Diagnostic Criteria for Reactive Hypoglycemia

Classification and Diagnosis

The American Diabetes Association classifies hypoglycemia as Level 2 when glucose is <54 mg/dL (<3.0 mmol/L), which corresponds to true reactive hypoglycemia requiring documented plasma glucose <55-60 mg/dL (<3.0-3.3 mmol/L) occurring simultaneously with sympathetic or neuroglycopenic symptoms 1, 2, 3, 4
Symptoms of reactive hypoglycemia must resolve with glucose administration or food intake to confirm the diagnosis, as stated by the American Diabetes Association 5

A low glucose value during an oral glucose tolerance test (OGTT) alone is NOT sufficient to diagnose reactive hypoglycemia due to high false-positive rates, and diagnosis requires documentation of hypoglycemia during spontaneous symptomatic episodes in the patient's natural environment 5