An all too common challenge faced by runners (both recreational and competitive) is HYPOGLYCEMIA, or low blood sugar. This issue can affect not only your race or your run, but it can also be a sign of more serious health concerns. If you experience low blood sugar, be sure to take action. Hypoglycemia can be managed and prevented.

WHAT IS HYPOGLYCEMIA? The condition of hypoglycemia occurs when the body’s blood sugar level drops below a level needed to optimally support energy. 1 The lab reference values for hypoglycemia vary, but a value of 69 or lower generally constitutes hypoglycemia. The value that brings about symptoms and concerns varies quite a bit, depending on one’s usual diet, activities, medications, stress and many other factors. For some, symptoms of hypoglycemia can present even if the blood sugar level is in a normal range (which is considered 70 – 100 or 110, depending upon the lab). If the physiologic drop in blood sugar level is substantial, the body’s natural response is activated, which can also result in symptoms. Hypoglycemia is often sub classified as either Reactive, Idiopathic or fasting. Individuals with diabetes, managed with insulin and/or insulin inducing medications, are at particular risk of experiencing hypoglycemia. 2

WHAT CAUSES HYPOGLYCEMIA? There are many factors, including age, diet, weight, amount/type and frequency of exercise, gluten intolerance, digestive impairment, alcohol consumption and hormonal imbalance. A diet high in processed sugar and starches is often the biggest culprit.

Insulin Resistance, a condition that is now estimated to affect at least 25% of the US population of adults and over 50% of obese children, is highly associated with hypoglycemia due to elevated insulin levels in the body. The primary driving factor is excess weight followed by inactivity and stress. 3

ARE THERE SPECIAL FACTORS ASSOCIATED WITH RUNNING OR OTHER SPORTS? For athletes, the difference between routine practice and performance can result in hypoglycemia (due to stress hormones) 4.

HOW CAN HYPOGLYCEMIA BE PREVENTED, ESPECIALLY DURING AN EVENT? The best prevention is to maintain ideal weight, minimize processed sugars and grains, exercise regularly and master stress. The occasional runner who has a less than stellar diet is at greater risk for an episode of hypoglycemia. During a race, it may be helpful to carry a gel product, or a packet of honey, and use if signs of hypoglycemia appear.

WHAT ABOUT CARB LOADING? WILL THIS HELP PREVENT HYPOGLYCEMIA? Carb loading, for many, can actually magnify hypoglycemia. The body has minimal storage capacity for carbohydrates, and the need for insulin goes up dramatically when higher carbs are consumed. This places an individual at greater risk for hypoglycemia. It can be tricky. One could try gentler, lower glycemic carbs like berries, winter squash or sweet potatoes. Consider gathering information about a diet shift long before a key race. It takes time to re-train the body to use alternate energy sources.

CAN ALCOHOL BRING ON HYPOGLYCEMIA? Alcohol can bring on a profound and dangerous drop in blood sugar; often the day following consumption. This is due to the role that the liver plays in processing not only all nutrients but also alcohol. The liver sees alcohol as a toxin and will preferentially process the alcohol first. A person could therefore experience an elevated blood sugar, followed by a dramatic drop several hours later.

DOES STRESS IMPACT BLOOD SUGAR? Can it cause hypoglycemia? Stress can have a profound effect upon blood sugars. For some, there is a rapid rise in glucose, followed by a drop, leading to hypoglycemia. For others, there may be a prolonged elevation in blood sugar, due to the power of the stress hormones. It can actually take a day or two to recover from such an episode.

IS HYPOGLYCEMIA ASSOCIATED WITH OTHER HEALTH RISKS? Yes. Many. The primary risk is Insulin Resistance, which is associated with weight gain, cardiovascular disease inflammation, cancer, arthritis and many other chronic health conditions. An acute episode of hypoglycemia can result in a serious accident, lapse in judgment or other response that can be injurious to one’s health.

WHAT ARE THE MOST EFFECTIVE WAYS TO TREAT HYPOGLYCEMIA? Treating acute hypoglycemia generally requires a small amount of a quick--acting carbohydrate. Generally, five to 15 grams will sufficiently bring the blood glucose level back into a safe range. Examples could be: one half or one whole small banana or apple, glucose tablets (check label for carb content) , or a small packet of honey. Keep in mind that if the drop in blood sugar is significant, the blood sugar is likely to rise again within a couple of hours, due to stress hormones – especially cortisol -- produced in the adrenal glands. For long-term treatment of hypoglycemia (not related to diabetes treated with insulin or meds), determining the best diet style is imperative. If one’s diet is heavy in carbohydrates, there is a greater likelihood of hypoglycemia. Exploring different diet patterns, such as those outlined in Mark Sisson’s The Primal Blueprint could prove useful. Another book that explores the issue of optimal fuel source is Why We Get Fat, and What to Do about It by Gary Taub. Achieving an optimal weight is key. Regular exercise also helps tremendously in better controlling insulin and blood glucose levels.

WHAT CAN ONE DO TO LEARN MORE ABOUT DETECTION AND PREVENTION? Home blood glucose monitoring can be a powerful tool in evaluating ones’ blood sugar balance. It can also be an important tool for assessing dietary choices that are best for each individual. Checking blood sugar levels upon rising, before and after meals and at other times during the 24-hour cycle can provide real clarity about an individual’s blood sugar balance. Meters are generally available at no cost or low cost and the strips can be purchased online at significant savings.

References:
http://medical-dictionary.thefreedictionary.com/hypoglycemia
http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hypoglycemia-low-blood.html
Diabetes Care November 2006 vol. 29 no. 11 2427-2432 Joyce M. Lee, MD, MPH12, Megumi J. Okumura, MD3, Matthew M. Davis, MD, MAPP245, William H. Herman, MD, MPH56 and James G. Gurney, PHD2 http://care.diabetesjournals.org/content/29/11/2427
Diabetes Spectrum April 2005 vol. 18 no. 2 102-107, Management of Competitive Athletes With Diabetes., W. Guyton Hornsby, Jr., PhD, CDE and ,Robert D. Chetlin, PhD, CSCS http://spectrum.diabetesjournals.org/content/18/2/102.full