By Leigh Farmer 

Shaking, sweating, rapid heartbeat, and irritability. 

Is it anxiety? Or low blood sugar? 

The signs and symptoms of mental and physical health issues are not as different as one might think. And, in the case of anxiety versus low blood sugar, the symptoms can be almost identical.  

To compound the confusion, both anxiety and diabetes are common. According to the National Alliance on Mental Health, more than 40 million adults have an anxiety disorder. Similarly, the Centers for Disease Control and Prevention reports 38 million American adults have diabetes.  

VCU Health News sat down with Priyanka Majety, M.D., the adult outpatient diabetes director for VCU Health, to talk about this issue. She offered some advice on how you can determine the best course of action if you are experiencing symptoms. 

Why are the symptoms of low blood sugar and anxiety so similar? 

Both conditions trigger the body’s fight or flight response which is the physiological instinct to flee a threatening situation. This response releases stress 
hormones that cause physical sensations such as shakiness, sweating, dizziness/ lightheadedness, heart palpitations/rapid heartbeat, difficulty concentrating, irritability, and a sense of dread or impending doom. 

Can you have both low blood sugar and anxiety at the same time? 

If a patient has no history of diabetes or hypoglycemia (low blood sugar), anxiety may initially seem like a more likely cause due to its prevalence in today’s world. However, anxiety and low blood sugar can coexist, further complicating the picture.  

Knowing whether you are at higher risk for hypoglycemia is very important. Factors such as alcohol use, insulin use, older age, kidney issues related to another medical diagnosis, liver dysfunction, and a history of bariatric surgery are indicators of a more complex medical issue. Additionally, certain oral diabetes medications can increase the risk of hypoglycemia, particularly in patients with other contributing risk factors. 

How can I tell if a symptom is a sign of low blood sugar or anxiety? 

The most reliable way to confirm if you’re experiencing hypoglycemia is by measuring blood glucose levels. True hypoglycemia is typically defined as a blood glucose level below 70 mg/dL in individuals with diabetes on therapy. In healthy individuals the blood glucose level can be in the 50s and still be normal. 
 
Another way to determine whether it’s low blood sugar or anxiety is to consider the context and timing of symptoms. Hypoglycemia improves rapidly after eating or consuming sugar, while anxiety symptoms may persist. Symptoms of hypoglycemia often appear after a long period without food, strenuous exercise, or insulin therapy. Anxiety, however, often arises in response to a psychological trigger, although it can also occur seemingly without reason.  

How should I treat those symptoms? What if I’m not sure of the cause? 

If unsure of the cause, the safest initial approach is to address low blood sugar first, as untreated hypoglycemia can lead to serious complications. Consuming a small amount (about 15 grams) of fast-acting carbohydrates, like fruit juice or glucose tablets, can alleviate hypoglycemia quickly. It is important to recheck your blood glucose 15 minutes after that to ensure the glucose level has risen. We call it “The Rule of 15” – eat 15gm of carbohydrates and wait 15 minutes to recheck. 

If symptoms still don't resolve themselves, anxiety may be the root cause. Practicing calming techniques, such as deep breathing, mindfulness, or grounding exercises, can bring some relief to anxiety. Seeking professional cognitive-behavioral therapy is important if the symptoms reoccur. In some cases, medication may be prescribed by a healthcare provider. Bottom line: anxiety should not be ignored.   

Is it necessary to go to a doctor if I can fix either of these issues at home? 

In both cases it is important to follow up with a health care provider to evaluate the cause. Proper diagnosis is essential for effective long-term treatment. Individuals experiencing recurrent symptoms should consult with their health care provider for a thorough evaluation. 

People with diabetes or conditions causing frequent hypoglycemia should be vigilant in monitoring blood glucose levels. In some cases, continuous glucose monitoring (CGM) devices can be helpful in identifying patterns of low blood sugar. 

Making a note of when symptoms occur, including what you last ate, stress 
level, physical activity, and what improved them can help identify 
patterns. 

Learn more about VCU Health's Division of Endocrinology, Diabetes and Metabolism 

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