January 9, 2022

Do you get hangry? That is, do you feel hunger less in your stomach, and more in the mind-absorbing, headache-inducing frustration of trying to think straight and not drop anything?

That probably means the sugar in your bloodstream is low. It can happen to anyone who goes a long time without eating, but some of us feel it every few hours. When low blood sugar is that frequent, it’s called reactive hypoglycemia.

I honestly thought it had nothing to do with autism, but a bunch of you mentioned it on my post about comorbidities, so here we are.

Reactive hypoglycemia is basically the inverse of diabetes. With diabetes, your blood sugar rises a lot, and you need insulin to bring it back down. With reactive hypoglycemia, your blood sugar drops a lot, and you need food to bring it back up.

Plain old “hypoglycemia” (without the “reactive”) means your blood sugar is currently low. Diabetics get hypoglycemia if they take too much insulin, but reactive hypoglycemics get it in “reaction” to the passage of time after a meal – and also in reaction to too much sugar.

That’s right, too much sugar can be just as problematic as too little. Everyone knows the feeling of a sugar crash, but for us it happens twice as fast and twice as hard.

There’s no cure for reactive hypoglycemia, but there are ways to manage it and make your life easier.

1. First, try to get a diagnosis. Some doctors will give one based on symptoms alone, while others will confirm it using a Glucose Tolerance Test. Follow their advice, especially if it contradicts mine.

2. Get a letter from your doctor, then use that to get an accommodation from your workplace – either to eat as you work, or to take frequent snack breaks.

3. Bring food everywhere. If you need to go places where food isn’t allowed, wear a medical bracelet that says, “Reactive hypoglycemic: NEEDS FOOD.”

4. Eat whenever you start to feel lightheaded, wobbly, or confused. Don’t wait for mealtime to come, or hangry to strike. If you have trouble noticing the signs, then set a timer to eat every few hours.

5. Figure out which foods work best for an immediate rescue when your blood sugar is low. I find that fruit works fast without making me crash, but your body may differ.

6. Figure out which foods keep your blood sugar stable the longest. Whole grains are a good choice for most people. For more ideas, search for foods with “low glycemic index.”

7. Avoid sweet foods if possible. Whenever you do eat something sweet, balance it with fat or protein so that the sugar enters your bloodstream more slowly… milk with cookies, for example!

If you have reactive hypoglycemia, either diagnosed or suspected, what helps you keep your blood sugar stable?

P.S. I write from my personal experience as an autistic. What I share is not a substitute for advice from an autistic medical professional. Also, some of my opinions have changed since I first wrote them.