extremely low blood sugar

Fruit juices are something you should never consume. The same for honey. They're among the worst offenders for hypoglycemics.

Your pancreas is releasing too much insulin when you eat food that require insulin. Extra insulin is what cause the low blood sugar and low blood sugar is what causes the release of stress hormones (cortisol and adrenalin) that triggers all sort of anxiety, depression, social phobia problems.

Carbohydrates are insulinogenic.
Proteins are insulinogenic
Fats are not insulinogenic.

So you don't only need to decrease carbohydrates but also to decrease proteins.
Stick with the RDA for proteins. I have talked with many people with RH and they all improved when they moved from consuming like 230 grams of proteins a day to 70-80 grams of proteins.

A fat only meal would cause no kind of hypoglycemia reaction. Try for yourself to eat cream with mascarpone with coconut oil and you will notice you feel perfectly fine.

Unfortunately we can't eat only fat and we need also proteins and carbs. But you can keep these to a minimum.

I don't suggest to snack every two hours.
The reason is that your body is already overproducing insulin and eating when insulin is high would trigger a sugar crash.

Your body needs 5 hours for insulin to get back to baseline levels. So I think three meals a day is better. Other people with hypoglycemia found major relief from their symptoms when they started to allowing insulin to lower between meals instead of eating every moment. Eating often just mask the symptoms. It does absolutely nothing to balance your sugar. The goal is to restore your body ability to balance blood sugar even when not food is ingested. Eating often is just a way to mask the fact that your body can't balance its own blood sugar, it does nothing to remove the cause.

As you have noticed yourself, you feel worse in the morning and better in the late afternoon and evening. The reason is that in the morning your insulin resistance is higher and in the evening your blood sugar is more balanced.

Try to have an almost carb free breakfast.
You can have bacon and eggs, fatty greek yogurt and heavy cream, egg salad without the toast, nuts and brie and so on.

Have a bit more carbohydrates at lunch mainly from starchy veggies and berries and dary.

At dinner eat more carbs if you want.
You should tolerate them a lot better and have gone through the worst moment (morning and afternoon) without symptoms.

Never have fruits on an empty stomach.
Avoid carbohydrates on a empty stomach.
Just avoiding them on an empty stomach can relieve your symptoms a lot.

Check the Glycemic Index of food and try to choose those with a low or moderate Glycemic Index. For example whole wheat pasta has a lower glycemic index and is better tolerated than other carbs.

Foods you can eat on their own are meat, fish, cheese, eggs, oils, vegetables and nuts.

Food you must combine with any of the foods in the list above are: whole grains, yogurt, milk, fruits, basmati rice, pasta.

Foods you shold avoid are: potatos, white rice, bread, chips, ice cream, sucrose, honey, fruit juices, sodas and cokes, candies and sweets.

You should avoid caffeine completely (so coffee and tea) as they trigger hypoglycemia.

Alhough there are several carbs you can eat, you still must keep the total amount of carbs lower. Even in diabetes and insulin resistence, although the kind of carb matters, the total amount of carbs in a day is still relevant.

You must find your "carb limit".

So you need to find the amount in grams of carbohydrates that makes you symptoms free.
As you improve following your diet, you will increase carbohydrates amonut to the point where you start having more episodes of low blood sugar. At that point is the threshold of carbohydrate that your body can tolerate.

For example right now my carbohydrate threshold is 85 grams a day.

You also need to take a diary and write down what you have eaten and how you feel in the next hours after your meal. In my diary I use emoticons to describe feeling good or feeling terrible or feeling anxious or feeling depressed. That way you will highlights the moments you didn't feel good (according to your dairy) and will search for the possible trigger in your previous meal. It's important to develop a list of personal triggers, food you know you must avoid to avoid low blood sugar symptoms.

If you're interested these are my triggers:

banana
peas
fruit juices
honey
artificial sweeteners
coffee
candies
broth
mashed potatos
low-fat yogurt
ice cream
cabbage
sweet corn
cherries
persimmons
dates
table sugar
polenta
bulghur
peaches
oranges
melon

You should exercise in the evening and start with very very moderate exercises and increase the intensity week by week. Start with simple walking where there are trees and green fields.

I agree with you that you need a referral to an endocrinologist ASAP.

Your hypoglycemia will not be cured by any diet or a food record. You should definitely consume juice when you are that low.

I had almost all of your symptoms until recently and was followed by an endocrinologist. For me, the CT scan revealed that I had an insulinoma (insulin-producing tumor) in my pancreas. Once the insulinoma was surgically removed, my blood sugars were normal and all of my symptoms were gone. I would be happy to chat with you privately.

It's wise to check for other problems that might cause hypoglycemia like Karina said. Before you can make a diagnosis of reactive hypoglycemia, you need to exclude other diseases that might cause blood sugar problems.

That being said don't believe that Hypoglycemia is always caused by other problems like tumors.

I have Reactive Hypoglycemia as bad as it gets and whatever other cause has been properly excluded. I have no kind of diabetes, tumor, adrenal insufficiency, cholesterol problem. It's just Reactive Hypoglycemia and even when I get terrible lows, drinking juice would be the worst thing I could do.

But as I said drinking juice and glucose tablets works for Organic Hypoglycemia like that caused by diabetic medications or insulin producing tumors. The chance you have Organic Hypoglycemia instead of Reactive Hypoglycemia are still small, but worth checking.

If you find out you have Reactive Hypoglycemia rather then Organic Hpoglycemia, come back and follow the advices we're providing here, because in that case diet is the only thing that can cure you !