Perhaps you’re starting to sense the onset of migraine symptoms as you wrap up tasks before lunch. Or maybe, after a long day, you find yourself struggling to focus on the TV show you’re watching. You feel irritable and drained.
“There’s a possibility of misdiagnosing hypoglycemia as anxiety because the symptoms overlap so much,” explained Dr. Priyanka Majety, an assistant professor of endocrinology, diabetes, and metabolism at Virginia Commonwealth University. “This is especially true if the individual doesn’t have a history of diabetes or hypoglycemia, as anxiety is more common and might seem like the more likely explanation.”
While hypoglycemia can occur in individuals with or without diabetes, it is more frequently seen in those with the condition. Non-diabetic low blood sugar can result from various factors, including skipping meals, taking certain medications such as antibiotics, consuming alcohol, or having health conditions like liver or kidney disease.
Effectively addressing your symptoms requires understanding the underlying issue. But how can you determine the root cause when every individual’s body and circumstances are unique? Dr. Majety and other experts share insights into distinguishing between these two conditions and managing those unpleasant sensations.
Symptoms That May Signal Anxiety or Low Blood Sugar
First, let’s outline the symptoms that these conditions share — there are more similarities than you might expect. Experts have identified the following examples:
Headaches or migraines
Jitteriness
Restlessness
Shakiness or tremors
Confusion, trouble concentrating, or mental fog
Fatigue or weakness
Disrupted or altered sleep patterns
Full-body sweating
Feeling cold or clammy
Rapid heartbeat
Lightheadedness or dizziness
Irritability
At times, you may experience both conditions simultaneously; it’s not necessarily a one-or-the-other situation. “Someone with low blood sugar might also experience anxiety,” noted Dr. Markyia Nichols, chief medical officer at Ciba Health, a health tech company.
Dr. Jennifer Kraker, a psychiatrist with two decades of experience in nutrition and psychiatry, has seen this overlap firsthand. “I’ve treated several patients with anxiety who were ultimately diagnosed with diabetes because of this exact presentation,” she shared.
This overlap occurs because the two conditions activate similar responses in the body.
“Both conditions trigger the body’s fight-or-flight mechanism, releasing stress hormones that produce comparable physical symptoms,” said Dr. Majety.
“When blood sugar drops, adrenaline (epinephrine) is released, signaling the liver to produce more glucose (blood sugar),” explained Dr. Nichols. “This release of adrenaline also increases heart rate, induces sweating, and can make you feel more anxious.”
However, it’s important to note that both conditions don’t always occur together.
Differentiating Between Anxiety and Low Blood Sugar
There are a few methods to identify whether your symptoms stem from anxiety or low blood sugar, depending on available tools and your preferences.
Testing
Specific tests can provide clarity and are often accessible at home. Dr. Nichols suggested using a continuous glucose monitor (CGM) or conducting a real-time test with a finger-stick device. Dr. Rozalina McCoy, an endocrinologist and associate professor at the University of Maryland, agreed, emphasizing that testing offers the most accurate understanding of your blood sugar levels.
“True hypoglycemia is generally defined as a blood glucose level below 70 mg/dL in individuals with diabetes on insulin therapy,” Dr. Majety explained. For non-diabetic individuals, a reading below 55 mg/dL is typically considered low, according to the National Institutes of Health. However, Dr. Majety added that in healthy individuals, levels in the 50s can sometimes still be normal.
If your reading is above these thresholds, anxiety might be the cause — but not always, cautioned Roberta Kleinman, a registered nurse and certified diabetes educator at ADW Diabetes. “Some individuals experience ‘low symptoms’ even when their blood sugar is within the normal range,” she noted.
Reflect on Your Habits and Environment
If testing isn’t an option, Marjorie Nolan Cohn, a registered dietitian and clinical director of Berry Street, recommended assessing recent behaviors. Ask yourself questions like: “Has it been more than three hours since I last ate? What did I eat? Did my meal include a balance of carbs, protein, and fats?”
It’s also essential to recognize that everyone’s body reacts differently day-to-day. Even if your meals seem adequate, your body might need more fuel than usual.
When considering anxiety, reflect on potential stressors, triggers, or situations that might be contributing to your feelings. Anxiety can result from numerous factors, including environmental discomfort, ongoing stress, a medical condition, trauma, or a family history of anxiety.
Steps to Address Symptoms
Understanding the cause of your symptoms is crucial, but what should you do if you’re unsure? Or if both anxiety and low blood sugar are at play?
Prioritize Treating Low Blood Sugar
Managing hypoglycemia is more critical, as untreated low blood sugar can lead to severe complications, especially for those with diabetes. “If the cause is uncertain, the safest course of action is to address low blood sugar first, since its untreated effects can be life-threatening,” advised Dr. Majety.
In extreme cases, untreated hypoglycemia can result in cardiac arrhythmias, coma, or even death, warned Dr. Kraker.
To treat low blood sugar, consume 15 grams of fast-acting carbohydrates — such as fruit juice or glucose tablets — and check your glucose levels again after 15 minutes. Avoid foods with fat, as fat slows absorption. For example, chocolate bars aren’t ideal for treating hypoglycemia. Other effective options include soda, Skittles, gummy bears, or similar snacks.
Use Relaxation Techniques for Anxiety
If anxiety is the culprit, Dr. Majety suggested relaxation methods such as mindfulness, deep breathing exercises, or grounding techniques. Therapy and, in some cases, medication may also help.
Consult with Professionals
Dr. Nichols emphasized the value of collaborating with a healthcare provider or team to interpret your lab results and create a comprehensive treatment plan tailored to your needs.
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