Feeling Shaky? It Could Be Hypoglycemia (Low Blood Sugar)

17 Sep 2025 By David A. Galbreath, M.D.

Feeling Shaky? It Could Be Hypoglycemia (Low Blood Sugar)

Have you ever experienced sudden shakiness, dizziness, or an overwhelming feeling of weakness? These can be alarming sensations, and one potential cause is hypoglycemia, also known as low blood sugar. Understanding what hypoglycemia is, its causes, symptoms, and how to manage it is crucial for maintaining overall health and well-being. In this article, we’ll delve into the intricacies of hypoglycemia, providing you with practical knowledge and actionable steps to handle it effectively.

Hypoglycemia occurs when the level of glucose in your blood drops below what is healthy. Glucose is the primary source of energy for your body, particularly the brain. When glucose levels are insufficient, the body and brain can't function properly, leading to a variety of symptoms. The severity of these symptoms can range from mild discomfort to severe complications.

Understanding Hypoglycemia: Types and Causes

Hypoglycemia isn't always a sign of diabetes; while it's commonly associated with diabetes management, non-diabetic individuals can also experience it. Understanding the underlying causes is key to addressing the problem effectively.

1. Diabetic Hypoglycemia

Insulin Overdose: This is one of the most common causes of hypoglycemia in people with diabetes. Taking too much insulin can lower blood glucose levels too drastically.
Missed or Delayed Meals: Irregular eating patterns or delaying meals can lead to a drop in blood sugar, especially if you've taken insulin or oral diabetes medications.
Increased Physical Activity: Exercise increases glucose uptake by the muscles. Without adequate carbohydrate intake or insulin adjustment, physical activity can induce hypoglycemia.
Alcohol Consumption: Alcohol can interfere with the liver's ability to release glucose into the bloodstream, especially when consumed without food.
Certain Diabetes Medications: Besides insulin, some oral diabetes medications (especially sulfonylureas) can cause the pancreas to release more insulin, leading to hypoglycemia.

2. Non-Diabetic Hypoglycemia

Also called reactive hypoglycemia or postprandial hypoglycemia, this form of hypoglycemia occurs within a few hours after eating a meal. It is less common than diabetic hypoglycemia, but understanding its possible causes is still essential.

Postprandial Hypoglycemia (Reactive Hypoglycemia): This occurs after eating, usually within a few hours. The body releases too much insulin in response to carbohydrate intake, causing a sudden drop in blood sugar.
Fasting Hypoglycemia: This occurs after prolonged periods without eating.
Certain Medical Conditions: Liver disease, kidney disease, adrenal gland disorders, and some tumors can cause hypoglycemia. For example, liver disease can impair glucose storage and release, while adrenal disorders can affect hormones that regulate blood sugar.
Certain Medications: Some medications, like quinine (used to treat malaria) and certain antibiotics, can also lead to hypoglycemia.
Post-Gastric Bypass: People who have undergone gastric bypass surgery can sometimes experience hypoglycemia because of the rapid emptying of food into the small intestine, leading to increased insulin production.
Hormone Deficiencies: Deficiencies in cortisol or growth hormone can cause hypoglycemia by impairing glucose regulation.

| Type of Hypoglycemia | Primary Causes | Common Scenarios | | :----------------------- | :------------------------------------------------------------------------------------------------------ | :------------------------------------------------------------------------------------------------------------------------------- | | Diabetic | Insulin overdose, missed meals, increased exercise, alcohol, specific diabetes medications | Taking too much insulin before a meal, skipping a meal after taking medication, strenuous workout without a snack | | Non-Diabetic | Postprandial response, fasting, medical conditions, medications, post-gastric bypass, hormone deficiencies | Eating a large, carbohydrate-rich meal, prolonged fasting, liver disease affecting glucose release, certain drug interactions |

Understanding these causes is crucial for both prevention and treatment of hypoglycemia. Identifying the specific trigger helps individuals and healthcare providers create a personalized management plan.

Recognizing the Signs: Symptoms of Hypoglycemia

The symptoms of hypoglycemia can vary from person to person and can depend on how quickly your blood sugar drops. Being aware of these signs can help you take timely action. Here are some common symptoms:

Early Symptoms

Shakiness or Trembling: One of the earliest and most common signs.
Sweating: Often accompanied by a feeling of being cold and clammy.
Rapid Heartbeat: Feeling like your heart is racing or pounding.
Anxiety or Nervousness: A sudden onset of unease.
Irritability or Confusion: Feeling unusually grumpy or having difficulty concentrating.
Hunger: An intense craving for food, particularly sugary items.
Dizziness or Lightheadedness: Feeling faint or unsteady.

Late Symptoms

If hypoglycemia progresses without intervention, more severe symptoms can develop:

Difficulty Concentrating: Trouble focusing on tasks or understanding conversations.
Slurred Speech: Speaking incoherently or having trouble forming words.
Confusion: Feeling disoriented and unclear about your surroundings.
Vision Changes: Blurred or double vision.
Weakness or Fatigue: An overwhelming feeling of physical exhaustion.
Seizures: Involuntary muscle contractions and loss of consciousness.
Loss of Consciousness: Passing out, requiring immediate medical attention.
Coma: A prolonged state of unconsciousness, a medical emergency.

Recognizing these symptoms early is crucial. The 15-15 rule is a common guideline: if you suspect hypoglycemia, check your blood glucose levels (if you have a monitor). If it's below 70 mg/dL, consume 15 grams of fast-acting carbohydrates (like glucose tablets, juice, or hard candies). Wait 15 minutes, then recheck your blood glucose. Repeat if necessary, and contact a healthcare professional if your blood sugar remains low after multiple attempts.

Diagnosing Hypoglycemia: Tests and Assessments

Diagnosing hypoglycemia involves several steps, including reviewing symptoms, conducting physical exams, and performing blood tests. Here's how healthcare providers typically approach the diagnostic process.

1. Medical History and Physical Examination

The doctor will start by asking about your medical history, current medications, eating habits, and any recent illnesses. This provides vital context for understanding potential causes of hypoglycemia.

Questions about diet and eating habits: Includes timing of meals, types of food consumed, and any recent dietary changes.
Medication Review: Assessing all medications, including prescriptions, over-the-counter drugs, and supplements.
Physical Exam: A general physical examination helps identify any underlying conditions that could contribute to hypoglycemia.

2. Blood Glucose Testing

The most direct way to diagnose hypoglycemia is by measuring blood glucose levels when symptoms are present.

Fasting Blood Glucose Test: Measures blood glucose after an overnight fast.
Random Blood Glucose Test: Measures blood glucose at any time, without regard to meals.
Postprandial Blood Glucose Test: Measures blood glucose two hours after eating a meal.
Continuous Glucose Monitoring (CGM): This device continuously monitors blood glucose levels over several days, providing a comprehensive picture of glucose fluctuations, which is especially useful for diagnosing reactive hypoglycemia.

3. Mixed-Meal Tolerance Test

This test is often used to diagnose reactive hypoglycemia. You'll be given a specially formulated meal high in carbohydrates, protein, and fat. Blood glucose levels are then monitored over several hours to see how your body responds to the meal.

4. Oral Glucose Tolerance Test (OGTT)

While primarily used for diagnosing diabetes and gestational diabetes, the OGTT can also detect hypoglycemia. It involves drinking a sugary solution, with blood glucose levels measured at intervals over a few hours.

5. Other Tests

If the cause of hypoglycemia is unclear, additional tests may be performed to rule out other medical conditions.

Insulin Levels: Measures the amount of insulin in the blood, which can help identify insulinomas (tumors in the pancreas that produce excess insulin).
C-Peptide Levels: Helps determine whether the pancreas is producing insulin naturally or if insulin is being administered externally.
Cortisol Levels: Assesses adrenal gland function.
Liver Function Tests: Checks for liver diseases that may impair glucose metabolism.
Imaging Studies: CT scans or MRIs may be used to detect tumors or other abnormalities in the pancreas, liver, or adrenal glands.

| Diagnostic Test | Purpose | When It's Used | | :------------------------- | :------------------------------------------------------------------------------------------- | :-------------------------------------------------------------------------------------------------------- | | Fasting Blood Glucose | Measures glucose after fasting | To identify baseline glucose levels and detect fasting hypoglycemia | | Random Blood Glucose | Measures glucose at any time | When symptoms of hypoglycemia are present, regardless of meal times | | Postprandial Blood Glucose | Measures glucose after eating | To assess how the body responds to food intake and detect reactive hypoglycemia | | Mixed-Meal Tolerance Test | Evaluates glucose and insulin response to a mixed meal | Suspected reactive hypoglycemia; assesses insulin response to a carbohydrate, protein, and fat mixture | | Oral Glucose Tolerance Test | Assesses glucose response after consuming a sugary drink | Primarily for diagnosing diabetes, but can detect hypoglycemia in some cases | | Insulin & C-Peptide Levels | Measures insulin production and source | To differentiate between endogenous insulin overproduction and exogenous insulin administration |

Treatment and Management Strategies

Effectively managing hypoglycemia involves a combination of immediate actions to raise blood sugar and long-term strategies to prevent future episodes. The approach varies based on whether you have diabetes or are experiencing non-diabetic hypoglycemia.

Immediate Treatment: The 15-15 Rule

The first step in treating hypoglycemia is to quickly raise your blood sugar levels. The 15-15 rule is the standard recommendation:

Check Blood Sugar: If possible, use a blood glucose meter to confirm your blood sugar is below 70 mg/dL.
Consume 15 Grams of Fast-Acting Carbohydrates: Choose one of the following:
- Glucose tablets (follow package instructions)
- 4 ounces (120 mL) of juice (apple or orange)
- 1 tablespoon of honey or sugar
- Hard candies (check the nutrition label for carbohydrate content)
- 4-6 crackers
- Wait 15 Minutes: Allow time for the carbohydrates to raise your blood sugar levels.
Recheck Blood Sugar: After 15 minutes, retest your blood sugar. If it's still below 70 mg/dL, repeat the process.
Eat a Snack or Meal: Once your blood sugar is above 70 mg/dL, eat a snack or meal that contains both carbohydrates and protein to stabilize your blood sugar and prevent another drop. Examples include:
- Whole-grain crackers with cheese
- Peanut butter on whole-wheat bread
- Yogurt with fruit
- A handful of nuts

Long-Term Management for People with Diabetes

Adjust Medications: Work with your healthcare provider to adjust your insulin or oral diabetes medication dosage. Regularly monitoring blood sugar levels can help identify patterns and necessary adjustments.
Meal Planning: Consistent meal timing and carbohydrate counting are crucial. Ensure each meal contains a balance of carbohydrates, proteins, and fats.
Regular Monitoring: Regularly checking blood glucose levels, especially before meals, after exercise, and at bedtime, can help prevent hypoglycemia. Continuous Glucose Monitoring (CGM) can provide real-time data and alerts.
Education: Learn to recognize the early signs of hypoglycemia and how to treat it. Family and friends should also be educated on how to assist in case of severe hypoglycemia.
Medical Alert: Wear a medical alert bracelet or necklace indicating that you have diabetes.

Long-Term Management for Non-Diabetic Hypoglycemia

Dietary Changes: Focus on eating small, frequent meals throughout the day to stabilize blood sugar levels. Avoid skipping meals.
Limit Sugary Foods and Refined Carbohydrates: These can cause rapid spikes and drops in blood sugar. Focus on whole grains, lean proteins, and healthy fats.
Increase Fiber Intake: Fiber slows down the absorption of sugar into the bloodstream, helping to stabilize blood sugar levels. Good sources include fruits, vegetables, and whole grains.
Protein and Fat at Every Meal: Include protein and healthy fats in each meal to slow down carbohydrate absorption and promote stable blood sugar.
Address Underlying Conditions: If hypoglycemia is caused by a medical condition, such as a tumor or hormone deficiency, addressing the underlying issue is essential.

| Strategy | For People with Diabetes | For People with Non-Diabetic Hypoglycemia | | :----------------------------- | :-------------------------------------------------------------------------------------- | :------------------------------------------------------------------------------------------- | | Immediate Treatment | 15-15 rule; fast-acting carbohydrates | 15-15 rule; fast-acting carbohydrates | | Medication Management | Work with doctor to adjust insulin or oral medications | N/A | | Meal Planning | Consistent meal timing, carb counting, balanced meals | Small, frequent meals; limit sugary foods and refined carbs; increase fiber intake | | Regular Monitoring | Blood glucose monitoring, CGM | Monitoring blood sugar to understand patterns, but not as frequent as in diabetes | | Lifestyle Adjustments | Medical alert bracelet, education for family and friends | Balanced meals, addressing underlying medical conditions |

Preventing Hypoglycemia: Lifestyle and Dietary Tips

Prevention is better than cure. Whether you have diabetes or experience non-diabetic hypoglycemia, several lifestyle and dietary changes can significantly reduce your risk of developing low blood sugar.

1. Consistent Meal Timing

Eat Regular Meals and Snacks: Aim to eat meals and snacks at consistent times each day. Avoid skipping meals, particularly if you are on medications that can cause hypoglycemia.
Plan Ahead: If you know you'll be delayed for a meal, have a snack on hand to prevent your blood sugar from dropping.

2. Balanced Diet

Focus on Whole Foods: Choose whole, unprocessed foods whenever possible. These foods are digested more slowly and provide a steady release of glucose into the bloodstream.
Combine Carbohydrates, Protein, and Fat: Each meal should include a balance of carbohydrates, protein, and healthy fats. This helps stabilize blood sugar levels.
Limit Sugary and Processed Foods: Reduce your intake of sugary drinks, pastries, and processed snacks, as these can cause rapid spikes and drops in blood sugar.

3. Carbohydrate Management

Choose Complex Carbohydrates: Opt for complex carbohydrates like whole grains, vegetables, and legumes, which are digested more slowly than simple carbohydrates. Mastering Your Diabetic Diet Foods That Won T Spike Your Blood Sugar
Be Mindful of Portion Sizes: Control the amount of carbohydrates you consume at each meal. This is particularly important for people with diabetes. Why Is My Morning Blood Glucose So High 5 Causes And Solutions

4. Stay Hydrated

Drink Plenty of Water: Dehydration can affect blood sugar levels. Drink plenty of water throughout the day to stay hydrated.

5. Exercise Smartly

Monitor Blood Sugar Before and After Exercise: Check your blood sugar before, during (if exercising for an extended period), and after exercise to see how your body responds.
Adjust Insulin or Carb Intake: If you have diabetes, adjust your insulin dosage or carbohydrate intake as needed based on your blood sugar levels and exercise intensity.
Carry a Snack: Always carry a fast-acting carbohydrate snack with you during exercise in case your blood sugar drops too low.

6. Alcohol Consumption

Drink in Moderation: If you choose to drink alcohol, do so in moderation and always consume it with food.
Monitor Blood Sugar: Be aware that alcohol can affect blood sugar levels, so monitor your blood sugar carefully.

7. Regular Blood Glucose Monitoring

Use a Blood Glucose Meter: Regularly check your blood glucose levels, especially if you have diabetes or are prone to hypoglycemia.
Keep a Log: Record your blood glucose levels, meals, medications, and activities to identify patterns and potential triggers for hypoglycemia.

8. Medications and Supplements

Review Medications with Your Doctor: Discuss all medications and supplements you are taking with your healthcare provider, as some can affect blood sugar levels.
Take Medications as Prescribed: If you have diabetes, take your medications as prescribed and follow your doctor's instructions carefully.

9. Stress Management

Practice Stress-Reduction Techniques: High stress levels can affect blood sugar. Practice stress-reduction techniques such as yoga, meditation, or deep breathing exercises.

10. Sleep Well

Get Adequate Sleep: Lack of sleep can disrupt hormone levels and affect blood sugar control. Aim for 7-8 hours of sleep per night.

| Prevention Tip | Explanation | Example | | :----------------------------- | :------------------------------------------------------------------------------------------------------- | :---------------------------------------------------------------------------------------------------- | | Consistent Meal Timing | Prevents blood sugar from dropping too low by providing a steady supply of glucose. | Eating breakfast, lunch, and dinner at the same times each day. | | Balanced Diet | Provides a stable release of glucose and avoids rapid spikes and drops. | Combining lean protein, complex carbohydrates, and healthy fats in each meal. | | Carbohydrate Management | Helps control blood sugar levels by choosing the right types and amounts of carbohydrates. | Choosing whole grains over refined grains and being mindful of portion sizes. | | Stay Hydrated | Supports overall health and can affect blood sugar regulation. | Drinking at least 8 glasses of water per day. | | Exercise Smartly | Improves insulin sensitivity but requires careful monitoring to prevent hypoglycemia. | Checking blood sugar before and after exercise, carrying a snack during physical activity. | | Moderate Alcohol Consumption | Alcohol can affect blood sugar levels; moderation and consumption with food are key. | Drinking alcohol with a meal and limiting intake to one drink for women and two drinks for men. | | Regular Blood Glucose Monitoring | Helps identify patterns and potential triggers for hypoglycemia. | Testing blood sugar before meals and at bedtime, keeping a log of readings. | | Medication Management | Ensures proper medication use and dosage. | Taking medications as prescribed by a healthcare provider and discussing any concerns. | | Stress Management | Reduces stress hormones that can affect blood sugar control. | Practicing meditation or yoga regularly. | | Adequate Sleep | Supports overall hormone balance and blood sugar regulation. | Aiming for 7-8 hours of sleep per night. |

When to Seek Medical Help

While many episodes of hypoglycemia can be managed at home with the 15-15 rule and lifestyle adjustments, certain situations require prompt medical attention. Knowing when to seek help can prevent severe complications. A1C Vs Daily Glucose Levels Which Is More Important For Your Diabetes Care

Emergency Situations

Severe Symptoms: If you experience severe symptoms like seizures, loss of consciousness, or coma, seek immediate medical help.
Inability to Treat Hypoglycemia: If you are unable to raise your blood sugar levels despite following the 15-15 rule multiple times, it's essential to get professional medical assistance.
No Blood Glucose Meter: If you suspect hypoglycemia but don't have a blood glucose meter to confirm, it's best to err on the side of caution and seek medical help.

When to Consult a Healthcare Provider

Frequent Hypoglycemia Episodes: If you experience frequent episodes of hypoglycemia, even if they are mild, consult with your healthcare provider to determine the underlying cause and adjust your management plan.
Unexplained Hypoglycemia: If you experience hypoglycemia and don't have diabetes or any known risk factors, it's essential to undergo a medical evaluation to identify any underlying medical conditions.
Medication Adjustments: If you have diabetes and frequently experience hypoglycemia, your healthcare provider may need to adjust your medication dosage or timing.
Changes in Medical Condition: If you experience any new symptoms or changes in your medical condition, consult with your healthcare provider, as this may affect your blood sugar control.
Pregnancy: If you are pregnant and experience hypoglycemia, it's essential to work closely with your healthcare provider to manage your blood sugar levels and ensure the health of both you and your baby.

| Situation | Action | | :-------------------------------------- | :------------------------------------------------------------------------------------------------------------- | | Severe Symptoms (Seizures, Unconsciousness) | Call emergency services (911 in the US) immediately. | | Inability to Treat Hypoglycemia | Seek medical help; you may need intravenous glucose or other interventions. | | No Blood Glucose Meter | Err on the side of caution; seek medical help to confirm and treat hypoglycemia. | | Frequent Hypoglycemia Episodes | Consult with a healthcare provider to identify the cause and adjust your management plan. | | Unexplained Hypoglycemia | Undergo a medical evaluation to rule out underlying medical conditions. | | Need Medication Adjustments | Work with your healthcare provider to adjust your insulin or other diabetes medications. | | Changes in Medical Condition | Consult with your healthcare provider, as new symptoms or conditions may affect blood sugar control. | | Pregnancy | Work closely with your healthcare provider to manage blood sugar levels and ensure the health of mother and baby. |

Conclusion: Empowering Yourself to Manage Hypoglycemia

Feeling shaky due to low blood sugar can be a disconcerting experience, but with the right knowledge and strategies, you can manage and prevent hypoglycemia effectively. Whether you have diabetes or experience non-diabetic hypoglycemia, understanding the causes, symptoms, and treatment options is essential.

By following the tips outlined in this article, including consistent meal timing, balanced diet, regular blood glucose monitoring, and appropriate medication management, you can empower yourself to maintain stable blood sugar levels and enjoy a healthier life. Always remember to consult with your healthcare provider for personalized advice and guidance.