By: Michael Lam, MD, MPH and Dorine Lam, RD, MS, MPH

A man suffering from adrenal fatigue

One of the classic signs of Adrenal Fatigue is hypoglycemia. Traditionally hypoglycemia is a medical term for a state produced by a lower than normal level of blood sugar.

Unfortunately, no single glucose value alone satisfactorily gauges all people because many variables are involved. While there are no disagreements as to the normal range of blood sugar (90-110 mg/dl), debate continues as to what degree of hypoglycemia warrants medical evaluation and treatment, or can cause harm.

Throughout the 24-hour cycle of a day, blood plasma glucose levels of healthy people are generally maintained between 72 and 144 mg/dL (4-8 mmol/L) while 60 or 70 mg/dL (3.3 or 3.9 mmol/L) is commonly cited as the lower limit of normal glucose.

Many healthy people can occasionally have glucose levels in the hypoglycemic range without symptoms of disease. This makes hypoglycemia a difficult clinical state to establish in the first place. The problem is further compounded in those with Adrenal Fatigue.

In adrenal fatigue, the hypoglycemia experience is more often than not sub-clinical. This means that the person has clinical signs of hypoglycemia even though the blood plasma level is invariably above 60-70 mg/dl. Their fasting serum blood sugar and glucose tolerance tests are usually normal. Conventional doctors not aware of the adrenal influence will miss this.

The diagram below shows how Adrenal Fatigue affects hypoglycemia. Compared to a normal person or even one with compromised insulin control, those with Adrenal Fatigue tend to have symptoms of hypoglycemia even though the serum blood sugar may be within the normal range. This is clinically evident. After a meal, those with advanced Adrenal Fatigue tend to have a faster dip in serum blood sugar below the Hypoglycemic Symptoms Threshold (HSL) level compared to normal. This triggers symptoms of hypoglycemia such as irritability and fatigue. The more advanced the Adrenal Fatigue, the more the blood sugar curve is shifted towards the left. As a result, the time between completion of a meal to the onset of hypoglycemic symptoms is shortened.

For this reason, it is common for those with Stage 3 and beyond Adrenal Fatigue to require sugar replenishment every 2-3 hours. A small snack usually suffices. In fact, as Adrenal Fatigue recovers, this period lengthens. Those with Stage 2 Adrenal Fatigue can go 4-6 hours without food and not have symptoms of hypoglycemia and hunger.  Many in Stage 1 can skip a meal and have no symptoms at all.

Our body needs a continuous supply of energy to maintain homeostasis throughout the day. Cellular energy demand is met by intake of food, which is then converted into sugar. When this demand is not being met, as in Adrenal Fatigue, the body will turn to existing protein and fat as resources of energy. This pathway is not as efficient but, nevertheless is put on overdrive in order to provide the energy required. Without adequate cortisol levels to elevate blood sugar levels by facilitating the conversion of glycogen, fats, and proteins to new glucose supplies, this increased demand is difficult or impossible to meet. Irregular blood sugar patterns with hypoglycemia are common as the body tries to kick start the process whenever it detects a low blood sugar level. This leads to a variety of symptoms.

Symptoms of hypoglycemia include hunger, nausea, headache, rage, lethargy, daydreams, confusion, amnesia, dizziness, fatigue, irritability, anxiety, jittery feelings, adrenaline rush, elevated heart rate, memory loss, and in severe cases, fainting, coma, and seizures.

Key hormones regulating blood sugar in the body include insulin, cortisol, and growth hormone. Conditions associated with Adrenal Fatigue that might also play a part in sugar regulation include PCOS, metabolic syndrome, drug effects, adrenal insufficiency, and diabetes. In the absence of other medical reasons, one must consider Adrenal Fatigue as a cause.

Acute hypoglycemia can easily be temporarily reversed by taking 10-20 grams of carbohydrate (3-4 ounces of orange, apple or grape juice). While this can be overcome with a sugar fix consisting of an instant load of sugary drink or food such as coffee or soda, this is a quick solution emergency remedy only. Usually symptoms go away immediately, but return after 1-2 hours. Reactivation and restoration of normal cell function require extra amounts of energy beyond what is normally required for maintenance of normal energy burn. With each hypoglycemic episode, more cells are damaged. Thus, the body reaches a new low with each insult of hypoglycemia. If this happens at the same time as demand for glucose increases, the stage becomes set for an adrenal crisis. With each plunge, the Adrenal Fatigue increases and hypoglycemia worsens. By the end of the day, the person may feel nearly exhausted without having done anything. Low blood sugar times are most likely to occur at around 10:00 a.m., 2:00 p.m., and from 3-4:00 p.m.


© Copyright 2013 Michael Lam, M.D. All Rights Reserved.

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