Key takeaways

Hypoglycemia can occur without diabetes, often due to other medications, conditions, or factors like prediabetes, stomach surgery, enzyme deficiencies, or non-food related issues such as certain illnesses and hormone dysregulation.
Symptoms of hypoglycemia vary and can include shakiness, anxiety, sweating, dizziness, hunger, and others. In severe cases, confusion, loss of consciousness, or seizures may occur, requiring emergency medical attention.
Non-diabetic hypoglycemia can be diagnosed and potentially cured by identifying and treating the underlying cause, with immediate treatment for low blood sugar episodes involving consumption of quick sugar foods or drinks, such as juice or honey.
For people with diabetes, preventive steps for hypoglycemia include adherence to a diabetes management plan. For people who do not have diabetes, dietary and exercise adjustments can help, including eating frequent small meals, or only exercising after eating. Underlying health conditions or medication issues must be addressed for long-term management.

Hypoglycemia occurs when your blood sugar is lower than it should be—sometimes it’s just called low blood sugar. It’s normal for blood sugar (aka blood glucose) levels to vary throughout the day. But if your levels fall far below the healthy target range (usually below 70 mg/dL), it can cause uncomfortable, and even dangerous, symptoms.

Can hypoglycemia occur without diabetes?

While hypoglycemia is commonly associated with diabetes mellitus, there are other medications and conditions that cause it—but hypoglycemia without diabetes is quite uncommon, according to Satjit Bhusri, MD, founder of Upper East Side Cardiology in New York City.

Diabetes is defined by excess sugar in the blood, or hyperglycemia. Hypoglycemia is defined by insufficient sugar in the blood.

What are the symptoms of hypoglycemia?

Changes in blood sugar affect everyone differently. According to the American Diabetes Association (ADA), some common symptoms of hypoglycemia include:

Shakiness or jitteriness
Anxiety or nervousness
Sweating, chills, or clamminess
Irritability
Fast heartbeat
Dizziness or lightheadedness
Hunger
Nausea
Sudden paleness
Feeling sleepy, weak, or lethargic
Tingling in lips or cheeks
Headache
Clumsiness

In cases of severe hypoglycemia, these symptoms can lead to confusion, impaired vision, loss of consciousness, or seizures. If someone passes out, or has a seizure from low blood sugar, you should call 911 immediately.

Most people have felt the effects of low blood sugar from time to time—when you’re really really hungry, or if you exercised on an empty stomach. But, “if you are experiencing symptoms of hypoglycemia several times a week, this signals that you should seek medical care,” explains Soma Mandal, MD, an internist at Summit Medical Group in Berkeley Heights, New Jersey.

What can cause hypoglycemia in people without diabetes?

There are two main types of non-diabetic hypoglycemia, each with different causes: reactive and nonreactive.

Reactive hypoglycemia

Reactive hypoglycemia typically occurs when you experience low blood glucose levels a few hours after eating a meal. It’s not fully understood what’s behind it, but it’s likely overproduction of insulin.

It can be caused by:

Prediabetes: Your body produces the incorrect amount of insulin. This can signal an increased risk of developing Type 2 diabetes.
Stomach surgery: Food passes too quickly through your system
Enzyme deficiencies: Impair your ability to break down food

Non-reactive hypoglycemia

Non-reactive hypoglycemia, also known as fasting hypoglycemia, isn’t directly related to food consumption. It’s caused by:

Medications, such as quinine
Illnesses involving the liver, kidneys, pancreas, or adrenal glands
Eating disorders, such as anorexia
Alcohol overconsumption
Hormone dysregulation
Tumors

These can all impact your body’s ability to release insulin, which can lead to low levels of blood sugar.

Can hypoglycemia without diabetes be cured?

Non-diabetic hypoglycemia can be cured. The first step is being appropriately diagnosed. “Hypoglycemia in diabetics and non-diabetics can be diagnosed by checking your fasting sugar level in your blood, which can typically be done as a point of care test at any provider’s office or urgent care walk-in center,” Dr. Bhusri says.

Your healthcare provider will do a physical exam, ask you questions about your health history, and may run other blood tests or screenings. These can include asking you to record your symptoms when fasting (not eating), or eating a carbohydrate-heavy meal and watching for symptoms in a few hours. In some cases, your healthcare provider may have you complete a mixed-meal tolerance test, in which you consume a certain amount of carbohydrates (either through food or drink), then monitor your blood sugar levels. These tests, along with a visit to an endocrinology specialist can help to find—and treat—the underlying cause.

In the short term, if you are hypoglycemic you can take steps to bring your blood glucose back to normal with a small serving of a quick sugar food such as fruit juice, honey, soda, milk, or hard candy. In the long-term, you have to cure the condition causing it.

Can hypoglycemia be prevented?

Yes, hypoglycemia can be avoided with preventive steps—whether you have diabetes or not.

If you have hypoglycemia with diabetes, it’s all about sticking to your diabetes management plan. Double-check your insulin or medication dosage before taking it, and let your healthcare provider know if you change your eating or exercise habits. It might affect your glucose levels.

Or, consider a continuous glucose monitor (CGM). It transmits blood sugar to a receiver, and alerts you if it’s dropping too low. Then, be sure to always have glucose tablets or injectable glucagon on hand. If you pass out from low blood sugar and require immediate treatment, your friends or loved ones can administer a dose.

If you have hypoglycemia without diabetes, diet and exercise adjustments should prevent many episodes of hypoglycemia if there is no underlying condition. Your healthcare provider may recommend eating frequent small meals, consuming a varied diet of fats, protein, and carbohydrates, or only exercising after eating.

Just remember, snacks and diet changes aren’t a long-term cure if it’s due to a health condition or medication. Work with your healthcare provider to find and resolve the true cause of your hypoglycemia.