Frequent Low Blood Sugar: Common Causes and What You Should Know
If you often feel dizzy, shaky, or unusually fatigued between meals, you might be experiencing frequent episodes of low blood sugar—also known as hypoglycemia. While occasional dips in blood glucose can happen to anyone, recurring hypoglycemia is not normal and may point to underlying health conditions that require medical attention.
Understanding the Triggers of Recurrent Hypoglycemia
Hypoglycemia occurs when blood glucose levels fall below 70 mg/dL. The body relies on glucose as its primary energy source, especially the brain. When glucose drops too low, it triggers a range of physical and cognitive symptoms. Frequent low blood sugar isn't just uncomfortable—it can be dangerous if left unmanaged. Identifying the root cause is essential for effective treatment.
1. Stress and Hormonal Fluctuations in Women
Women are particularly susceptible to reactive hypoglycemia during periods of high stress. Emotional or psychological stress can disrupt the balance of hormones like cortisol and adrenaline, which play a key role in glucose regulation. This imbalance may lead to sudden drops in blood sugar, especially in individuals with sensitive metabolic systems. Symptoms such as anxiety, sweating, and heart palpitations during stressful situations could signal stress-induced hypoglycemia.
2. Early Signs of Type 2 Diabetes
One of the most overlooked causes of frequent low blood sugar is early-stage type 2 diabetes. It may sound counterintuitive—diabetes is typically associated with high blood sugar—but in its early phases, the body may overcompensate by releasing too much insulin after meals.
This delayed insulin spike, known as a shifted insulin secretion curve, often peaks 3 to 4 hours after eating. As a result, blood sugar plummets by the time the next meal approaches. People may feel fine right after breakfast but experience intense hunger, shakiness, or confusion before lunch. Recognizing this pattern early can help prevent full-blown diabetes through lifestyle changes and medical monitoring.
3. Insulin-Producing Tumors: Insulinoma
A rare but serious cause of chronic hypoglycemia is insulinoma—a tumor in the beta cells of the pancreas. Most insulinomas are benign, but they produce insulin autonomously, meaning they release insulin regardless of blood sugar levels.
This unregulated insulin production leads to persistent fasting hypoglycemia, especially noticeable in the morning or after prolonged periods without food. If you frequently wake up with headaches, confusion, or nausea, an insulinoma should be ruled out. Diagnosis usually involves fasting blood tests to measure insulin and glucose levels, followed by imaging studies like contrast-enhanced CT scans or MRI to locate the tumor.
4. Liver Disease and Glucose Storage Problems
The liver plays a crucial role in maintaining stable blood sugar by storing and releasing glucose as needed. In patients with chronic liver disease or cirrhosis, this function becomes impaired due to reduced glycogen synthesis and storage capacity.
As a result, the liver cannot adequately release glucose during fasting states, leading to recurrent hypoglycemia. Individuals with a history of hepatitis, fatty liver disease, or alcohol-related liver damage should have their liver function evaluated if they experience unexplained low blood sugar. Blood tests assessing liver enzymes, albumin, and coagulation profiles can provide vital clues.
5. Rare Immune-Related Conditions: Insulin Autoimmune Syndrome
An even rarer cause is insulin autoimmune syndrome (IAS), also known as Hirata's disease. In this condition, the body produces antibodies that mistakenly bind to insulin or the insulin receptor, causing unpredictable fluctuations in blood glucose.
Unlike other forms of hypoglycemia, IAS is more common in certain populations and can occur without diabetes. It's often triggered by medications containing sulfhydryl groups, such as methimazole. Diagnosing IAS requires specialized testing to detect autoantibodies against insulin, and treatment focuses on managing antibody activity and stabilizing glucose levels.
When to See a Doctor
Frequent low blood sugar should never be ignored. Whether it happens between meals, overnight, or seemingly at random, it's a sign that your body's glucose regulation system is off balance. Early diagnosis and intervention can prevent complications such as seizures, loss of consciousness, or long-term neurological damage.
If you're experiencing recurrent symptoms like trembling, sweating, irritability, blurred vision, or difficulty concentrating, consult a healthcare provider. A comprehensive evaluation—including blood work, glucose monitoring, and possibly imaging—can uncover the real cause behind your hypoglycemia and guide personalized treatment.