RH is a complex condition, and the exact causes are still not yet understood. After a meal, especially one high in simple carbohydrates, glucose enters the bloodstream, which triggers a release of insulin.[1] However, in RH, this response is faulty, and hypoglycemia results.[2][3] The autonomic nervous system is activated when blood glucose drops too low, leading to the signs and symptoms of RH.[4][3]
RH is defined by its association with meals, but several internal factors may be to blame. Possible causative factors include enlarged insulin-producing islet cells, increased numbers of islet cells, anti-insulin antibodies causing fluctuations in insulin production, altered glucose regulation in the liver, tumors, neuropsychiatric diseases, and digestion/insulin dysfunction (particularly those resulting from gastric surgery).[4][5][6][7][8]