assoc. of AU Hypoglycemic Health Assoc. of AU
Testing For Hypoglycemia And How Your Doctor Can Help

By Dr George Samra, MB, BS (Sydney), FACNEM

The correct test for Reactive Hypoglycemia is a G.T.T. The test should be ordered by the doctor as follows: G.T.T. – 4 hours. All 1/2 hourly readings. No special diet prior.

The Glucose Tolerance Test is the classical test used in diagnosing Diabetes. The Diabetic test is a 2 hour G.T.T. with just 3 readings, the fasting, the 1 hour and the 2 hour. This test is not correct for testing Functional or Reactive Hypoglycemia. With Hypoglycemia one is interested in the full reactions to a sugar load. In both cases a 75gram load of glucose is given to the patient after having collected blood for the fasting level. With Reactive Hypoglycemia the emphasis in on the word “Reactive”- one is looking for the sugar reactive phenomenon in which the blood sugar either drops suddenly or falls very low. Part of diagnostic criteria for Hypoglycemia is the rate of fall of blood sugars, hence the relationship between consecutive readings is very important. Sudden drops in blood glucose will usually trigger an adrenaline response and subsequently adrenaline symptoms such as nervousness, shakiness, dry mouth, irritability, agitation, neck stiffness and sometimes palpitations or a racy heart.

With Reactive Hypoglycemia one is also seeking to ascertain how low the blood sugar may go as this in fact is one of the measures of severity. The brain is dependent on blood glucose as it’s only fuel supply under normal circumstances. When the blood glucose falls below a certain level, usually 3.6mm/L, there is a lack of available fuel to the brain and symptoms of brain starvation will occur – these include tiredness, moodiness, depression, forgetfulness, poor concentration and cloudy headedness.

The purpose of the G.T.T is to clarify how well one tolerates glucose and by doing it properly one is able to see if the blood sugars drop too rapidly or fall too low. It is important that the glucose tolerance test is done accurately and properly. The following rules apply:

1.    Fasting for at least 10 hour prior. Usually this means fasting from 10.00p.m. the previous night.

2.    Once the fasting sugar level has been collected. A 75gm glucose load is given to the patient. In children this may be adjusted according to their size, however usually a 50gm glucose load is suitable for the vast majority of children.

3.    The pathology lab should be made aware that we are not trying to diagnose Diabetes but rather Reactive Functional Hypoglycemia. For this reason the doctor is requesting a longer test, i.e. 4 hours instead of 2 hours as well as all 1/2 hourly readings.

Does Insulin Need to be Measured?
Usually Insulin levels do not need to be measured. However, when the doctor suspects an Insulinoma (Cancer of the head of the Pancreas) and also in the case of an obese patient insulin levels may prove very useful in clarifying the diagnosis.

Determination of the Glucose Tolerance Test Results
The different types of Hypoglycemia have been classified based on the Glucose Tolerance Test. If the blood glucose levels falls below 3.6mm/L (65mg per 100ml) then Absolute Hypoglycemia is present. If the blood glucose level drops rapidly i.e., greater than 1.6mm/L (30mg per 100ml) in 1/2 an hour or greater than 2.6mm/L (50mg per 100ml) in 1 hour, then Relative Hypoglycemia exists. If the curve has a sharp gradient and numbers below 3.6mm/L together, then is regarded as the classical Reactive Hypoglycemia. The lower the blood sugar readings and the larger the gradient the blood glucose falls the more severe is the diagnosis. A fasting Hypoglycemia alerts the doctor the possible diagnosis of Insulinoma. The flat curve response and its implications have also been described elsewhere on this web site.

See results of a GTT and  here.


What to Say to Your Doctor & How to Approach Your Doctor
Most doctors have a problem understanding Reactive Hypoglycemia and this frustrates them. For this reason I’m including a letter to the doctor that you should download and which should help you get a satisfactory response from your doctor.


Web Site http://www.hypoglycemia.asn.au

Dear Doctor,

Your patient has identified with the many symptoms suffered by patients with Reactive or Functional Hypoglycemia. As you well know, Hypoglycemia is low blood sugar, however Reactive Hypoglycemia is a sugar reactive phenomenon (and is not Diabetes.) After a sugar load such as a soft drink or cake, patients with this condition often suffer symptoms due to a sudden drop in their blood sugars, which typically occurs between 1 1/2 hours and 2 1/2 hours after the sugar consumption. Typical symptoms of Hypoglycemia include tiredness, poor concentration, moodiness, depression, forgetfulness, nervousness and irritability.

The brain relies on glucose as its only fuel under normal circumstances. The symptoms of Hypoglycemia relate to the fact that the brain is not being fueled properly at some point in time. In order to investigate this condition and help your patient please order a Glucose Tolerance Test as follows:
GTT 4 Hours. All 1/2 Hourly Readings. No Special Diet Prior.

This is the correct way to order a test for Reactive Hypoglycemia. The patient is usually given a 75gm load of glucose soon after the fasting level has been collected. With the prolonged GTT and with the 1/2 hourly readings one is able to ascertain both the rate of fall of blood sugars as well as whether they in fact fall below the Hypoglycemia line that is usually 3.6 mm/L (65mg per 100ml). Guidelines for interpretation of the Glucose Tolerance Test are available on the web site or directly from the Hypoglycemic Health Association.

Thank you sincerely for your co-operation. This test may help to clarify many troublesome symptoms that your patient has been experiencing.


Yours sincerely,
The Hypoglycemic Health Association.


arrow31 Responses

  1. Basel Shishani
    31 mos, 3 wks ago

    1. Wikipedia article http://en.wikipedia.org/wiki/Glucose_tolerance_test states that:

    The OGTT is of limited value in the diagnosis of reactive hypoglycemia, since (1) normal levels do not preclude the diagnosis, (2) abnormal levels do not prove that the patient’s other symptoms are related to a demonstrated atypical OGTT, and (3) many people without symptoms of reactive hypoglycemia may have the late low glucoses.[citation needed]

    Maybe you would like to comment on these points.

    2. There are few sites out there talking about doing the GTT at home (fasting, taking 76g glucose, and testing with a glucometre)- do you think it’s a good idea?

  2. Jurriaan Plesman
    31 mos, 3 wks ago

    We have found that the GTT is fairly good at diagnosing hypoglycemia (pre-diabetic diabetes)
    1) Normal levels may still produce symptoms of hypoglycemia, where there is a flaw in glycolysis (ten step break down of glucose into pyruvate) called hypoglycia. Please see type 6, Hypoglycia in “What is Hypoglycemia?
    2) Translated into English this question seems to mean: “abnormal GTT do not prove that the patient’s other symptoms are related to a demonstrated abnormal GTT”.
    This may be true, because apart from or in addition to hypoglycemia the patient could also suffer from an array of other metabolic disorders, such as heavy metal intoxication or hypothyroidism, or “leaky gut syndrome”. See “Silent Diseases and Mood disorders“.
    3) This question is somewhat obscure, but it may may mean that a person could could be shown to have hypoglycemia in a longer than normal GTT. The question can also mean that a person may have hypoglycemia and show no symptoms normally associated with hypoglycemia; such as perhaps “anger management problems” or “perfectionism” or “irritability” etc etc.
    4) The last question is about an alternative to doing a home GTT by completing the NBI test, or “Hypoglycemia Questionnaire”. But many people are using the test with a Glucometer at home. If you do so you can compare the results with the six types of hypoglycemia as explained in the article “What is Hypoglycemia?
    Nevertheless, a GTT is best performed under controlled conditions in a laboratory by a nutritional doctor.

    An important principle in nutritional therapy is to FIRST eliminate any possible biochemical abnormality by pathology tests that can be responsible for sympytoms, BEFORE considering “psychological” factors.

    I hope this answers the question.
    Jurriaan Plesman

  3. Heather
    28 mos, 1 wk ago

    I have had symptoms of shaky hands tact heart chest pains and there are times when I don’t eat regularly I feel different hard to explain it thenwhen I’m walking the room around me feels like a mirror room from a carnival and then I can’t talk I basically mumble so low and I’m not myself like I’m a different person when U see food I’m shoving everything in my mouth like I haven’t ate for days

  4. Jurriaan Plesman
    23 mos, 2 wks ago

    Hi Heather, It is difficult to understand what your symptoms are. I suggest you adopt the hypoglycemic diet and if things don’t improve please consult a nutritional doctor.

  5. Jurriaan Plesman
    23 mos, 1 wk ago

    Not many people are successful in testing themselves properly for hypoglycemia. We have several paper-and-pencil questionnaires that are just as reliable. They can be found at:
    Nutrition-Behavior Inventory (NBI)


    Hypoglycemic Questionnaire (short test)

    When testing with a Glucometer at home, you must follow strictly the instructions by Dr George Samra. If you want to interpret the result of your readings from a glucometer – half-hourly readings over four hours total – you can compare the results with that shown shown in

    What is Hypoglycemia?

    There are six types of hypoglycemia. Please note Type 6.

  6. Debra
    22 mos ago

    I wake up at 2:00 am every day, sweaty. I get a panicky feeling in the pit of my stomach and need to make a bowel movement quickly, sometimes two or three Bowel movements. I get palpitations and sometimes I can fall asleep again, but more often that’s the end of sleep for me. I always have a whole wheat bread with some peanut butter before bed. I believe I’m having hypoglycemia at night, but doctors measure my glucose (95) and conclude I’m not hypoglycemic. I’m desperate to find a solution because I look awful and feel awful when I don’t get any sleep. I’m barely functioning. I feel better by mid- afternoon, only to start the cycle all over again. Any help you can provide?

  7. Michelle
    20 mos, 3 wks ago

    I have been sick for 8 months I have lost an unintended 71 lbs ( which I struggled the last 5years loosing due to PCOS) I have nausea, lack of apetite, fatigue, neck stiffness and pain, back pain, joint pain, shakiness, severe itchy skin use to be only at night now it’s all day, cold hands and feet, reaccurent sinus infections, and the most confusing issues with my blood sugar. As far as my blood sugar I noticed In may I felt terrible bouts of these alternating symptoms only to find out I was expieriencing low blood sugar. My doctors took me off of metformin ( I took for 2 years for PCOS) and I had blood sugars in the 400′s and as low as 37. They freaked out and put me on Januvia even though I am NOT diabetic. I have in the last 5 months been to multiple specialists and had a million tests, procedures, surgerys looking for what’s killing me! they have found abnormalities but not to degrees to explain what is causing this! As of September I have developed anemia of chronic disease( low transferrin borderline low iron stores) my hair is falling out (gross) I bruise easily and get rashes of petechia I recently came off my januvia for another OGGT my fasting blood sugars are most comfortable to me symptomaticly, my dating blood glucose after was 84 my 30 minutes blood sugar (after 75mg sugar drink) was 110. 30 minutes later it was 77 and thirty minutes later it 74 and 30 min later it was 70. It was not long enough and now I’ll be doing a five hour on Monday- they tested my insulin at each 30 min and my c peptide both were low insulin very low c peptide moderately low. I am lucky I have good doctors desperately looking for answers but I am scared it will be too late. Next week I’ll be having a bone marrow biopsy and a scalp biopsy even though they are not sure what could cause the spontaneous reactive hypoglycemia- I have 3 small children with a chronic disease who I need to be around to take care of and a husband who loves me. With little minor health issues before. I am a 30yr old female. I am looking for ideas or and direction anyone has??

  8. 17 mos ago

    i found out myself hypoglycemic only last week and started following a diet plan. i got a severe migraine, one such i never hve had in my life time, and i think that was a withdrawal symptom. Actually i don’t have a sugar addiction or coffee addiction, actually i dont take coffee at all. still i eat cookies and biscuits. of late i get a strange feeling in my brain, a kind of something spreading from one side to the other.. is it some nerve disorder or rather lack of glucose.it continues after the diet plan also. im confused, any reply…pls

  9. Jurriaan Plesman
    16 mos, 4 wks ago

    I might be an idea to try out the hypoglycemic diet, including avoidance of allergies (See Dr George Samra’s books and articles in our web site). If after three week the symptoms persist I strongly advise to see a nutritional doctor. Cheers Jur.

  10. Jurriaan Plesman
    16 mos, 4 wks ago

    My goodness, you have a lot of problems. I am glad to hear you are in the hands of good doctors. Also try to get some advice from nutritional doctors. No doubt the hypoglycemic diet will help you but be aware of allergies. Read some articles on allergies at our web site. I hope you will recover.

  11. Jurriaan Plesman
    16 mos, 4 wks ago

    Always be careful, when doctors say you are not hypoglycemic. Usually they are not aware how to test for hypoglycemia as distinct from diabetes.

    Testing for Hypoglycemia,

    You can also test yourself at home by

    Testing for Hypoglycemia by Questionnaires
    Nutrition-Behavior Inventory (NBI)

    Hypoglycemic Questionnaire (short test)

    If you score high it may be an indication that by ou are hypoglycemic.

    Usually people that wake up at night are found to be hypoglycemic. Look up the use of GLYCERINE in “Research for Hypoglycemia”

  12. Edwina
    15 mos, 3 wks ago

    I have been suffering from migraine for 25 yrs and mild but chronic hypoglycaemic problems.
    In the last four years I have suffered from crushing insomnia waking up every 2-3 hrs through the night with heart palpitations and I am assuming elevated adrenalin levels after these episodes as I’m awake for 2-3 hrs afterwards.
    Could this all be related to hypoglycaemic episodes?

  13. Jurriaan Plesman
    15 mos, 3 wks ago

    Yes you insomnia could be related to hypoglycemia. Also read:

  14. Jurriaan Plesman
    15 mos, 3 wks ago

    Yes youR insomnia could be related to hypoglycemia. Also read:
    Biochemistry of Insomnia

  15. Susan
    14 mos ago

    My son is 9 yr 2 mos. and has always been a very lean kid. He is 70 pounds and 54.5 inches tall. Over the years we have noticed periods where he becomes extremely irritable and combative. It’s like a “meltdown” to the extreme! This seems to usually happen when he has not eaten in a long time. He has always been a kids that eats small amounts very frequently. The last “meltdown” occured around 7pm and I don’t think he had eaten for approx. 7 hours or so. I wanted to test his blood sugar but was hesitant to deal with the battle. We ended up giving him some protein mango smoothie and approx 45 min to 1 hour later he insisted that he wanted his blood sugar tested. It was 92. I know 92 is within the “normal” range however I don’t know what it was before he had some food.
    There is a family history (maternal grandfather – diabetes type II) (maternal grandmother – hypoglycemic)
    Is there some type of test that could be done to know if this is hypoglycemia? I mean I’m pretty certain that it is based on the fact that these symptoms seem to resolve after he eats, but feel like people think it’s just a normal “tantrum” when I try to explain it to others….
    Thank you!

  16. Susan
    14 mos ago

    I should also note that we’ve noticed extreme hyperactivity if he eats or drinks simple sugars (i.e. candy/junk) without anything else with it.

  17. Crystal
    14 mos ago

    I also suffer from many of the same symptoms that you describe. I am newly diagnoised hypoglycemic. The reason your email grabbed my attention is the pain. I also have neck pain and stiffness to the point that they have diagnoised cervical dystonia. I met a physio in Canada and he was able to identify that I actually have crainal nerve damage that is causing the hypoglycemia along with all the other symptoms that you are describing. It is very rare but the weight loss and nausea triggered him. It affects your vagus nerve which can effect your pancreas. I am awaiting testing for reactive hypoglycemia . I am also only 40 with two children and have been dealing with this for 6 years I am willing to talk with you if you wish. YOu are making the hairs on my arms stand up because my physio has only met one other person with this issue. Take care.

  18. Jurriaan Plesman
    13 mos, 4 wks ago

    You can communicate with fellow hypoglycemics at The Hypoglycemic facebook page at: https://www.facebook.com/groups/183150461841144/

  19. billyboy
    12 mos, 1 wk ago

    My daughter has suffered with severe depression and anxiety for three years. We believe that this was triggered by an antibiotic and eventually found a doctor who agreed with us (most thought we were, shall we say unsophisticated). Anyway we noticed after a lot of trial error and observation that we could manage her with a low GI diet quite successfully. In fact we got her through a whole semester of uni like this. Unfortunately I went away for three days leaving her with plenty of prepared food that she didn’t eat. She also drank three litres of apple juice (empty carton next to her bed). When I returned home we were shocked to find that she had been admitted to hospital (again). I told them to put her on a low GI diet and she would be just fine but they wouldn’t believe me. She deteriorated massively and after much complaining from me they gave her a GTT. Sadly they reported that there was no glucose issue and promptly told her so. The next month was an absolute nightmare for us, she refused to trust her parents advice and wouldn’t eat low GI anymore. Long story short she was admitted to the mental health hospital where they refused to put her on a low GI diet too (because they think it is nonsense)and are not at all motivated to give her our doctor’s prescription. She also has immeasurably low chromium, iron so low she needs an infusion and low zinc and selenium. After ten blood tests and eight hospital stays nobody noticed!! It is so frustrating because I know that she will improve massively in 48 hours if they would only let me prepare her meals. I suspect that this is too threatening for them, they will not even think about trialling this. This has been heartbreaking for her family.

  20. Jurriaan Plesman
    12 mos, 1 wk ago

    This is the trouble when you deal with an arrogant profession that believes in drugs only. This is exactly the reason why we have a created a Hypoglycemic web site: to educate the public and the profession. It may help if you allow your daughter to have a greater say in her own recovery by educating her on the connection between Mood disorders and Nutrition. Perhaps you should get the assistance of a Nutritional Doctor from ACNEM at: http://www.acnem.org/modules/mastop_publish/?tac=23

  21. Bill Wormald
    12 mos ago

    Thanks for your comment and understanding. We are
    fortunate to have found an excellent nutritional doctor in
    Perth who quickly recognised the symptoms and prescribed a
    chromium supplement (hopefully to assist with the
    hypoglycemic attacks), and selenium and zinc (hopefully to
    assist with the mental health issues). He also requested a
    stool sample to examine her microbiome for dysbiosis.
    Unfortunately my daughter has been convinced by the
    hospital that her parents (and presumably her doctor) are
    wrong. They do not seem at all motivated to follow our doctor’s advice or give his prescription. I am sure that they think I am a bit strange too, to suggest that a low GI diet could help in any way. It will be difficult to regain our daughter’s trust. In the meantime I will try to obtain her GTT graph to get a second opinion from another nutritional specialist (this is frustrating as we have full confidence in our existing doctor). If I can obtain this Would you be available for such a professional consultation, or would we need to choose a second doctor from your web site list?

  22. Jurriaan Plesman
    11 mos, 4 wks ago

    I believe there is a Nutritional Doctor in Perth by the name of Blake Graham. Also look up ACNEM doctors at:

  23. Amber wise
    11 mos, 3 wks ago

    What if my docter refuses to do these tests.

  24. Jurriaan Plesman
    11 mos, 3 wks ago

    Use the questionnaires tests as explained at:
    Testing for Hypoglycemia,

  25. Tamra
    9 mos, 1 wk ago

    I had a 7 hour glucose test when I was 16. The doctor informed my mother that I have hypoglycemia. I had a great doctor when I was about 20 who told me to stay away from sugar and simple carbs. I am now 43. For most of my life I have kept the symptoms at bay. It is only if I get hook on sugar again that I get bad symptoms. With all the new science and information, I am curious how to know if I have reactive or absolute hypoglycemia. Is there a way to determine which it is without more testing? I am sure it does not matter as far as diet, exercise and self-care, but I would like my doctor to be more aware. He does not understand that when I describe a “crash” I am not describing diabetes. He continues to order fasting blood draws. It is frustrating.

  26. Jurriaan Plesman
    9 mos, 1 wk ago

    The best thing to do is to refer your doctor to this web site. If he is not interested, get a new doctor and tell him why.

  27. Jurriaan Plesman
    3 mos ago

    There is very little you can do with narrow-minded doctors. That’s the way they are trained. But you can CHOOSE your own nutritional doctor doctor. They are trained in both conventional AND nutritional medicine.

  28. Jurriaan Plesman
    3 mos ago

    There is very little you can do with narrow-minded doctors. That’s the way they are trained. But you can CHOOSE your own nutritional doctor. They are trained in both conventional AND nutritional medicine.

  29. Sandra
    2 mos, 3 wks ago

    I have been suffering from strange symptoms since 2005. Anxiety, depression, panic attacks etc. In last year I was admitted to the hospital due to brain abcess caused by mainly oral bacteria and strep milleri. Deterioration in my health has been progressive, looking back. I have never understood what could cause this. My life was never more stressful than other peoples etc…but looking back, there were some symptoms I never addressed to doctors such as shivering, fog brain, etc. At times I would find myself shaking in bed without knowing why. Post abscess surgery I found myself for a week having extreme salt urges at 7pm every night. These went away after a week or so. Lab tests showed salt levels all ok. Reason why I am looking into a hypoglycemic connection is due to a friend who suggested this to me because of the behavior in the hospital and salt urges. The more I read about hypoglycemia, the more I am thinking my immune system must have been effected if this is the case…..hence the abscess and recent seizure, which I am absolutely baffled by. I know there is a risk of one after this type of surgery, but my recovery as docs describe it has been a miracle. Why seizure? Here is my overall condition:

    - recent thyroid tests, b12 tests ok
    - vit D good 39.2
    - low blood pressure
    - rapid pulse (always)
    - irregular heart beats
    - opthomological migraines (less now after supplementing magnesium)
    - blurry vision with floaters (floaters on and off)
    - nearsighted
    - difficulties adjusting vision during night
    - cold in extremities
    - feeling of something in throat (lower part) at times (on and off, almost as if that area tends to swell like a joint)
    - neck tension
    - shivering/small tremors in hands, legs on and off

  30. jenn
    2 mos, 3 wks ago

    I had a dizzy spell last Sunday it made me feel like I had been so drunk all I wanted to do is pass out. I have heart problems I was born with . ambulance people checked me out said vitals where grate. They said it might be vertigo and seen a dr today said I may have this stuff but he did not check me for it. I some times get the dizzy spells right before I get badly sick with like a cold or somthing. I don’t know what’s wrong and I don’t like it. Any suggestions?

  31. Jurriaan Plesman
    2 wks ago

    I am not sure whether this is related to hypoglycemia. The best thing to check it out with a doctor and get checked for pre diabetic hypoglycemia.

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