Feeling Shaky and Confused? Recognizing Low Blood Sugar Symptoms (Hypoglycemia)

18 Sep 2025 By Richard O. White, M.D.

Feeling Shaky and Confused? Recognizing Low Blood Sugar Symptoms (Hypoglycemia)

Have you ever felt unexpectedly shaky, sweaty, and confused, almost out of nowhere? These could be signs of hypoglycemia, or low blood sugar. While often associated with people who have diabetes, it can sometimes occur in others too. Understanding the symptoms, causes, and what to do about low blood sugar is crucial for your health and well-being. This article breaks down everything you need to know, offering a comprehensive guide to recognizing, managing, and preventing hypoglycemia.

What is Hypoglycemia (Low Blood Sugar)?

Hypoglycemia happens when the level of glucose in your blood drops too low. Glucose, derived from the food we eat, is the primary source of energy for the body, especially the brain. When glucose levels fall below a certain threshold, the body and brain start to malfunction, triggering a range of symptoms. Blood Sugar Support Supplements What Actually Works A 2024 Review

For most people, hypoglycemia is diagnosed when blood glucose levels fall below 70 milligrams per deciliter (mg/dL). However, individual thresholds can vary based on medical history and overall health.

It's important to distinguish between hypoglycemia in people with diabetes and non-diabetic hypoglycemia, also known as reactive hypoglycemia. People with diabetes might experience low blood sugar due to medication (especially insulin or sulfonylureas), missed meals, or excessive exercise. Reactive hypoglycemia, on the other hand, can occur in people without diabetes, often after consuming a large meal high in carbohydrates.

The Importance of Recognizing Symptoms

Early recognition of hypoglycemia is vital. Left untreated, it can lead to severe consequences, including seizures, loss of consciousness, and, in rare cases, brain damage. Even mild hypoglycemia can impair cognitive function, affecting concentration, decision-making, and coordination, which can be particularly dangerous when driving or operating machinery. Feeling Shaky And Dizzy Understanding The Signs Of Severe Hypoglycemia

Common Symptoms of Hypoglycemia

The symptoms of hypoglycemia can vary from person to person and depend on how quickly the blood sugar levels drop. Some people may experience symptoms at higher blood sugar levels than others. It's important to familiarize yourself with the common signs and symptoms so you can take timely action.

Here's a comprehensive list of potential symptoms:

Early Symptoms:

Shakiness: A trembling or quivering sensation, especially in the hands and legs.
Sweating: Sudden onset of perspiration, often cold and clammy.
Anxiety or Nervousness: Feeling unusually worried, agitated, or irritable.
Rapid Heartbeat: A sensation of the heart racing or pounding.
Hunger: Intense cravings for food, particularly sugary snacks.
Tingling: A pins-and-needles sensation around the mouth or fingertips.
Pallor: Pale skin, especially noticeable on the face.

Moderate Symptoms:

Confusion: Difficulty thinking clearly, disorientation, and impaired judgment.
Dizziness or Lightheadedness: Feeling unsteady or like you might faint.
Blurred Vision: Difficulty focusing or seeing clearly.
Weakness: General feeling of being tired and lacking strength.
Headache: Dull or throbbing pain in the head.
Difficulty Speaking: Slurred speech or trouble finding the right words.
Lack of Coordination: Clumsiness and difficulty with motor skills.

Severe Symptoms:

Loss of Consciousness: Fainting or passing out.
Seizures: Uncontrolled muscle spasms and jerking.
Coma: Prolonged unconsciousness.

Important Note: Not everyone experiences all of these symptoms. Some people may have mild symptoms, while others may progress rapidly to more severe manifestations. Pay attention to your body and any unusual feelings, especially if you have a history of blood sugar problems.

Causes of Hypoglycemia

Understanding what causes hypoglycemia is crucial for preventing it. There are several potential reasons why someone might experience low blood sugar, and the causes can differ between individuals with and without diabetes.

Hypoglycemia in People with Diabetes:

For people with diabetes, hypoglycemia is often related to the management of their condition. The most common causes include:

Excessive Insulin or Oral Medications: Taking too much insulin or certain oral diabetes medications (sulfonylureas and meglitinides) can cause blood sugar levels to drop too low.
- Example: Accidentally taking a double dose of insulin or forgetting to adjust the dosage after changes in diet or activity levels.
Missed or Delayed Meals: Skipping meals, delaying eating, or not consuming enough carbohydrates can lead to low blood sugar.
- Example: Being too busy to eat lunch or not having a snack before a long workout.
Intense Exercise: Physical activity increases glucose utilization, and if insulin doses or food intake are not adjusted accordingly, hypoglycemia can occur.
- Example: Going for a strenuous hike without having a snack beforehand or after.
Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose into the bloodstream, particularly when consumed on an empty stomach.
- Example: Drinking alcohol without eating or while taking certain diabetes medications.
Kidney Problems: Impaired kidney function can affect how medications are cleared from the body, potentially leading to hypoglycemia.
Illness: Infections or other illnesses can affect appetite, medication absorption, and glucose metabolism, leading to fluctuating blood sugar levels.

Hypoglycemia in People Without Diabetes:

While less common, hypoglycemia can also occur in people without diabetes. This is often referred to as non-diabetic hypoglycemia or reactive hypoglycemia. Possible causes include:

Reactive Hypoglycemia: This occurs a few hours after eating a meal, typically one high in carbohydrates. The body releases an excessive amount of insulin in response to the rapid rise in blood sugar, causing a subsequent drop to below normal levels.
- Example: Feeling shaky and lightheaded a couple of hours after eating a large pasta dinner.
Fasting Hypoglycemia: This occurs when blood sugar levels drop after a period of fasting or not eating. Possible causes include:
- Alcohol-Induced Hypoglycemia: Similar to its effects on people with diabetes, alcohol can interfere with glucose production in the liver, leading to hypoglycemia.
- Severe Liver Disease: The liver plays a crucial role in glucose storage and release. Liver damage can impair these functions, causing hypoglycemia.
- Kidney Disease: Similar to its impact on people with diabetes, kidney disease can affect medication clearance and glucose metabolism.
- Certain Medications: Some medications, such as quinine (used to treat malaria) and salicylates (like aspirin), can cause hypoglycemia.
- Hormone Deficiencies: Deficiencies in hormones like cortisol or growth hormone can impair glucose regulation.
- Insulinoma: A rare tumor in the pancreas that produces excessive amounts of insulin.
- Post-Gastric Bypass Surgery: Changes in digestion after gastric bypass surgery can sometimes lead to reactive hypoglycemia.

| Cause of Hypoglycemia | Associated Conditions/Factors | Mechanism | | :------------------------------- | :---------------------------------------------------------------- | :--------------------------------------------------------------------------------------------------------------------------------------- | | Excessive Insulin (Diabetics) | Overdosing, incorrect timing, sensitivity changes | Increased glucose uptake by cells, decreased hepatic glucose production | | Missed/Delayed Meals (Diabetics) | Inadequate carbohydrate intake, irregular eating schedule | Reduced glucose supply from food | | Intense Exercise (Diabetics) | Without adjusting insulin or food intake | Increased glucose utilization by muscles, leading to depletion of blood glucose | | Reactive Hypoglycemia | High carbohydrate meals | Overproduction of insulin in response to rapid glucose spike, leading to subsequent drop | | Alcohol Consumption | Empty stomach, concurrent diabetes medication use | Impaired hepatic glucose production, exacerbated by other risk factors | | Liver/Kidney Disease | Impaired organ function | Reduced glucose storage/release (liver), altered medication clearance (kidney) |

What to Do When You Experience Low Blood Sugar

If you experience symptoms of hypoglycemia, it's crucial to act quickly to raise your blood sugar levels. Here's a step-by-step guide on what to do:

Check Your Blood Sugar (if possible): If you have a glucose meter, check your blood sugar levels immediately. This will help confirm whether you are indeed experiencing hypoglycemia.
Follow the "15-15 Rule": If you can't check your blood sugar or don't have a meter, don't delay treatment. Consume 15 grams of fast-acting carbohydrates, then wait 15 minutes and recheck your blood sugar (if possible). If your blood sugar is still below 70 mg/dL, repeat the process until it rises above that level.

Examples of 15 Grams of Fast-Acting Carbohydrates:

4 ounces (1/2 cup) of juice (orange, apple, or grape)
4 ounces (1/2 cup) of regular (not diet) soda
1 tablespoon of honey or syrup
Glucose tablets (follow package instructions for the correct dosage to achieve 15 grams)
Hard candies (approximately 3-4, but check labels for carbohydrate content)
Gels or chews specifically designed for raising blood sugar (follow package instructions)

Important Considerations:

Avoid High-Fat Foods: While it might be tempting to eat something like chocolate, the fat content can slow down the absorption of glucose, delaying the rise in blood sugar.
Avoid Complex Carbohydrates: Similarly, complex carbohydrates like whole grains take longer to digest and are not ideal for quickly raising blood sugar.
Follow Up with Protein and Complex Carbohydrates: Once your blood sugar is above 70 mg/dL, eat a snack containing both protein and complex carbohydrates to stabilize your blood sugar levels and prevent another drop. Examples include:
- Crackers with peanut butter
- Cheese and whole-wheat crackers
- A small sandwich with lean meat and vegetables
If You Lose Consciousness: If you lose consciousness, someone should administer glucagon if it's available and they know how to use it. Glucagon is a hormone that stimulates the liver to release stored glucose into the bloodstream. Call for emergency medical assistance immediately. Don't try to give food or liquid to someone who is unconscious, as they could choke.
Seek Medical Attention: If you experience severe hypoglycemia, especially if it's accompanied by loss of consciousness or seizures, seek immediate medical attention. Your doctor can help determine the underlying cause of the hypoglycemia and adjust your treatment plan accordingly.

Preventing Hypoglycemia

Prevention is key, especially for people with diabetes. Here are some strategies to help prevent hypoglycemia: Exercises Proven To Help Lower And Control Blood Sugar Levels

For People with Diabetes:

Monitor Blood Sugar Regularly: Frequent blood sugar monitoring helps you understand how different factors (food, exercise, medications) affect your blood sugar levels.
Follow Your Meal Plan: Stick to a consistent eating schedule and meal plan as prescribed by your healthcare team. Avoid skipping meals or delaying eating.
Adjust Insulin Doses: Work with your doctor to adjust your insulin doses based on your activity levels, food intake, and blood sugar readings.
Carry a Quick Source of Carbohydrates: Always have a quick source of carbohydrates readily available (glucose tablets, juice, hard candies) in case you experience symptoms of hypoglycemia.
Wear a Medical Alert Bracelet: A medical alert bracelet or necklace can inform others about your diabetes and what to do in case of an emergency.
Inform Family and Friends: Educate your family and friends about the signs and symptoms of hypoglycemia and how to administer glucagon if necessary.
Limit Alcohol Consumption: If you drink alcohol, do so in moderation and always consume it with food. Check your blood sugar levels before and after drinking.
Check Blood Sugar Before Driving: Always check your blood sugar levels before driving, especially if you take insulin or other diabetes medications that can cause hypoglycemia.

For People Without Diabetes:

Eat Regular Meals: Avoid skipping meals or going for long periods without eating.
Limit Sugary Foods and Drinks: Consuming excessive amounts of sugary foods and drinks can lead to reactive hypoglycemia.
Choose Complex Carbohydrates: Opt for whole grains, fruits, and vegetables instead of refined carbohydrates like white bread, pasta, and sugary cereals.
Include Protein and Healthy Fats: Add protein and healthy fats to your meals and snacks to help stabilize blood sugar levels.
Avoid Alcohol on an Empty Stomach: If you drink alcohol, always do so with food.
Stay Hydrated: Drink plenty of water throughout the day to help regulate blood sugar levels.
Talk to Your Doctor: If you experience frequent episodes of hypoglycemia, talk to your doctor to rule out any underlying medical conditions.

When to See a Doctor

While occasional episodes of mild hypoglycemia may be managed at home, it's important to seek medical attention if you experience any of the following:

Frequent Episodes: If you have frequent episodes of hypoglycemia, even if they are mild, it's important to determine the underlying cause and develop a management plan with your doctor.
Severe Symptoms: Seek immediate medical attention for severe symptoms such as loss of consciousness, seizures, or coma.
Unexplained Hypoglycemia: If you experience hypoglycemia without any obvious cause (e.g., not related to diabetes or medication use), it could be a sign of an underlying medical condition that needs to be evaluated.
Difficult to Manage Hypoglycemia: If you have diabetes and find it difficult to manage your blood sugar levels despite following your treatment plan, your doctor may need to adjust your medication or recommend further testing.
Changes in Medication: Discuss any changes in your medications with your doctor, as some medications can increase the risk of hypoglycemia.

Your doctor may order blood tests to evaluate your blood sugar levels, hormone levels, and liver and kidney function. They may also recommend a glucose tolerance test to assess how your body responds to sugar. Based on the results of these tests, your doctor can diagnose the underlying cause of your hypoglycemia and develop a personalized treatment plan.

Recognizing the symptoms of hypoglycemia and knowing how to respond quickly and appropriately can help prevent serious complications. Whether you have diabetes or not, understanding the causes of low blood sugar and taking steps to prevent it is essential for maintaining your health and well-being. If you have concerns about hypoglycemia, talk to your doctor for guidance and support.