The Link Between Low Blood Sugar and Anxiety

There’s plenty in life to make you anxious. When you have diabetes, you can add low blood sugar (your doctor may call it hypoglycemia) to the list. But why does it happen? More importantly, what can you do about it?

Why Low Blood Sugar Makes You Anxious

When your blood sugar drops, your body tries to bring it up. It pumps out epinephrine (adrenaline), a “fight or flight” hormone that, among other things, tells your liver to make more glucose (blood sugar).

Adrenaline also makes your heart race and your palms sweat. And it can make you feel cranky and anxious. These are warning signs that your blood sugar is too low. If it stays there, your body puts out more hormones, including one called cortisol, also known as "the stress hormone," partially because it helps control things like your mood and fear.

Put adrenaline and cortisol together, and you've got a recipe for anxiety.

Why Your Blood Sugar Drops

The goal of diabetes treatment is to lower your blood sugar. But sometimes, it drops too low. Most people feel symptoms if it goes below 70 milligrams per deciliter (mg/dL). It can happen when you:

  • Take too much diabetes medicine
  • Skip meals
  • Eat less
  • Exercise more than normal

People who don’t have diabetes can get low blood sugar, too. Some medicines and diseases can cause it. It can also happen if you:

What You Can Do

If you have diabetes, a great way to help keep anxiety away is to keep your blood sugar in a safe range. That’s not as easy as it sounds. But these tips can make it a bit easier:

Be careful with insulin. Too much of it is the most common reason for low blood sugar. If you're taking insulin to treat your diabetes, be sure to use the right type and dose every time. When you inject it, make sure to do it just under your skin. A shot into the muscle absorbs too fast and doesn’t last as long.

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Go low (glycemic). Some foods make your blood sugar shoot up fast and drop a few hours later. Other foods keep it on a more even keel. A food’s glycemic index is a good way to know which is which.

It's a number that gives you an idea of how fast your body turns carbs into sugar. The higher the number, the quicker it happens and the higher your blood sugar will spike. High-glycemic foods include:

  • Simple sugars
  • Sugary drinks
  • Carbs like white bread, pasta, rice, and potatoes

Low-glycemic foods include:

You can still eat some high-glycemic foods now and then. But enjoy smaller portions with plenty of healthy fat, protein, and carbs at the same time. What you eat matters. But how much and in what combination are just as important.

Exercise wisely. Exercise can lower your blood sugar. A good workout is a great way to ease anxiety. While you're getting your sweat on, your brain pumps out endorphins and other “feel-good” chemicals. Over time, exercise rewires your brain so you feel better overall.

Just be sure to adjust your carbs and insulin before you work out so that your blood sugar doesn't drop too much. How much you need to tweak it depends on things like the type of exercise you're doing and how much you weigh. Your doctor can help you figure out how you can exercise safely.

Limit alcohol. Adult drinks can lower your blood sugar for up to 24 hours. If you drink alcohol, keep it moderate. Women should keep it to one drink a day. For men, the limit is two. A serving is 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of liquor. Never drink on an empty stomach.

When Lifestyle Changes Aren’t Enough

Even if you eat healthy, stay active, and avoid lows, you might still feel anxious. If this happens, it might help to talk to a therapist or other counselor. Cognitive behavioral therapy (CBT) is one type of talk therapy proven to help with anxiety. You work with a counselor to recognize when you're having negative thoughts and think through new ways of dealing with situations that challenge you. Talk with your doctor about it.

WebMD Medical Reference Reviewed by Michael Dansinger, MD on May 07, 2020

Sources

SOURCES:

American Diabetes Association: “Hypoglycemia (Low Blood Sugar),”  “What Can I Eat?”

Annals of the New York Academy of Sciences: “Neuroendocrine Responses to Hypoglycemia.”

Endotext.org: “Non-Diabetic Hypoglycemia.”

The American Journal of Clinical Nutrition: “High glycemic index diet as a risk factor for depression: analyses from the Women’s Health Initiative.”

British Journal of Pharmacology: “Adrenaline: insights into its metabolic roles in hypoglycaemia and diabetes.”

PsychologyToday.com: “The Connection Between Anxiety, Anger, and Adrenaline.”

American Diabetes Association: “Hypoglycemia (Low Blood Sugar).”

Harvard Health Publishing: “Glycemic index for 60+ foods,” “Exercise is an all-natural treatment to fight depression.”

Case Reports in Psychiatry: “Generalized Anxiety Disorder and Hypoglycemia Symptoms Improved with Diet Modification.”

The American Journal of Clinical Nutrition: “Glycemic Index, Glycemic Load, and Common Psychological Disorders.”

Expert Review of Neurotherapeutics: “Exploring exercise as an avenue for the treatment of anxiety disorders.”

Dialogues in Clinical Neuroscience: “Cognitive behavioral therapy for anxiety disorders: An update on the empirical evidence.”

The Lancet: Diabetes & Endocrinology: “Exercise management in type 1 diabetes: A consensus statement.”

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