Low blood sugar and anxiety are linked, but it is important to understand the complexity of the relationship. Symptoms of low sugar can reflect the symptoms of anxiety, or aggravate existing anxiety. Tremor, rapid heartbeat, irritability, nausea, difficulty concentrating and panic are all common symptoms.
Some people, especially diabetics, may also experience anxiety about regulating blood sugar levels. This may manifest as a consistent and overwhelming fear of hypoglycemia (low sugar levels) or anxiety about managing your condition.
Why low sugar levels cause anxiety
When blood sugar drops, the body tries to raise them. It pumps epinephrine (adrenaline), which is actually a “fight or flight” hormone that, among other things, signals the liver to produce more glucose (blood sugar).
Adrenaline also causes the heart to beat at a faster rate and forcing the hands to sweat and this can cause nervousness and anxiety. These are warning signs that your blood sugar is too low. If this condition persists, the body produces more hormones, including the hormone cortisol, also known as the “stress hormone”, in part because it helps control things like mood and fear. Hence, if you combine adrenaline and cortisol together, you get a recipe for anxiety.
Symptoms of low blood sugar and anxiety
Many of the symptoms of low blood sugar and anxiety overlap. Without checking blood sugar levels, it can be difficult to differentiate between the two conditions.
Symptoms of low blood sugar (hypoglycemia) include:
- instability
- hunger
- Anxiety or panic
- sweat
- Headache
- irritability
- nausea
- dizziness
- rapid heartbeat
- confusion
- Blurred vision
- loss of consciousness
Symptoms of anxiety include:
- Excessive worry, disproportionate to the situation and loss of control
- dry mouth
- irritability
- Difficulty concentrating
- Muscle tension or headache
- tremor
- nausea
- rapid heartbeat
- sweat
- Insomnia
- Behavior is too careful
- Panic attacks
Low blood sugar mimics anxiety
The reciprocal symptoms of low blood sugar and anxiety are not accidental. There is a common physiological basis of the two conditions. When hypoglycemia occurs, the body tries to normalize the levels by raising the blood glucose level through the secretion of epinephrine (adrenaline), which triggers glucose production in the liver. However, increased adrenaline levels trigger a “fight or flight” response in the body. The same biochemical process is also associated with anxiety.
A condition of lower long-term or chronic sugar can also cause the body to produce cortisol, which is the “stress hormone”. Cortisol helps the tissues in the body to respond less to insulin, which helps increase the flow of glucose into the bloodstream.
Although it may help raise and normalize blood sugar levels, higher cortisol levels are also linked to anxiety. For this reason, many of the warning signs and symptoms of low blood sugar are common with that of anxiety.
Why does the blood sugar level drop?
The goal of diabetes treatment is to lower blood sugar. Sometimes, the sugar level drops too much. Most people experience symptoms if their blood sugar drops below 70 milligrams per deciliter (mg / dL). This can happen when:
- Taking too many diabetes medications
- Skip meals
- Eat less
- Exercising more than usual
People without diabetes
Diabetes is not a precondition for experiencing low blood sugar. People without diabetes can still experience low blood sugar levels, although this is rare. Conditions that can lead to hypoglycemia in people without diabetes include gastrointestinal surgery, pancreatic tumor, anorexia nervosa, alcohol or aspirin overuse, liver disease, liver cancer and more.
what can be done?
Check your sugar levels – If you are diabetic, a great way to help stave off anxiety is to keep your blood sugar levels within safe range. It’s not as easy as it sounds. It is recommended to do this using a continuous sugar meter and without punctures.
Be careful with insulin – Too much insulin is the most common cause of low blood sugar. If you are taking insulin to treat diabetes, be sure to use the correct type and dose each time. When injecting, be sure to do it right under the skin. When injected into the muscle, the insulin is absorbed too quickly and its effect does not last as long as it should have.
Choose foods with a low glycemic value – Certain foods cause your blood sugar to rise rapidly and drop after a few hours. There are foods that maintain more constant sugar levels and no sharp fluctuations. Checking the glycemic index in the foods you purchase and preferring foods with a low glycemic index is a good way to deal with it.
A glycemic index is a measure that gives an idea of how fast the body converts carbohydrates into sugar. The higher the number, the faster it happens and the blood sugar level will rise sharply. Foods with a high glycemic index usually include: simple sugars, sugary drinks, carbohydrates like white bread, pasta, rice and potatoes.
Foods with a low glycemic index include: Chicken, fish and other proteins, nuts, almonds, beans, non-starchy vegetables like asparagus, beets, broccoli and tomatoes.
Foods with a high glycemic index can still be eaten occasionally but smaller portions with lots of healthy fat, protein and carbohydrates should be kept at the same time. What you eat is important but how much, when and in what combination are just as important.
Exercise Wisely – Exercise can lower blood sugar. Good training is a great way to relieve anxiety. While you are sweating, your brain secretes endorphins and other chemicals that make you “feel good”. Over time, exercise rewires the brain so that you feel better in general.
Be sure to adjust your carbs and insulin – It is important to do this before training or exercise so that when exercising the blood sugar level will not drop too much. How much you need to change in your training routine depends on things like the type of practice you are doing and how much you are considering. Your medical staff can help you understand how you can exercise safely.
Limit alcohol consumption – Alcoholic beverages can lower blood sugar for up to 24 hours. If you drink alcohol, be sure to drink moderately. Women should not go over drinking one drink a day. For men, the limit is two. A serving of 350 grams of beer, 140 grams of wine, or 45 grams of liquor. Never drink on an empty stomach.
Anxiety and diabetes overlap in other ways – People with diabetes can experience anxiety for other reasons related to their condition.
Anxiety about low blood sugar
An episode of low blood sugar, which can include anything from confusion and tremors to nausea, loss of consciousness and seizures, can be very frightening. It therefore makes sense that some people with diabetes also experience anxiety associated with a low blood sugar event – and not just as a physiological response to low blood sugar.
This anxiety is so prevalent that the term “fear of hypoglycemia” (FoH) is common among physicians and researchers. A study found that a history of mild hypoglycemia increases FoH in people with diabetes.
Anxiety about treating diabetes
Managing blood sugar and other aspects of health when you have diabetes can be time consuming and stressful, and also contribute to anxiety. For people with diabetes, monitoring blood sugar levels usually involves a home finger prick test. Fear of needles, as well as fear of the consequences, can lead to anxiety.
A related study found that 33% of people with diabetes experience anxiety specific to the glucose test method. Thirty percent of people with diabetes in the same study suffered from generalized diabetes-related anxiety.
Other areas of diabetes management may also lead to stress and anxiety. This includes monitoring potential symptoms of vision loss (diabetic retinopathy), nerve damage (diabetic neuropathy), slow-healing wounds in the feet or limbs, kidney damage and more.
Managing diabetes anxiety
If you are diabetic, know that the concerns about managing the situation are very valid. However, there is a line between normal feelings of worry, and levels of anxiety that interrupt your daily thoughts or activities and relationships. Talk to your personal physician If you feel you are experiencing anxiety, in addition to learning and getting help on how to feel ready to manage your diabetes, the diabetes clinic staff may also recommend a treatment plan or lifestyle changes to deal with the anxiety. This can include: psychotherapy, medications, relaxation exercises, support groups, breathing techniques, yoga, meditation and dietary change.
Low blood sugar and anxiety levels are related, but it is not clear what the exact direction of the relationship is. The symptoms of low blood sugar reflect the symptoms of anxiety, due to a similar biochemical process that takes place in the body. Psychological, emotional and environmental factors surrounding diabetes management.
Even if you eat healthy, stay active and avoid hypoglycemic events, you may still feel anxious. If this happens, it may help to talk to the diabetes clinic staff, and decide together what treatment is right for you.
The author is the director of the diabetes unit at Wolfson Medical Center and a senior diabetes physician at the DMC Diabetes Center