During the day, depending on various factors, blood sugar (glucose) levels fluctuate slightly at physiological levels. This is normal.

Glucose is the main source of energy for our body and brain. Glucose comes from foods and drinks. One of the hormones involved in glucose utilization, is insulin. Insulin’s job is to help glucose enter our cells where it’s used for energy. The levels of circulating blood sugar should not be too low and not too high. The standard normal lab range is around 3.5 and 6.0 mmol/L (63 to 108 mg/dL).

A stable blood sugar level is essential to our overall health.

If blood sugar falls below the healthy range, it’s called HYPOGLYCEMIA. Then, you might not feel well. There are several reasons why this can happen; the most common is a side effect of drugs used to treat diabetes. Diabetics are under a medical care and are educated about the risk of hypoglycemic symptoms so I am not going to talk about hypoglycemia in relation to diabetes management. Hypoglycemia can happen in people who do not have diabetes.

Here, I cover some aspects of non-diabetic hypoglycemia. It’s relatively common but many people are not aware of it.

Typical symptoms of hypoglycemia include:
  • feeling hungry
  • feeling dizziness and light-headed if meals are missed
  • feeling shaky, jittery
  • feeling tired and eating to relieve fatigue
  • becoming easily irritated, upset, tearfull and nervous
  • craving for sweets between meals
  • increased energy after meals
  • weakness
  • tingling lips
  • a fast or pounding heartbeat (palpitations)
  • poor memory, forgetfulness
  • anxiety
  • blurred vision
  • paleness

Some people experience hypoglycemia also during sleep. If that happens, they may cry out or have nightmares, sweat excessively, feel tired, irritable, or confused after waking up.

Symptoms of hypoglycemia can differ from person to person. You may have one or more mild-to-moderate symptoms.

Why some people feel anxious, they sweat, or have thumbing heart when their blood sugar levels drop? Because low blood sugar triggers the release of stress hormones (to promote glucose release from its storage form like glycogen) and puts the body in the “fight-or-flight” mode. Moreover, at the point of glucose shortage (combined with a lack of ketones) the brain will not get enough glucose which can be manifested as drowsiness, difficulty concentrating, confusion, blurred vision, slurred speech, or numbness.

To know whether you are experiencing low blood sugar, you need to check your blood sugar. If you are experiencing symptoms and you are unable to check your blood sugar for any reason, you can try to treat hypoglycemia and best discuss it with your general practitioner.

What causes non-diabetic hypoglycemia?

There are two types of non-diabetic hypoglycemia:

  • Fasting hypoglycemia: may be related to a disease (liver disease, hypothyroidism, eating disorders), certain medications, herbal supplements such as fenugreek, ginseng, cinnamon, or to alcohol, malnutrition, or exercise.
  • Reactive hypoglycemia: which happens within a few hours of eating a meal, the causes may be unknown but possibly include: hyperinsulinemia (elevated insulin levels), meals high in refined carbohydrates such as white bread or foods high in sugar, prediabetes. And it’s more prevalent in women with polycystic ovary syndrome (PCOS).

In addition, low blood sugar can be caused by a low carbohydrate intake as well as by a high carbohydrate intake. Chronic high carbohydrate consumption (especially simple sugars) can cause over production of insulin and insulin helps our body to “insert” glucose into the cells where it can be utilized as energy. Some people make too much insulin (inappropriate levels for the level of blood glucose) and if insulin is able to effectively “insert” glucose into the cells, blood sugar can drop too much causing hypoglycemia.  The possible risk of high insulin levels includes a high risk of brain issues because insulin inhibits lipolysis and ketogenesis, thus preventing the generation of alternative brain substrates (such as ketone bodies), the brain might be deprived of the fuel then.

NOTE. If you started a low-carb diet and you experience some of the symptoms mentioned above, you might be getting too little fuel (energy from carbs and/or fats). Meaning that your carbohydrate intake went down but your fat intake did not increase to balance the fuel intake which can lead to hypoglycemic episodes. It’s quite common to follow a low-carb diet without a proper consideration of providing the fuel for the body and the brain.

How to prevent low blood sugar?

  • Have small amount of protein every 2 – 3 hours. This does not mean eat a full meal every two to three hours – a few bites will do. The idea is to keep your blood sugar stable without activating your adrenals to release stress hormones and raise blood glucose. Suggested proteins include nuts, seeds, a boiled egg, or meat, or a low-carbohydrate protein drink. For some people, eating 5 to 6 small meals each day instead of 3 large meals and snacks works best.
  • Avoid refined carbohydrates such as white bread, cakes, cookies, regular sodas, syrups, and candy.
  • Avoid drinks or foods that contain caffeine and alcohol. Caffeine and alcohol may cause you to have the same symptoms as hypoglycemia, and may cause you to feel worse.
  • Avoid sweets before bed. If you have a tendency to hypoglycemia, your blood sugar will crash during the night, long before your next meal is due. Chances are your adrenals will kick into action, creating restless sleep or that 3am wake up with anxiety.
  • Eat diversity of healthy foods. In a nutshell, foods that should be on your menu include vegetables (various vegetables which will provide complex carbohydrates, polyphenols, anti-oxidants and other nutrients), protein source (mushrooms, poultry, fish, nuts, meat, seeds, legumes, eggs, alternatively a protein powder), healthy fats (extra virgin olive oil, flax seed oil, avocado, coconut fat, goose fat, duck fat, borage oil, evening primrose, and ghee/grass-fed butter), healthy (resistant) starches (sweet potato, rice, buckwheat, quinoa, tubers) in moderation, and various herbs and spices.
  • Check your carbohydrate intake. If you are on a very low-carb diet (and not on a ketogenic diet), you might be getting too little carbs to sustain a stable blood glucose.
  • Track your symptoms and situations in which they happen. Pay attention when your symptoms occur, is it before meals or when you skip a meal? Write down your symptoms, time the episodes and relation to food ingestion, comorbid conditions, medications and social.
  • In case of severe hypoglycemia, have a sugary drink or snack – try something like a small glass of fruit juice or a small handful of sweets.

Treatment of hypoglycemia

Treatment depends on the cause of the hypoglycemia. For example, if a medicine you take is causing hypoglycemia, you need to discuss it with your health care professional. If hypoglycemia is caused by low hormone levels, you may need to take hormones.

Information provided below is meant for educational purposes only, and does not constitute medical or nutritional advice or act as a substitute for seeking such advice from a qualified health professional. 

Reference list

  1. Desimone ME, Weinstock RS. Non-Diabetic Hypoglycemia. In: Feingold KR, Anawalt B, Boyce A, et al., eds. Endotext. South Dartmouth (MA): MDText.com, Inc.; 2000.
  2. Kittah NE, Vella A. MANAGEMENT OF ENDOCRINE DISEASE: Pathogenesis and management of hypoglycemia. Eur J Endocrinol. 2017;177(1):R37–R47.
  3. Kandaswamy L, Raghavan R, Pappachan JM. Spontaneous hypoglycemia: diagnostic evaluation and management. Endocrine. 2016;53(1):47–57.
  4. Scheen AJ. Central nervous system: a conductor orchestrating metabolic regulations harmed by both hyperglycaemia and hypoglycaemia. Diabetes Metab. 2010;36 Suppl 3:S31–S38.
  5. Diabetes Canada Clinical Practice Guidelines Expert Committee, Yale JF, Paty B, Senior PA. Hypoglycemia. Can J Diabetes. 2018;42 Suppl 1:S104–S108.
  6. Mumm H, Altinok ML, Henriksen JE, Ravn P, Glintborg D, Andersen M. Prevalence and possible mechanisms of reactive hypoglycemia in polycystic ovary syndrome. Hum Reprod. 2016;31(5):1105–1112.

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