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You’re shaky, you’re overheating, and you want to bite someone’s head off. Unless you’re a vampire, you’re most likely just experiencing an isolated bout of low blood sugar (aka hypoglycemia) from either skipping a meal or completing a heavy workout.

If this happens often, though, it could be a sign of hypoglycemia without diabetes mellitus.

This is a condition in which your blood glucose (sugar) level drops below 70 milligrams per deciliter (mg/dl). (Normal is around 100 mg/dl when fasting but will be a little higher after you eat something.)

Glucose fuels our bodies, and when it runs low, so do we. If you don’t have diabetes, hypoglycemia tends to be rare. Still, if you’re experiencing regular bouts of hanger, go see a healthcare provider.

Hypoglycemia is easy to confuse with hyperglycemia. The word “hyperglycemia” translates as high (“hyper”) glucose (“glyc”) in the blood (“emia”). Hyperglycemia happens when your blood sugar level spikes, which is a defining feature of diabetes.

Two forms of hypoglycemia can affect someone without diabetes:

  • Fasting hypoglycemia is often triggered by medications or by drinking a lot of alcohol in a short time.
  • Reactive hypoglycemia happens when your blood sugar plummets within a few hours after you eat a meal. It can be a warning sign that you’re at risk for type 2 diabetes.

Hypoglycemia can come on quickly. Symptoms vary from person to person and depend on the intensity and degree of the blood sugar level drop — mild, moderate, or severe. In severe cases, your blood sugar can fall so low that you may pass out or have a seizure.

These symptoms of hypoglycemia can happen alone or in any combination:

  • shakiness
  • clamminess
  • hunger
  • headache
  • blurred vision
  • sleepiness
  • dizziness or lightheadedness
  • confusion or disorientation

As if that weren’t freaky enough, hypoglycemic episodes can happen at night, giving you nightmares or night sweats.

Two dominant hormones regulate blood sugar levels: insulin and glucagon.

Like a red traffic light, insulin stops the spread of glucose in your bloodstream, and glucagon green-lights its release. Hypoglycemia happens when you’re caught at a red light while you’re running out of gas.

Reactive hypoglycemia

Reactive (also called postprandial) hypoglycemia happens after a meal when the digested and absorbed food is met by an onslaught of insulin that lowers your blood sugar.

It’s more common in people who have obesity or a family history of diabetes. It also tends to affect those who’ve had gastric bypass surgery because food moves through their upper gastrointestinal tract more quickly.

Non-reactive hypoglycemia (aka fasting hypoglycemia)

Fasting hypoglycemia can be brought on by drinking alcohol on an empty stomach or by taking certain meds to treat pain, infection (including a certain form of pneumonia), or malaria.

Illnesses that affect your liver, heart, or kidneys can also lower your blood sugar. In rare cases, a tumor growing on your pancreas, such as an insulinoma, could be a factor.

Other possible triggers include:

Drinking alcohol on an empty stomach

After a long day, you might down some vino before you’ve eaten dinner. Soon after, you might start to feel clammy or lightheaded and may seem drunk. But that’s not the whole story.

Your liver, which releases its secret stash of sugar into your bloodstream to help keep your blood glucose level stable, is too busy processing alcohol to function normally. This can cause temporary hypoglycemia.

Medication

Certain meds can affect your blood sugar level.

Fasting hypoglycemia can be triggered by:

  • salicylates, including aspirin (a type of pain reliever)
  • sulfonamide antibiotics (a type of antibiotic)
  • pentamidine (a medication used to treat a serious kind of pneumonia)
  • quinine (a medication used to treat malaria)

Anorexia

Someone with an eating disorder may not consume enough food for their body to produce sufficient glucose.

Hepatitis

Hepatitis is an inflammatory condition that affects your liver, slowing down its ability to convert its stored glycogen into glucose and thus release glucose into your bloodstream.

Gland disorders

Your pituitary gland and adrenal glands affect insulin and glucagon production. Disorders in these glands can disrupt the regulation of your blood sugar levels.

Kidney disorders

Your kidneys help your body process medication and wastes. If your kidneys aren’t working well, certain medications can build up in your bloodstream and alter your blood sugar levels.

Pancreatic tumor

Pancreatic tumors are rare, but their presence can trigger hypoglycemic episodes.

Dumping syndrome

Dumping syndrome can develop after gastric bypass surgery or esophageal surgery. Dumping syndrome happens when food (especially sugar) moves too quickly from your stomach into your small intestine, triggering an overload of insulin.

Symptoms such as abdominal cramps and diarrhea can appear either shortly after eating or an hour or two later.

Hypoglycemia without diabetes happens when your body can’t stabilize your blood sugar.

It can also be related to prediabetes, a condition in which sugar starts to accumulate in your bloodstream and insulin production becomes off-kilter with your blood sugar level and then swings too low.

Family history, lack of exercise, and having a lot of fat on your body — especially in your abdominal area — can increase your chances for prediabetes.

Take notes!

Having repeated hypoglycemia attacks is a big deal. Even if you feel fierce and invincible, it’s a good idea to keep a diary of these experiences.

When you have a hypoglycemic episode, record the time of day, your symptoms, what you ate or drank prior to it, the medications you’re taking, and your stress level.

Bring the diary to your next doctor’s appointment and share it with your doctor. This info could help them make a diagnosis sooner.

To diagnose nondiabetic hypoglycemia, your doctor will review your symptoms, do a physical exam, study your risk factors, and then order a fasting or random glucose test to check your blood sugar level.

This test involves taking a blood sample and may include an 8-hour overnight fast or a longer supervised fast (48 to 72 hours).

During the longer fast, a healthcare provider will check your blood glucose levels every few hours. This is probably the most reliable test to identify fasting hypoglycemia.

Then what?

If your symptoms point to reactive hypoglycemia, your doctor might order a mixed-meal tolerance test (MMTT).

During this test, you’ll drink a beverage containing protein, fats, and sugar, which raises your blood glucose and, in turn, causes your body to produce more insulin.

A healthcare provider will then draw blood and check your glucose levels multiple times over the course of 5 hours.

When will I know?

Test results are usually available within a day or two. If your blood sugar level is lower than 50 to 70 mg/dl, hypoglycemia may be the diagnosis.

Before a meal, normal blood sugar levels register 80 to 130 mg/dl. In general, after an 8-hour fast, blood sugar levels measure about 70 to 100 mg/dl.

What if the signs point to prediabetes?

Once your doctor diagnoses hypoglycemia, they will likely recommend taking steps to try to stop prediabetes from progressing into type 2 diabetes.

Alas, there’s no fairy godmother who can wave her magic wand and transform your body chemistry. But you might be able to.

Making lifestyle changes (such as eating a well balanced, lower carb diet and adding daily exercise) can help you manage your weight, cholesterol, and blood pressure.

Psst…

According to the CDC, exercising for 30 minutes a day, 5 days a week may reduce your risk of type 2 diabetes by as much as 58 percent.

Yasss! It’s important to treat low blood sugar to avoid serious long-term side effects.

Try this when hypoglycemia strikes:

  1. Eat 15 grams of carbohydrates that your body can quickly use as sugar — that could be a glass of fruit juice, 15 Skittles, 4 teaspoons of sugar, glucose tablets, hard candy, 2 teaspoons of honey, or raisins.
  2. Wait 15 minutes. Measure your blood glucose.
  3. If the hypoglycemia persists, repeat steps one and two.

If these episodes continue, your doctor may recommend carrying an injectable glucagon kit with you at all times.

It’s a good idea to let your family and co-workers know about your condition, since they might have to administer the glucagon injection to raise your blood glucose level if you’re unable to.

Ongoing hypoglycemia treatments may include:

  • self-monitoring your blood glucose throughout the day
  • working with a dietitian to develop a healthy meal plan
  • carrying glucose tablets, hard candy, or other snacks with you

Ultimately, treatment for hypoglycemia depends on what’s causing it. For instance, if your doctor finds a tumor in your body, you may need surgery. If medication is triggering it, your doctor can prescribe a different one.

The good and the bad

A hypoglycemic diet goes against the traditional “eat three times a day” advice. Instead, it takes into account the size and frequency of meals for managing blood sugar levels.

Simple carbs like doughnuts, cookies, or candied yams aren’t your friends. Your body digests them so quickly that they spray your system with glucose like a shaken-up bottle of Mountain Dew.

More bad news: You should limit your alcohol intake and maybe even your caffeine intake.

A standard alcoholic drink equates to 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor.

Instead, celebrate with lots of small meals throughout the day.

Meals should include protein (meat, legumes, nuts, and seeds), complex carbs (whole wheat pasta, whole grains, and potatoes), high fiber foods, whole grain breads, vegetables, and whole fresh fruits to balance sugar absorption.

Yummy snacking

Try these midmorning and midafternoon noms:

  • an apple with a few slices of cheddar cheese
  • a banana with a handful of nuts or seeds
  • a slice of whole grain toast with mashed avocado or hummus
  • whole grain crackers topped with sardines or tuna
  • veggies dipped in hummus
  • a vegetable smoothie

Hypoglycemia is serious business. Your brain (and the rest of your body) depends on blood sugar for energy — it literally can’t function without it.

Reduced blood sugar can lead to falls, injuries, and, if you’re driving, car accidents. Ignoring symptoms of hypoglycemia for too long can also result in seizures, loss of consciousness, and possibly death.

Being mindful of what you eat and drink can go a long way in decreasing the frequency of hypoglycemic episodes.

Try these tips:

  • Eat a balanced diet that’s low in sugar and high in protein, fiber, and complex carbs.
  • Eat small meals every few hours.
  • Always carry a snack with you. When you start to feel hangry, munch on a cheese stick, a handful of raisins and walnuts, or an orange to lift your sugar level.
  • Even though this seems contrary to every diet you’ve ever heard of, snack before and after exercising.
  • Order an appetizer with your beer or wine.
  • Snack before going to bed at night so you wake up feeling more balanced.

tl;dr

  • Hypoglycemia without (or with) diabetes occurs when your blood sugar level drops below 70 mg/dl.
  • Symptoms include shakiness, headaches, dizziness, and blurry vision.
  • For immediate treatment, eat 15 grams of sugar (like raisins, Skittles, or a small glass of juice) and wait 15 minutes. If you don’t feel better, repeat the process.
  • Frequent bouts of hypoglycemia mean it’s time to see your doctor.
  • Possible causes include medications, underlying medical conditions, or prediabetes.
  • If you’re diagnosed with hypoglycemia, you can help manage it by changing your diet, exercising more, and avoiding a heavy alcohol intake.