Glucose is your body's main energy source and fluctuates within a certain range during an average day. Hypoglycemia occurs when your blood sugar (glucose) level is lower than the standard range for you. Generally, a blood glucose level below 70 milligrams per deciliter (mg/dL) or 3.9 millimoles per liter (mmol/L) is considered low blood sugar or hypoglycemia.
Hypoglycemia is often related to type 1 diabetes or diabetes medications, but other drugs and conditions can also cause low blood sugar in people who do not have diabetes. Amongst people with diabetes who take insulin, 4 in 5 people with type 1 diabetes and nearly half of those with type 2 diabetes reported a low blood sugar event at least once over four weeks.
Knowing how to identify and recognize your unique signs of low blood sugar is important since glucose is essential for all bodily activity and is especially necessary for the function of the nervous system and brain. Therefore, hypoglycemia can be dangerous if left untreated. Common symptoms of hypoglycemia include a rapid heartbeat, shaking, sweating, nervousness or anxiety, irritability or confusion, dizziness, and hunger. Treatment of hypoglycemia involves quickly getting your blood sugar back to within the standard range with a high-sugar food or drink or with medication. A functional medicine approach to hypoglycemia involves identifying and treating the contributing cause(s) of the blood sugar dropping too low.
How Do Our Bodies Regulate Blood Glucose?
Your body breaks down the food you eat into glucose. Glucose is your body's main energy source and enters your cells with the help of insulin, a hormone produced by your pancreas.
Glucose fluctuates within a certain range during an average day to allow the body to function well. Normally, glucose levels in the body are kept within a narrow range by various hormones. When you consume and digest food, insulin is released from the pancreas to drive glucose into cells and lower blood sugar to its normal range. Extra glucose that is not immediately needed for energy is stored in your liver and muscles in the form of glycogen or converted to fat for later use. Hormones like cortisol and growth hormone counterbalance the action of insulin.
When your blood sugar drops because you have not eaten for several hours, you stop producing insulin. The pancreas releases glucagon to signal your liver to break down the stored glycogen and release glucose into your bloodstream to maintain your blood sugar within a standard range until you eat again. With prolonged fasting, fat is broken down to be used as an alternative fuel to maintain energy levels.
What is Hypoglycemia?
Hypoglycemia occurs when your blood sugar (glucose) level is lower than the standard range for you and begins to impact how the body functions. Generally, a blood glucose level below 70 milligrams per deciliter (mg/dL) or 3.9 millimoles per liter (mmol/L) is considered low blood sugar or hypoglycemia.
This can occur when the balance of hormones gets dysregulated, or hormones like insulin are too high or secreted too fast.
Conventionally, hypoglycemia is officially diagnosed when an individual meets "Whipple’s Triad" of criteria:
- symptoms consistent with hypoglycemia
- low plasma glucose measured with a precise method (not a glucometer)
- relief of those symptoms when plasma glucose is raised
Hypoglycemia Symptoms
Low blood sugar deprives the brain of its primary fuel source (glucose), causing symptoms like difficulty thinking and lightheadedness. When blood sugar drops, it also triggers an outpouring of counter-regulatory hormones from the adrenals, including adrenaline and cortisol. These hormones oppose the action of insulin to mobilize glucose back into the bloodstream and drive blood sugar levels back up. These "rescue" hormones contribute to a "fight-or-flight" response that produces symptoms like a rapid heart rate, nervousness, palpitations, sweating, shakiness/tremor, waking up in the middle of the night, and panic.
Each person may react in a unique way to blood sugar falling too low, but some common signs and symptoms of hypoglycemia can include:
- shakiness
- sweating
- headache
- hunger
- nausea
- an irregular or fast heartbeat
- fatigue
- becoming pale
- irritability or anxiety
- difficulty concentrating
- dizziness or lightheadedness
- tingling or numbness of the lips, tongue, or cheek
As blood sugar drops to a lower range, additional symptoms can occur, including:
- confusion
- unusual behavior
- coordination problems
- slurred speech
- blurry vision or tunnel vision
- nightmares, if asleep
If blood sugar continues to drop to a severely low level, one may become unresponsive and lose consciousness or suffer from seizures.
Some people–especially those who have had diabetes for more than 5-10 years or take certain medicines, such as beta blockers for high blood pressure–may not have any symptoms when the blood sugar is low. This is known as hypoglycemia unawareness.
Risk Factors for Hypoglycemia
Hypoglycemia is most common in those with diabetes. Too much insulin or other diabetes medications can cause blood sugar levels to drop too much, causing hypoglycemia. Hypoglycemia can also occur when taking these medications if you eat less or exercise more than usual.
Several factors make it more likely for blood sugar to fall below the usually regulated standard range.
- taking too much insulin
- not eating enough carbs for how much insulin is taken or inappropriate timing of taking insulin
- a side effect of medicines that help the pancreas release insulin into the bloodstream, like medications classified as sulfonylureas or meglitinides
- the amount and timing of physical activity
- drinking alcohol, especially without food
- prolonged fasting or malnutrition
- imbalanced amounts of fat, protein, and fiber in a meal
- hot and humid weather
- unexpected stress
- severe illness
- spending time at a high altitude
- going through puberty
- menstruation
- stomach bypass surgery or other surgeries that interfere with the usual emptying of the stomach may result in low blood sugars after eating certain meals (reactive hypoglycemia or postprandial hypoglycemia)
Other factors that impact hormone levels and metabolism can also make blood sugar imbalances more likely.
For example, sleep deprivation, chronic stress, and/or over-exercising can all contribute to imbalances in cortisol and epinephrine/adrenaline, hormones that are involved in the stress response that have impacts on blood sugar levels. Cortisol binds to receptors on the fat cells, liver, and pancreas to help increase glucose for energy that the muscles use. When cortisol is dysregulated—too high, too low, a mix of both, or not in its normal rhythm of fluctuating levels—blood sugar imbalances can occur.
Epinephrine/adrenaline is another hormone that the body uses to mobilize energy during stress by stimulating the release of glucose from the locations in the body where it's stored. If your blood sugar gets too low and isn't corrected, adrenaline is secreted for a quick release of blood sugar, resulting in common symptoms of hypoglycemia like shakiness, hunger, and palpitations.
Disrupted gut bacteria (dysbiosis) can also contribute to blood sugar imbalances. Gut bacteria help you digest and metabolize carbohydrates and sugars. Imbalances in yeast and fungi in the gut can also impact blood sugar. Yeast overgrowth with candida disrupts the pancreas, thyroid, liver, adrenal glands, insulin levels, and cortisol, which disrupts the way the body processes glucose. Pathogenic yeast and fungi can also feed on glucose in your body, which brings your blood sugar crashing down.
Functional Medicine Labs to Test for Root Cause of Hypoglycemia
Blood Sugar and Insulin Function
Several tests can evaluate blood sugar balance and insulin function.
- fasting glucose: this test measures the level of glucose in the blood when you have not eaten for several hours, usually after an overnight fast. When blood glucose levels are too low, it indicates hypoglycemia.
- hemoglobin A1c: measures average blood sugar level over the previous two to three months.
- fasting insulin: if there is too much insulin in the blood, too much glucose will go into your cells. This leaves less in the bloodstream and can cause low blood sugar or hypoglycemia.
- C-peptide: a marker that the body is producing insulin.
Together, these can identify type 1 diabetes and/or insulin resistance, which lead to metabolic syndrome, heart disease, type 2 diabetes, NAFLD, and difficulty regulating blood sugar levels.
One test that looks at many of these metabolic markers of glucose balance and insulin function is the Metabolomic Profile.
Cellular Health
The NutraEval FMV also provides insights into cellular health, toxin exposure, and how the body handles oxidative stress, which can all impact metabolism and blood sugar balance.
Gut Health
A comprehensive stool test like the GI Effects reflects the overall health and balance of the digestive tract by measuring a variety of microbes and intestinal health markers. This testing can look at imbalances in yeasts like candida as well, which can contribute to blood sugar imbalances. It can help assess the balance of the microbiome as well as how well you are breaking down and digesting carbohydrates and other nutrients, which can guide an individualized approach to metabolic health and nutrition based on your unique needs.
Cortisol Balance
The Dutch Plus test uses dried urine specimens to assess adrenal hormones and their metabolites. It can help provide a picture of the way that stress hormones fluctuate during a 24-hour period.
Continuous Glucose Monitor
A blood sugar meter (glucometer) or continuous glucose monitor (CGM) allows for the measurement of blood sugar levels. A CGM is a small device that you stick to your upper arm for two weeks that reads your glucose levels every 15 minutes to get a sense of your blood sugar levels and the pattern of its fluctuations.
Integrative Medicine Treatment for Hypoglycemia
Nutrition
During an acute episode of hypoglycemia, it is generally recommended to eat or drink 15 to 20 grams of fast-acting carbohydrates like honey or fruit juice. These contain sugars without protein or fat that more quickly enter the bloodstream to raise blood sugar levels. Recheck blood sugar levels 15 minutes after eating, and if blood sugar levels are still under 70 mg/dL (3.9 mmol/L), it is recommended to eat or drink another 15 to 20 grams of fast-acting carbohydrates, and recheck your blood sugar level again in 15 minutes, repeating until the blood sugar is above 70 mg/dL (3.9 mmol/L).
In the longer term, some studies suggest that a Mediterranean-style diet may improve glycemic control to improve blood sugar levels. This way of eating focuses on whole, nutrient-dense foods inspired by the traditional diets of people living around the Mediterranean Sea. It incorporates fresh and seasonal fruits and vegetables, unprocessed whole grains, and heart-healthy fats like olive oil. Including enough fiber and a diversity of phytonutrients from a variety of colorful plant foods helps to lower inflammation and control blood sugar spikes.
Eating balanced meals at regular times and avoiding prolonged fasting or skipping meals can also help to prevent hypoglycemic episodes. Work with a knowledgeable practitioner to determine the optimal amount of carbohydrates to help keep your blood glucose level in your target range based on your unique metabolism, activity level, and needs.
In general, meals that are high in simple or processed sugars/carbohydrates will cause blood sugar to rise and then crash, resulting in low blood sugar. Balancing more complex carbohydrates with protein and healthy fats allows the body to digest and absorb sugars more slowly to provide a steady stream of fuel for your brain and body.
Balance the Gut Microbiome
Decreasing gut inflammation and balancing the microbiome helps decrease stress and systemic inflammation and can improve glucose metabolism and blood sugar levels. A diverse plant-focused diet rich in dietary fiber supports balanced gut bacteria that promote a healthy gut lining and proper digestion, weight, and blood sugar balance.
Research has shown that taking the probiotic Lactobacillus reuteri promoted optimal glucose and insulin levels. Prebiotic foods like garlic, bananas, and asparagus feed healthy gut bacteria, while probiotics in naturally fermented foods like sauerkraut and miso promote microbial diversity to help regulate blood sugar and insulin sensitivity.
Complementary and Alternative Medicine
Carnitine
Carnitine is an amino acid that helps to transport long-chain fatty acids across the inner mitochondrial membrane to be used as a source for making energy (ATP synthesis). If you don't have enough l-carnitine for the body to use fat for energy when glucose levels drop, hypoglycemia may result. Carnitine deficiency can occur due to genetic conditions or in a milder form during and after pregnancy and after prolonged vegan/vegetarian diets.
Although the body can make l-carnitine, the process requires adequate levels of nutrients, including the amino acids lysine and methionine, vitamin C, vitamin B6, iron, and oxygen. Foods that are rich in carnitine include wild-caught fatty fish, grass-fed red meats, pastured poultry, grass-fed whey, and grass-fed dairy. Carnitine supplementation may also help in some cases to improve glycemic balance.
Chromium
Chromium is a mineral required in trace amounts that is directly involved in metabolizing carbohydrates, fats, and proteins and enhances the action of insulin. Chromium supplementation has been shown to help naturally raise blood glucose levels in individuals with hypoglycemia.
Foods rich in chromium include broccoli, green beans, nuts, brewer's yeast, egg yolks, chicken, and beef.
Manage Stress and Get Enough Sleep
Unmanaged chronic stress and inadequate or disrupted sleep are associated with blood sugar imbalances. Finding a practice that is meaningful for you to manage stress and maintaining a regular sleep routine and consistently adequate sleep is key for balanced blood sugar in the long term.
Summary
Glucose is a type of sugar that is the body's primary source of energy. When blood glucose levels fall too low, the body does not have enough energy to function fully. Hypoglycemia occurs when the blood sugar levels fall too low, causing symptoms like brain fog, confusion, shakiness, rapid heart rate, lightheadedness, and hunger.
In people with diabetes, taking too much insulin or certain medications can cause blood sugar levels to drop too low. Not eating enough or exercising too much can also result in blood glucose levels falling too low. Chronic stress and dysbiosis in the gut can also throw off the balance of hormones that regulate blood sugar levels.
Acute treatment of hypoglycemia focuses on returning blood sugar to safe levels. In the longer term, a functional medicine approach can help regulate blood sugar levels and prevent episodes of hypoglycemia. Eating well-balanced meals and snacks that include complex carbohydrates, fiber, protein, and healthy fats at regular intervals and avoiding processed sugars can help keep blood sugar steady. Lifestyle habits that help manage stress and balance the microbiome in the gut are also foundational for long-term blood sugar balance.
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