AskNadia: Which Diabetes Tests Should I Order

Dear Nadia,

I am pre-diabetic, or  I was. My A1c has been in the normal range for about a year now. However, for the last two months, I have been suffering from hypoglycemia. The first few times my numbers were in the 50s and 60s, but when I treated it tonight, it was 49. I had become confused and could barely figure out how to test myself. I forgot which end to put the test strip in and which end to put into my blood meter.

I was very confused. I had eaten a can of Vienna sausages an hour earlier and was in the middle of preparing burritos for dinner when I felt extremely panicky. I knew I needed to get to my meter. Then it took me a few minutes to use it. Afterward, I barely made it to my refrigerator to pull out a Twix bar to push my numbers up.

Before the Vienna sausages, I had drunk two cups of coffee, each with about five to six teaspoons of sugar in it. Before that, I had drunk a cup of apple juice. This has happened four times under the same circumstances: after drinking my super sweet coffee. I do not understand why this is happening. It seems I consume more sugar on the days that this happens.  Why is this happening? Could it be a problem with my liver? I think my liver enzymes are off, but I do not know which ones.

I am not overweight. I weigh 117 lbs and am 5’5″. I only eat once or twice a day, which I have done my whole life. I am 49 years old and hardly exercise because I am disabled. I know that I obviously need to force feed myself now, and I am not looking forward to making myself eat when I am not hungry. I just want to know what you think could be causing this. What types of tests do you think my doctor should order?

Thanks in advance.


Dear Lorinda:

How frustrating and scary to experience hypoglycemia as frequently as you do. What types of discussions have you had with your physician about these episodes?


A while back, I interviewed Dr. Leana Wen, co-author of “When Doctors Don’t Listen: How to Avoid Misdiagnoses and Unnecessary Tests.” I suggest reading the interview because Dr. Wen points out how physicians are trained in assessing patients and what patients should do when preparing for a healthcare appointment.


My recommendation is to make anther appointment with your physician and update them on the frequency of your hypoglycemia episodes. Ask them if they have evaluated you for “reactive hypoglycemia” or “hyperinsulinemia.”



Reactive Hypoglycemia

Your pattern of high sugar consumption followed by hypoglycemia could be a condition known as “reactive hypoglycemia.” Ironically, high sugar intake is followed by plunging blood glucose numbers. The condition is often accompanied by feelings of anxiety—which probably describes the panic you feel when you become aware that your numbers have dropped. The Mayo Clinic reports that “reactive hypoglycemia” symptoms are similar to low blood sugar, but it does not mean that you are in fact experiencing hypoglycemia. The common denominator are the symptoms.

Experiencing a low blood sugar after a meal for people with “reactive hypoglycemia” is uncommon. This does not mean it does not occur. It simply means it is unusual.  Although there are several theories as to why it occurs, it is yet to be determined.



Insulin Resistance Hyperinsulinemia

As you know, insulin is released to regulate blood sugars. “Hyperinsulinemia” is when the ratio of insulin being released is greater than what is required to normalize the blood sugar. Insulin resistance is believed to be the cause of “hyperinsulinemia.”



Liver Enzymes

Studies have shown that certain liver enzymes are linked to type 2 diabetes. Your healthcare  professional should be able to shed more light on how this relates to your insulin resistance and pre-diabetes.

I hope this helps in offering more discussions with your physician so they can help you identify and control your fluctuating blood sugars.




Mayo Clinic


Insulin Resistance and Hyperinsulinemia


Nadia’s feedback on your question is in no way intended to initiate or replace your healthcare professionals therapy or advice. Please check in with your medical team to discuss your diabetes management concerns.

AskNadia or Share Your Diabetes Story.

Email Nadia

Watch Nadia’s Videos

About Nadia:

Nadia is a diabetes advocate that was not only born into a family with diabetes but also married into one. She was propelled at a young age into “caretaker mode,” and

with her knowledge of the scarcity of resources, support, and understanding for people with diabetes, co-founded Diabetes Interview, now Diabetes Health magazine.

Nadia has received 14 nominations for her work as a diabetes advocate.
 She has been featured on ABC, NBC, CBS, and other major cable networks. Her publications, medical supply business, and website have been cited, recognized and published in the San Francisco Chronicle, The Wall Street Journal, Ann Landers advice column, former Chrysler chairman Lee Iacocca, Entrepreneur magazine, Houston News,, Brand Week, Drug Topics, and many other media outlets.





Leave a Reply

Your email address will not be published.