What is the functional medicine approach to evaluating hypoglycemia (low blood sugar)?

From the Guidelines

Functional medicine evaluates hypoglycemia by addressing root causes rather than just managing symptoms, and the most effective approach involves comprehensive testing, dietary modifications, and lifestyle interventions to stabilize blood sugar and prevent recurrence. The approach begins with comprehensive testing including fasting glucose, insulin levels, HbA1c, and a complete metabolic panel, often supplemented with a continuous glucose monitor to track real-time fluctuations 1. Practitioners typically recommend dietary modifications emphasizing complex carbohydrates paired with protein and healthy fats, consuming small frequent meals (every 3-4 hours), and avoiding refined sugars and alcohol, as supported by the American Diabetes Association's nutrition recommendations 1.

Some key considerations in managing hypoglycemia include:

• Consuming 15-20 g of glucose as the preferred treatment for conscious individuals with hypoglycemia, with the option to repeat treatment after 15 minutes if symptoms persist 1
• Prescribing glucagon for individuals at significant risk of severe hypoglycemia and ensuring caregivers know how to administer it 1
• Assessing cognitive function and being vigilant for hypoglycemia in individuals with low or declining cognition 1
• Raising glycemic targets to avoid hypoglycemia for at least several weeks in patients with hypoglycemia unawareness or severe hypoglycemia 1

Specific supplements that may help stabilize blood sugar include chromium (200-1000 mcg daily), magnesium (300-400 mg daily), alpha-lipoic acid (600-1200 mg daily), and adaptogenic herbs like ashwagandha, although the evidence for these supplements is not as strong as for dietary and lifestyle interventions 1. Lifestyle interventions focus on stress management through meditation or yoga, regular moderate exercise, and adequate sleep (7-9 hours nightly) 1. Adrenal function assessment is often included since cortisol dysregulation can impact blood sugar regulation, highlighting the importance of a holistic approach to managing hypoglycemia.

The functional medicine approach is effective because it recognizes that hypoglycemia may result from multiple interconnected factors including insulin resistance, hormonal imbalances, gut dysbiosis, chronic stress, and nutrient deficiencies, addressing these underlying issues rather than simply treating the symptoms 1. By prioritizing the most recent and highest quality evidence, the functional medicine approach to evaluating hypoglycemia offers a comprehensive and effective strategy for managing this condition and improving patient outcomes.

From the Research

Functional Medicine Approach to Evaluating Hypoglycemia

• Hypoglycemia is a common complication in patients with type 1 and type 2 diabetes, and it constitutes a major limiting factor in achieving glycaemic control among people with diabetes 2.
• A functional medicine approach to evaluating hypoglycemia involves identifying the underlying causes of hypoglycemia, such as poor glycaemic control, increased risk of hypoglycaemic events with the use of insulin and/or sulphonylureas, and impaired hypoglycaemia awareness 2, 3.
• The use of continuous glucose monitoring (CGM) can help identify patterns of hypoglycemia and impaired hypoglycaemia awareness, and can be used to individualize glycaemic goals and promote new therapies to improve quality of life of patients 2.
• A tailored approach, using clinical and pathophysiologic disease stratification, can help individualize glycaemic goals and promote new therapies to improve quality of life of patients 2.
• The management of hypoglycemia involves prompt treatment with fast-acting glucose to prevent brain fuel deprivation and functional brain failure, and the use of an algorithm for the management of hypoglycemia in hospital settings 4.

Nutritional Considerations

• Chromium is an essential mineral that appears to have a beneficial role in the regulation of insulin action and its effects on carbohydrate, protein and lipid metabolism, and may help reduce the risk of cardiovascular disease and type 2 diabetes 5.
• Berberine has been shown to have a glucose-lowering effect in type 2 diabetes, and may be a safe and effective treatment option for patients with type 2 diabetes, as it does not increase the incidence of total adverse events and the risk of hypoglycemia 6.

Therapeutic Considerations

• Optimizing insulin doses and carbohydrate intake, in addition to a short warm up before or after physical activity sessions, may help avoid hypoglycemia 2.
• The use of GLP-1 receptor agonists or SGLT2 inhibitors may be a better treatment option for vulnerable patients with type 2 diabetes at dual risk of severe hypoglycemia and cardiovascular outcomes, rather than insulin 2.
• Conversations about hypoglycemia facilitated by a healthcare professional may reduce the burden and fear of hypoglycemia among patients with diabetes and their family members 2.