This Life-Threatening Issue Is Often Confused With Anxiety. Here’s How To Spot It.

Maybe migraine attack symptoms are starting to creep in as you finish up work tasks before lunch. Or maybe after a long day, you can’t concentrate on the TV show you’re watching. You feel irritated and tired.
If you’re the kind of person who Googles your health symptoms (no judgment!) you may realize that these experiences could mean you’re dealing with anxiety or ― more surprisingly ― low blood sugar, AKA hypoglycemia.
“There is potential for misdiagnosing hypoglycemia as anxiety because the symptoms are so similar,” said Dr. Priyanka Majety an assistant professor of endocrinology, diabetes and metabolism at Virginia Commonwealth University. “Especially if the individual has no history of diabetes or hypoglycemia, as anxiety is more common and may seem like a more likely cause.”
Hypoglycemia can affect people both with diabetes and without, although it’s more common in people with the condition. Some of the causes of non-diabetic low blood sugar include skipping meals, taking certain medications like antibiotics, drinking alcohol or health issues like liver or kidney disease.
To address your symptoms effectively, you need to know what the problem is first. But how do you figure that out — especially given each person’s body and situation is different? Majety and other experts explain how to differentiate between these two conditions and how to treat those icky feelings.
First, let’s get a more comprehensive list of symptoms these two conditions share. There are more than you might think. Experts gave these examples:
Sometimes, you might have both conditions at once; this isn’t necessarily an either/or situation. “Someone with low blood sugar can also be experiencing anxiety,” said Dr. Markyia Nichols, chief medical officer at the health tech company Ciba Health.
In fact, Dr. Jennifer Kraker, a psychiatrist with 20 years of clinical experience in nutrition and psychiatry, has seen it in her practice. For example, “I’ve had several patients with anxiety whom I’ve diagnosed with diabetes with exactly this presentation,” she said.
This can happen not only because the two aren’t mutually exclusive, but also because they cause the same reactions in the body.
“Both conditions trigger the body’s fight-or-flight response, releasing stress hormones that cause similar physical sensations,” Majety said.
“When blood sugar drops, epinephrine (adrenaline) is released, which sends signals to your liver to make more glucose (blood sugar),” Nichols said. “Adrenaline also increases heart rate, makes you sweat and can lead to you feeling more anxious.”
With that said, both aren’t always at play.
There are a few ways to figure out whether it’s your brain or your blood sugar, depending on what tools you have available and your preferences.
Specific tests provide insight and can even be done at home. Nichols mentioned a continuous glucose monitor (CGM) or testing in real-time with a finger-stick. Dr. Rozalina McCoy, an endocrinologist and associate professor of medicine at the University of Maryland, agreed this is the best option if you need to know your blood sugar with any degree of precision.
“True hypoglycemia is typically defined as a blood glucose level below 70 mg/dL in individuals with diabetes on insulin therapy,” Majety said. A non-diabetic individual is considered to have low blood sugar if their level is 55 mg/dL or below, according to the National Institutes of Health, though Majety said in healthy individuals, a reading in the 50s can “still be normal.”
If you test above that, anxiety may be the culprit, but it isn’t necessarily, according to Roberta Kleinman, a registered nurse and certified diabetes educator at ADW Diabetes. “Some people feel ‘low symptoms’ even when their blood sugar is in the normal range.”
If you don’t have one of those devices, Marjorie Nolan Cohn, a registered dietitian and clinical director of the nutritionist software company Berry Street, encouraged asking yourself a few blood sugar-related questions: “Has it been longer than three hours since I last ate? What type of food did I eat last? Did the meal include a balance of carbs, protein and fat sources?”
Remember that each person’s body is different and has different needs each day, too. In other words, you may think you’ve eaten enough — or around the same as usual — but your body could still need more. Respect that!
Check-in questions for anxiety, she continued, might include any triggers you remember or ongoing stressors that have built up. Anxiety can stem from various causes: a stressful situation, a medical condition, an uncomfortable environment, trauma, a family history of the condition and more.
Another helpful option is testing by treating, according to Kraker.
“If these symptoms resolve rather quickly after eating and continue to stabilize thereafter, it is likely low blood sugar,” she said.
Majety recommended about 15 grams of fast-acting carbohydrates — like fruit juice or glucose tablets — because they can alleviate hypoglycemia quickly.
“It is also important not to treat with things that have fat in them, since fat slows down absorption and the treatment won’t work as well,” McCoy added. “So common things people [eat], like a chocolate bar, for example, are actually not good treatments.”
Other fast-acting carbs include soda, Skittles, gummy bears, Gushers and more.
The treatment depends on the cause, but what if you still don’t know which one you’re dealing with? Or what if it’s both?
“It’s also important to note that low blood sugar perpetuates anxiety, and anxiety can impact appetite,” Cohn said.
With that said, consider the following:
According to Majety, treating hypoglycemia is more urgent. This is especially true if you have diabetes, but vital even if you don’t. “If unsure of the cause, the safest initial approach is to address low blood sugar first, as untreated hypoglycemia can lead to serious complications.”
On the most severe end, Kraker listed cardiac arrhythmias, coma and death.
As mentioned above, treating hypoglycemia means eating 15 grams of a fast-acting carb, then rechecking your glucose levels in 15 minutes.
If anxiety is behind the issues, Majety recommended calming techniques, such as deep breathing, mindfulness and grounding exercises, as well as medication and cognitive behavioral therapy with a therapist.
Majety added the importance of following up with a health care provider, as well.
“Getting a well-rounded care team to look at your labs … in real-time all together, and coming up with a comprehensive treatment plan, is going to yield the best results,” Nichols said.
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She encouraged getting a physician, registered dietitian and mental health professional for your multidisciplinary health team. Finding the right fit for each of those may take time, but don’t give up.
“Trust your body — you, the patient, know yourself best,” Kraker added. “The right clinician will be your advocate in helping you find answers.”