What's the reason for being hypoglycemic after 2 hrs of a meal?

My blood sugar level was 63 mg/dl when measured after 2 hrs of eating a meal (at 1 pm) today...I ate 2 ladoos made of whole wheat, ghee and sugar and 1 chappati with bengan ka bhartha at 11 am...had taken 1 metformin 1000 mg at 9 am after eating breakfast of a bowl of puffed rice and two monaco biscuits...

Not feeling well at all...this happens to me once in a while since 6 months...a problem of being hypoglycemic after breakfast ....why does the blood sugar level falls below optimum after eating such a high carb meal though Metformin SR tablet was taken?

what to do? experts advise please...


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39 Replies

  • See a health professional.

    I would think it is a reactive hypoglycaemia due to a high-glycaemic load exacerbated by medication.

  • "reactive hypoglycaemia"


  • Concerned, Shrisamarth

    from google search, meaning of reactive hypoglycemia is...

    Reactive hypoglycemia, or postprandial hypoglycemia, is a medical term describing recurrent episodes of symptomatic hypoglycemia occurring within 4 hours after a high carbohydrate meal in people who do not have diabetes.

    WHAT ABOUT PEOPLE WHO ALREADY HAVING DIABETES? Will you call it reactive hypoglycemia in diabetic people also when hypoglycemia happens after 2 hours of a meal?

  • Reactive hypoglycemia can happen in case of diabetics also. There is no fixed timing. it all depends on how your insulin is released.

    Other reason for reactive hypoglycemia could be some hormonal imbalance.

  • Shrisamarth

    You are very true when you say hormonal imbalance to be a reason for reactive hypoglycemia...

    I am undergoing thyroid imbalance due to my increased dose recently of thyroid hormone (thyroxine)...and I feel that it is due to that....may be...

  • High doses of medicines,not necessarily taken immediately,may be reason behind it!

  • always optimistic

    Metformin I took was SR...so drug is not released all at a once to give rise to such a hypoglycemic situation according to me....

  • high dose of medicine may be the cause ,take500mg and 500 with lunch and check the position

  • MF alone can never cause HYPO. There has to be some other reason. Also, MF has a build up and wash out time so changing dose will not show up immediately on meter.

  • Anup,

    I think it's glimepride which is causing hypo...I am taking Glycomet GP-1 forte tablet which contains 1g of Metformin and 1 mg of glimepride. I read before few months that Metformin should not be taken with sulfonyl ureas but I continued since I never had problem with it for initial 2 years after being diagnosed with diabetes. But recently, I got to know that glimepride causes pancreas to release insulin...so may be insulin spikes happens once in a while after breakfast due to glimepride causing hypo...so I have decided now to take only Metsmall SR 1000 mg tab which I already take at night also....will take in morning the same and eliminate Glycomet GP-1 forte...

    I have not changed dose of Metformin since beginning...

  • Pharmacist should not be doing blind dosing. Second point, you disclosed Glimi just now and original post had no mention of it. Pharmacist should have know what Glimi does even two years back also.

    Glimi will also never let you get over your IR or lose weight easily. I would rather look at specific reasons than look at history. Just because it did not give problem in 2 years doesn't mean it won't give problems any day.

    TZD class drugs cause obesity and heart attacks too. Enough studies to back this statement. That's why we do not believe in RUJUTA Dwivekars horribly wrong therapy for diabetics and follow what we follow.

  • Anup,

    I know it was my blunder to continue with glimepride...and didn't read in detail about mechanism of action of glimepride before and also I was not actually knowing in detail how bcf reduces with the progress of disease due to hyperinsulinemia...I just got to know recently in last July when I consulted one diabetologist/endo online where he explained me how Metformin works....I didn't mention then also to him that I am taking Glycomet GP-1 forte...and it contains glimepride...because I was just under impression (ofcourse blindly) that I am taking only Metformin SR 1 g each morning and night. Glimepride just slept out of my mind...

    Anyway, sooner the better I understood what is the reason behind my hypo...only once in a while though...I knew however that Glimepride won't allow to lose weight but somehow at the back of my mind, my GP had prescribed it in the beginning and he told me then that it is always good to have combination of drugs then single ingredient...so I think it was working better for my glucose control...but now I understood that it has done enough damage to my BCF as well in addition to causing hypo...

    got glycomet tablets for another 3 months or so and bought online so not sure I will be able to give it back....but I am now not taking it for sure after enough understanding it....money wasted is ok...health is more important especially being Pharmacist, I should have understood it long back...but due to job tensions and lack of enough informations, I could not give so much time to gain knowledge about drugs in real life...

    thanks Anup for yr response....sorry for not mentioning glycomet in original post...it was just out of my mind as such...

  • GP will prescribe Pioz, Invokana, Januvia and finally insulin shots when all these drugs stop working -- which it will. The current diet will help it to happen sooner.

  • anup

    I understand it very well....but unable to follow LCHF diet at present given my and my family's circumstances.

    At present, I will try to control carbs as much as possible...though it's difficult being vegetarian...will monitor my glucose levels more closely and more frequently to understand the effect of particular food on my PPBS levels and will try to reduce FBS also....may be by trying to increase insulin sensitivity?

    I am getting blood work done tomorrow so in this week itself, I will post my results in forum for all of you to know and advise.


  • champak045,

    I'm going to send you a PM in a few minutes. Please look for it.

  • It was just a suggestion .I am not a science stream man .

  • sezal,

    Anup is telling me...I am a Pharmacist.

  • Ashka9

    Whenever I have a small cup of tea with sugar (unavoidable sometimes) my BS comes to around 71-75. Have seen this a few times. This reading is around 3 hrs after the tea with sugar.

    This sugar causes a surge of blood sugar initially as we lack the first phase insulin release or face insulin resistance. But this sugar also causes a surge of insulin release which brings down the levels to a hypo level later on.

    This glycemic excursions are not good for us as the excess insulin levels will cause long term damages and also tax the pancreas for insulin which is as it is taxed. Also this excursion will only build up the insulin resistance in coming days

    This the conclusion I am having based on my own experience

  • Thanks, Mr. Shashikant

    I understood what you said, not good at all...blood sugar spikes and fall...after a high carb meal or sugar....

    Anyway, feeling better after I ate again a 2 and a half chappati with bengan ka bhartha...my BS level has come down to normal it seems...

  • We are all basically carbohydrate intolerant

    We should be avoiding such risks

    I read in the other forum that sweets made of grains spikes badly compared to those made with nuts or besan

    2 wheat ladoos is just a sugar bomb.

  • But Mr. Shashikant, being hypoglycemic after a meal is not for the first time...it is happening with me once in a while since 8 months or so....even after eating healthy diet like baked dishes made of daal (legumes) + rice flour....though eaten in very small quantity.

    And I have heard this happening with almost many diabetics...my neighbour and one of my distant relatives and talked to friends about it...it happens almost with all diabetics though on medicines...like Metformin...whereby Metformin is known to reduce blood sugar only if it is higher than normal...one of the doctor told me that...and I take Metformin SR (Sustained Release) tablet...so drug is not released all at once...right? so....as such I should not be hypo after high carb meal...instead it should by hyperglycemic result.

  • Prior to detection I used to have similar symptoms

    This is a sign of hyperglycemic excursions

    High and then low

    Cause is same. High carb meal. High insulin release. Sugar crash, more carb needed.

    I could understand that.. Which used to happen earlier only now.

    Believe this concept

    Take it or leave it.

    But that's the reality.. A harsh reality.

    With LCHF I am now stable. My BS is around 90-95 for most part of the Day with no ravenous hunger signals.

    ( I am a crazy guy.. Keep testing many times a day to understand the BS levels... Some times.. Also I had a cgm implanted for 14 days... So could understand all these)

  • Thanks, Mr. Shashikant

    I understand the concept you explained not now but since I got diabetes....but this high and low is not happening with me everyday..only sometimes...say once or twice a month...

    eating same roti/sabji....everyday....with legumes for some meals..

  • Probably when u have some sugar based sweets...? Pl recollect

    It will help u avoid in future

  • hnn thanks Mr. Shashikant..

    I will take care in future and will try to avoid sugar altogether...as such I am not fond of sweets...and I eat it very sparingly

    I eliminated sugar and sweets for about 2 years after I got diagnosed diabetes in Mar. 2014 but somehow I started eating sugar in some dishes since it is unavoidable...

  • I am a crazy guy.. Keep testing many times a day to understand the BS levels...

    That's not being crazy. It just means you are actively monitoring everything. That's the way one succeeds when it comes to diabetes self management. Test-eat-test is the key when doing something new.

  • That's true

    Crazy for this real world

    But necessity for better control

    This multiple testing has made my prediction quiet accurate many a times

    I could just predict the BS I will have just before pricking my finger

    CGM has really helped me fine tune everything

  • Do we really care for what the real world says when it comes to what we do?

    We don't :)

  • Our health comes first

    Be the information from any source

    Health first not ego or any preconceived notion.

  • Pre conceived notions aren't bad as long as one is flexible enough to dump it for something good and not let ego dominate one's thought process.

    As for EGO, there's no medication for that. One needs to read a book -- I Am Ok You Are Ok -- by Dr Thomas Harris to understand inter-personal interactions and behavior. After that one could also read a book -- Games People Play by Dr Eric Berne. These two books complement each other :)

  • Ego is nothing but superiority complex-a psychological disease.

  • Thanks. Now doing it.

    Reason was that these tea with sugar I would have some Time but rarely and it would be outside in some teastall at the end of day where he would be winding up

    It would take me a few hours to get home and test myself


  • You have my sympathy and I hope what follows will be viewed in the light of encouragement, not opprobrium, but:

    Whole wheat, sugar, chappati, puffed rice, monaco biscuits?

    Your blood sugar must be up and down like a yoyo on a meal by meal basis.

    Trying to balance a bad diet with medication is like trying to ride a unicycle with a bent wheel and one pedal!

    Overdoing the Metformin might cause a hypo, but who knows what's going on?

    What you base your diet on from the example above has undoubtedly caused you condition in the first place, and I'd suggest you are very reluctant to change. Unless you make those changes you will fall under the saying - 'Keep on doing what you're doing and you'll keep on getting what you've got'.

    I hope you are feel better soon.

  • Mike Pollard,

    I take your words in a positive manner and I don't have any EGO so to say. I generally avoid eating biscuits and sweets but eat it sometimes.

    I know high carb diet may be bad so I avoid rice also....eat rice or rice based items only once or twice a week.

    I don't know how to replace wheat...I tried it for 10 days and wished for going gluten free for about 3 months for my Hashimotos thyroiditis but then had my father hospitalized with brain stroke and expired later so could not keep up with the diet routine where I have to make separate meals for myself and can't eat all those items cooked daily for the other family members.

    At present, my family circumstances are not such that I can shop separate grocery for myself and follow strict diet routine and also cooking separately all the meals by myself because other family members won't be changing their diet for me. Nobody else has diabetes in my family.

    I tried ragi flour, besan (bengal gram flour, millets) while going on gluten free, but I wasn't feeling satisfied without wheat roti and I was not able to digest millets and gram flour or ragi flour daily...may be not habituated to eat it daily?

    Anyway, I will try to figure out what to do ...meaning what exact diet I should follow, which grains I should eat and which I should avoid while also having hypothyroidism. If carb intake is too less, thyroid hormones will further reduce which are already released less due to underactive thyroid. So, I have to look into other aspects of diet also...like convenience, able to follow it for long, how will it affect my other diseases...and whether it will be feasible financially also...RIGHT? I am not reluctant to change at all...that's what I wish to convey it to you....there are many factors affecting a person't situation.

    I will soon post my recent HbA1c result and other blood reports to have all of your experts' advise.

  • How are you feeling this afternoon?

  • Activity2004

    I was ok after I ate 2 and a half roti with bengan ka bhurtha again...at around 1:45 pm..yesterday...my BS level came back to normal

    thanks for yr concern

  • Did you have any protein with breakfast?

  • Yeah, I had coffee made in only milk and some besan sev with mamra....(puffed rice) in breakfast yesterday....but after that I didn't get low BS ....I got it after I ate again at 11 am 2 ladoos and 1 chappati with bengan ka bhurtha....I got unwell around 1 am....yesterday

  • At times PP blood sugar can be lower than fasting. It is usually due to excessive response of pancreas to food intake by producing more insulin than required, at times blood sugar may be very low to produce symptom of Hypoglycaemia. Treatment of this is to take small meals more often or reduce the dosage/strengh of metformin in consultation with your doctor.

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