Feeling Shaky Before Eating? Hypoglycemia Causes and Prevention
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Feeling Shaky Before Eating? Hypoglycemia Causes and Prevention

Feeling Shaky Before Eating? Hypoglycemia Causes and Prevention
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Updated on July 31, 2025
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If it’s been a while since you ate and you suddenly start to experience weakness, dizziness, sweating, or shaking, it might be due to hypoglycemia — commonly called low blood sugar. While this can be frightening and even dangerous, hypoglycemia is preventable and easily treatable.

Understanding Hypoglycemia

There are two types of hypoglycemia: fasting and reactive (postprandial). Fasting hypoglycemia is abnormally low blood sugar that occurs when you are in a fasting state, meaning you haven’t eaten for a while. Reactive hypoglycemia (also called postprandial hypoglycemia) happens a few hours after a meal. The exact cause of reactive hypoglycemia is unknown, but it’s more commonly seen in people who have had bariatric surgery.

Various hormones in your body work together to control your blood sugar and maintain it within a specific range throughout the day. Insulin works to lower blood sugar levels, whereas glucagon, epinephrine, cortisol, and growth hormone defend against blood sugar dropping too low. In healthy individuals, fasting blood sugar usually stays between 70 and 99 milligrams per deciliter (mg/dL).

However, you can experience symptoms of hypoglycemia if your blood sugar dips below 70 mg/dL.

 Typical symptoms include hunger, sweating, nervousness, and shakiness. Symptoms can become increasingly severe if your blood sugar drops even more. You may experience dizziness, sleepiness, confusion, or difficulty speaking, and you’ll likely feel anxious or weak if your blood sugar drops below 55 mg/dL.
Sudden shaking and sweating can occur when your blood sugar is low because your body releases hormones like glucagon and epinephrine to help bring it up. The shaking and sweating symptoms are side effects of the epinephrine.

True hypoglycemia in people without diabetes is rare.

Who’s at Risk

True fasting hypoglycemia is not common in healthy people because your body is efficient at regulating blood sugar, even when you skip a meal or don’t eat for a day or two. Most often, symptoms occur if you’re taking certain medications. The following medicines can potentially contribute to hypoglycemia:

  • Insulin, used for type 1 and type 2 diabetes
  • Sulfonylureas, used to treat type 2 diabetes

  • Beta-blockers, most commonly used for heart conditions
  • ACE inhibitors, used to lower blood pressure
  • Quinolones, a class of antibiotics
  • Tramadol, used for moderate to moderately severe pain
  • Pentamidine, used to treat a type of pneumonia
  • Quinine, used to treat malaria

Alcohol can also be a trigger.

Hypoglycemia is more likely to occur in someone with diabetes. “Some oral diabetes medications work by stimulating your insulin to work better,” says Erin Charboneau-Palma, RD, a dietitian and certified diabetes care and education specialist with Kelly’s Choice in Skaneateles, New York. “That in turn lowers your blood sugar, and hypoglycemia can be a side effect.”

“It’s especially important that you don’t skip meals with these meds or if you take insulin shots,” she says.

If you’re otherwise healthy and often experience hypoglycemia, it’s important to talk to your doctor. Other rare but serious reasons for low blood sugar include illnesses that affect your pancreas, liver, or kidneys.

How to Treat Hypoglycemia

Hypoglycemia can catch you off guard if you get busy and forget to eat. If you suddenly start sweating and shaking, it’s important to stop and eat or drink something to boost your blood sugar.

Carbohydrates have the most significant effect on your blood sugar, so eating or drinking a carbohydrate-rich food or beverage should ease your symptoms and raise your blood sugar within a few minutes.

Foods high in carbs include:

  • A piece of fruit
  • A piece of bread or a handful of crackers or pretzels
  • A glass of chocolate milk
  • A 4-ounce (oz) glass of juice or sweetened soft drink (not diet)
  • A handful of jelly beans or gumdrops
If you have diabetes and experience low blood sugar symptoms, the American Diabetes Association recommends eating 15 grams (g) of carbohydrates, waiting 15 minutes, and checking your blood sugar.

 Repeat this until your blood sugar comes up to at least 70 mg/dL.

How to Prevent Hypoglycemia

To prevent hypoglycemia, try not to skip meals. Also, pack a snack if you’ll be busy and unable to stop for a meal, especially if you’re drinking alcohol or taking medications that can trigger hypoglycemia.

Palma advises eating a snack that includes both protein and carbs — a combination that will help keep your blood sugar more stable until your next meal. Good options include cheese and crackers, nut butter and rice cakes, or fruit and nuts.

Feeling shaky when you haven’t eaten can be dangerous if you’re driving or doing something that requires focus and concentration. Steer clear of hypoglycemia by not skipping meals and traveling with a healthy snack. If it happens often, talk to your doctor to rule out any health problems.

The Takeaway

  • If you feel shaky before meals, it may be due to hypoglycemia, or low blood sugar, which can occur after several hours of not eating.
  • Prevent hypoglycemia by not skipping meals. If you’re busy, carry a carbohydrate-rich snack like fruit, crackers, or juice to boost your blood sugar if symptoms start.
  • Consider eating snacks that combine protein and carbohydrates to maintain more stable blood sugar levels throughout the day.
  • See your doctor if you have recurrent episodes of shakiness or other symptoms of hypoglycemia, especially if you have diabetes or are taking medications.
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Hypoglycemia (Low Blood Sugar). Cleveland Clinic. January 31, 2023.
  2. Blood Sugar Test — Blood. Mount Sinai. January 10, 2025.
  3. Hypoglycemia. Endocrine Society. January 24, 2022.
  4. Hypoglycemia. Harvard Health Publishing. December 15, 2022.
  5. Prybys K. Drug-Induced Hypoglycemia. University of Maryland School of Medicine. May 16, 2019.
  6. Costello RA et al. Sulfonylureas. StatPearls. July 12, 2023.
  7. Hypoglycemia. Mayo Clinic. November 18, 2023.
  8. Treating Low Blood Sugar. UCSF Health.
  9. Low Blood Glucose (Hypoglycemia). American Diabetes Association.
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Anna L. Goldman, MD

Medical Reviewer
Castle Connolly Top Doctor

Anna L. Goldman, MD, is a board-certified endocrinologist. She teaches first year medical students at Harvard Medical School and practices general endocrinology in Boston.

Dr. Goldman attended college at Wesleyan University and then completed her residency at Icahn School of Medicine at Mount Sinai Hospital in New York City, where she was also a chief resident. She moved to Boston to do her fellowship in endocrinology at Brigham and Women's Hospital. She joined the faculty after graduation and served as the associate program director for the fellowship program for a number of years.

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Anne Danahy MS RDN

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Anne Danahy MS RDN is a Scottsdale-based health writer and integrative nutritionist. She specializes in women's health, healthy aging, and chronic disease prevention and management. Anne works with individuals and groups, as well as brands and the media to educate and inspire her audience to eat better, age gracefully, and live more vibrantly.

Anne holds a Bachelor of Arts from the University of Notre Dame, and a Master of Science in food and nutrition from Framingham State University in Massachusetts. Visit her at her health and nutrition blog: CravingSomethingHealthy.com or AnneDanahy.com

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