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Q: I've been feeling tired and shaky off and on for more than a year. Sometimes it goes away when I eat candy, but at other times this doesn't seem to make any difference. My doctor tested my blood for sugar with a glucose tolerance test and told me I was hypoglycemic. He told me to eat more calories per day (3,500) and to snack between meals.

Although it has gotten better, I still have the problem, plus I've been gaining weight. What should I do?

-- T.G., Montreal, Canada
A: It sounds like the diet your doctor recommended has helped you considerably. But I'm concerned that that you may have a major problem with weight gain if you keep it up for a long time.

Hypoglycemia has been blamed for a variety of symptoms such as those you describe. And sometimes it's the cause, but sometimes it's not. These symptoms also can be the result of chronic fatigue syndrome and high levels of anxiety and stress, among other things.

There are two main types of hypoglycemia. The first occurs while one is fasting for many hours, such as overnight; the second, called postprandial hypoglycemia, occurs within a few hours after eating.

True fasting hypoglycemia is almost always caused by a tumor of the pancreas, where insulin is produced. The best treatment is to surgically remove the tumor.

But since your doctor said you had hypoglycemia after seeing the results of a glucose tolerance test (a test that measures the blood sugar level for up to four hours after drinking sugar water), it's much more likely that your symptoms are caused by a type of postprandial hypoglycemia.

However, the best way to determine if your symptoms are actually caused by low blood sugar is to measure your sugar levels when you are having the symptoms. Since this is likely to be happening at home, I suggest that you talk with your doctor about how you can collect blood quickly.

You can either do it yourself or have someone take you immediately to the doctor's office or a walk-in medical clinic, if they are close enough. Be sure to have everyone ready so that when you arrive, the blood will be drawn immediately.

To confirm the cause with even more certainty, drink sugar water -- two tablespoons in eight ounces -- immediately after taking the blood sample and see if your symptoms and the low blood sugar go away at the same time.

If your drop in blood sugar occurs within one to three hours after eating, a specific correctable cause often cannot be found. But it can be successfully treated by eating much smaller-sized meals.

If the drop in blood sugar doesn't occur until four or more hours after eating, you may have diabetes.

No matter what type of hypoglycemia you have, your condition can be made worse by drinking alcohol. It's certainly worth stopping to see if there is any improvement.

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