Adrenal Fatigue and Hypoglycemia Symptoms – Part 1

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM; Dorine Lam, RDN, MS, MPH

Hypoglycemia Symptoms

A man suffering from Adrenal Fatigue and hypoglycemia symptomsOne of the classic signs of Adrenal Fatigue are hypoglycemia symptoms. 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 hypoglycemia 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 symptoms experienced is more often than not sub-clinical. This means that the person has clinical hypoglycemia symptoms 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 contributes to hypoglycemia symptoms. Compared to a normal person or even one with compromised insulin control, those with Adrenal Fatigue tend to have hypoglycemia symptoms 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 hypoglycemia symptoms is shortened.

Sugar and Adrenal Fatigue

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 hypoglycemia symptoms?and hunger.? Many in Stage 1 can skip a meal and have no symptoms at all.

Graph of blood sugar drops which can trigger hypoglycemia symptoms

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.

Hypoglycemia symptoms 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 Polycystic Ovarian Syndrome, 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.

Read Part 2 Now!

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

Dr. Lam’s Key Question

To battle hypoglycemia both the use or natural foods or protein shakes may help.

A man suffering from Adrenal Fatigue and hypoglycemia symptoms
5 -
Dear Dr. Lam and Staff,

I would like to thank you for the generous and clear medical information you share on your website. It's safe to say you recently saved my life. I am incredibly grateful. I was and still am in Stage 2-3 Adrenal Fatigue based on a Saliva Test provided for free through a distant doctor friend. However, I have had four recent years of financial hardship which has made the AF worse. I live in a small rural town and felt I had nowhere to turn to for medical advice. After a series of health crashes since the summer and some very bad crashes, similar to what sent me to the ER a year ago. This event wiped me out financially and they had no clue what was going on even though I had extreme low pulse and blood pressure. As I read and researched your site, I realized my CHF-like symptoms were dehydration, low sodium, and hypoglycemia. It had presented itself differently than what I've experienced, and I had gotten to the point that I felt nauseous about eating. So THANK YOU! Amazingly, I have found a naturopath in town that is covered by my health insurance. However, I will continue to turn to you to learn more. Again, thank you for being there during a very dark and scary time when I felt my body was cycling down with no hope of recovery. I am extremely grateful for your open-hearted and generous services.


  • Collette says:

    As someone who deals with hypoglycemia, I found this very insightful!

  • Brigitte says:

    Hi Dr Lam,

    I have had issues with blood sugar and adrenal fatigue symptoms for the past 17 years but have only recently (as things have got worse) worked out this was what was going on. During this time I have been to the doctor many times who has tested my Hba1c levels many times and always said they are fine and so any problems are ‘in my head’. I also have PCOS and a family history of diabetes.

    Last year I found an alternative doctor in the UK who said I have adrenal fatigue and recommended taking bovine adrenal gland supplements. I did so for around 6 months (with some improvements) but then after not finding a full recovery with this approach saw a kinesiologist who did not recommend I continue with these and has instead put me on high doses of vitamin and mineral supplements. Now I am experiencing adrenal fatigue symptoms again as I try (still unaided) to work out what to eat and when. Despite eating only small amounts of whole carbs, protein with every meal, low GI foods, lots of vegetables and little dairy I am often dizzy and fatigued, have night sweats, have trouble thinking straight and in concentrating. I have hypoglaecemic symptoms and wonder if I also have insulin resistance. I have just bought an glucometer to try to find out more about what is actually happening but am getting increasingly depressed not knowing who to turn to for help. You speak often of seeing your doctor to test this or that but my doctor just says my results don’t warrant any further testing or the expense of sending me to an endocrinologist and I feel there’s no point going back there. You don’t mention bovine adrenal supplements anywhere – what is your opinion on this? Do you know anyone in the UK who might be able to help me find out more about my situation and find a way forward to better health? I don’t have health insurance and don’t know if it’s feasible to work with you in the U.S.? I’d be grateful for any ideas for a way forward for me or thoughts on the above. Many thanks for being open to questions.

    • Dr.Lam says:

      Your situation is not unique. You are not alone in your recovery effort. We have many clients on our telephone coaching program from the UK because of the lack of expertise in your country, unfortunately. You can call my office. I have written extensively on glandular. Click Adrenal Fatigue Glandular & Herbal Therapy for more information.

      Dr. Lam

  • Emilia says:

    How would PCOS affect your sugars?

  • Lindy says:

    How does hypoglycemia affect pregnancy?

  • Grace says:

    Can hypoglycemia have an impact on a person’s intimacy?

    • Dr.Lam says:

      Hypoglycemia has systemic ramifications and no organ is spared. The degree of dysfunction depends on the level of severity.

      Dr. Lam

  • Tori says:

    Can hypoglycemia affect depression?

    • Dr.Lam says:

      Hypoglycemia is a system wide event that will affect the function of all aspect of the body.


  • Utah says:

    It seems that hypoglycemia is a common symptom of AFS. Do you find many cases where people are hyperglycemic?

  • K. G says:

    I’ve had a history of chronic stress & intense exercise without proper replenishment history – I exercise to ease my stress (in hindsight counterproductive, I now take it a lot easier and cannot manage to sustain such levels). I am excessively tired, headachy, having frequent low blood pressure, dizziness, waking nightly between 1-3pm, shakes, constant anxiety, weight loss problems, sickness stomach pains (the list is endless) Its taken a while for my doctor to finally get me to an endocrinologist, after numerous requests – My cortisol showed 290. Blood sugars dip to 3.3. I have signs of hypoglycaemia before & after eating. I have found for a long time I cannot tolerate sugary food AT ALL and snacks/meals must be balanced and pain, otherwise I feel so sickly and shaky, anxious. My worry is the cortisol reading and if my body has now got to advanced adrenal fatigue stage 3 – and mostly worry if I can recover from this late stage if so???
    My endocrinologist is doing a further test to see/check its not/is addisons disease (which I am praying it isn’t) I’m 27 years old and feel SO bad/ill most of the time. Can you suggest anything??? As most doctors seem to dismiss adrenal fatigue and don’t seem to have much experience with recognising/treating it. I’m all for treating my body well and allowing it the space to heal naturally, I very anti medication as I think sometimes you end up needing a pill for he pills you too and I am very sensitive to everything ! So I cringe at the though of possibly living on replacement cortisol steroids if the cortisol tests remain low… I’m trying to stay as calm and stress free as possible and love my body back to health – Can you give me any advice??? Thank You

    • Dr.Lam says:

      You need to finish your work up first and then, given your complexity, call my office and we will talk. I will be able to tell you your options.

      DR Lam

  • Samantha says:

    My daughter is showing symptoms of hypoglycemia. She is only 7. When she is above 100 she seems fine. When she drops below 100 she gets slight headaches and below 90 they get worse with shaking feeling although it’s not always apparent she is shaking. She has dark circles under her eyes the majority of the time and even with snacks 2-3hrs her levels barely make it over 100. She is moody and cries a lot for little things now. Is this normal for a hypo patient? Is there anything more I can do to help her levels until she sees her specialist? Her family provider already has her on up to 8grams of protein or up to 15grams of carbs every 2 hrs and a times I almost double it trying to get her levels up.

    • Dr.Lam says:

      Metabolic derrangement in young children often point to underlying issues. A pediatric endocrinologist is a good person to see. Until conventional diagnosis has been ruled out, AFS should not be considered.

      Dr Lam

    • Esther says:

      Samantha, I was sorry to read about your daughter’s symptoms. I know this was a few months ago now, but wondering if you were able to figure out what her underlying issues were? When one of my kids experienced similar symptoms, it turned out to be a parasite issue. (Parasites steal our nutrients and minerals, and can cause severe deficiencies!) Perhaps looking into that could prove helpful??

  • Talilah says:

    What’s the difference btwn hypoglycemia v hyperglycemia v adrenal fatigue?

    • Dr.Lam says:

      Hypoglycemia is too low blood sugar. Hyperglycemia is too high blood sugar. Reactive hypoglycemia, the type associated with AFS, is normal blood sugar but symptomatic.

      Dr Lam

  • Alison says:

    I know anything that causes dizziness could cause a fall etc, but I want to know if hypoglycemia can directly be life threatening?

    • Dr.Lam says:

      Regular hypoglycemia can be life threatening, but that is normally not what happens in AFS. In AFS, it is reactive hypoglycemia.

      Dr Lam

  • Colin says:

    Is there any way to recover the cells damaged by a hypoglycemic episode?

    • Dr.Lam says:

      Cells usually self heal if damage is not too great. Recovery starts with not insulting the system and helping the body heal itself.

      Dr Lam.

  • Jenn says:

    Sometimes my blood sugar can go as low as in the 40s. Typically symptoms happen after 4:00pm. Shaky, weak, sweaty. As soon as I eat they subside. However I am exhausted ALL day. Can fall asleep in an instant. And I crave sugar/sweets all the time. What can I do to not feel so tired all the time? Or is this something I have to live with?

    • Dr.Lam says:

      Too low blood sugar can be dangerous to you and you should see your doctor and stabilize the blood sugar. Feeling tired can be related to blood sugar but also can be due to other causes.
      Click Adrenal Exhaustion for more information.

      Dr Lam

  • Clyde says:

    How does alcohol consumption affect hypoglycemia?

    • Dr.Lam says:

      The body generally breaks down the alcohol and blood sugar self adjusts. We do not see it as a common problem in reactive hypoglycemia AFS setting unless the person has underlying metabolic derrangements.

      Dr Lam

  • Malcolm says:

    Can adrenal fatigue make hypoglycemic headaches worse?

  • Adrianne says:

    My am cortisol level this week was 10 (279). Aside from severe muscle aches in my back, hips and thighs, my most bothersome issue is feeling shaky and cognitive issues (tunnel vision, difficulty finding words, remembering what I am doing, and concentrating). My fasting blood sugars are normal at 5.2mmol (or 93) but 2 hours after eating, they fall below my fasting levels to 4.7mmol (or 84). I start to feel symptomatic as soon as I get to 4.9mmol.

    Is this common with adrenal fatigue or adrenal insufficiency? It is not a very big decline, but it seems to be enough for me to feel completely out of sorts.

    • Dr.Lam says:

      hypoglycemia and cognitive issues are often associated with adrenal weakness. You should see your doctor to make sure

      Dr Lam

  • Gen says:

    I should probably go into the second part of the article, Im sure your comprehensive information will answer any of my questions. I have an issue after I eat, I get some of the symptoms associated with hypoglycemia but they tend to happen after I eat my food, not before. I tend to work hard most days and try to remember to eat when I get a break, but sometimes that break can be far in between. I dont get any symptoms before , but after the meal or heavy snack, I can get really tired and find it hard to concentrate. Is this the same thing ?

    • Dr.Lam says:

      hypoglycemia can happen before or after meals or in betwee. It depends on your individual metabolic profile. We need to look at the complete clinical picture to have a better idea.

      Dr Lam

    • Heather says:

      Thank you Gen for your question! I’m experiencing the EXACT same thing. Only having some symptoms AFTER eating. Also it’s mainly during the day it happens, not after the evening meal. People with AF usually feel better after 6 p.m. I’ve been diagnosed with AF and hypoglycemia from 3 hr glucose tolerance test. So far treatments haven’t helped with symptoms.

  • gloria duncan says:

    i have had seizures off and on for 20 years that doctors have not found a reason for. At first i thought it had something wrong with the adrenals since i had a pain in my left side but doctors dismissed it. my doctor isn’t interested in anything that’s not generating a profit so he does nothing. I really appreciate the fact that you looked beyond the average doctors view point to offer a solution to those of us that are forgotten. THANKS!!!

  • Lauren says:

    If you have hypoglycemia connected to adrenal fatigue. How do you get them to heal if you also need sugar to keep your blood sugar up?

    Seems like it cancels it out. So you’re getting low blood sugar attacks from adrenal fatigue– so you need sugar to get it up– while at same time you’re hurting you’re adrenals by having the sugar.

    • Dr.Lam says:

      Its a fine balance Lauren. Eating and snacking frequently is quite helpful, but everyone is different and you dont want to overdo.

      Dr Lam

  • John B says:

    I often feel really hyped up, inside my body, after meals. I can only compare it to having an energy drink and feeling a bit anxious inside. Is this considered hyperglycemia ?

    • Dr.Lam says:

      That can be a reflection of sugar imbalance, either too high , or even too low as ardrenaline and insulin output increases. need more clinical data and history to determine. you can see your doctor for workup and they will find out.

  • T. says:

    Thank you for this article. How can a person know if their they are more prediabetic or hypoglycemic? My A1c is prediabetic but I am in early menopause and low glycemic fruit usually brings down the after meal numbers if eaten with salad greens, half an avocado and turkey breast. However it is not always possible to eat exactly this combination to get better after meal numbers.

    • Dr.Lam says:

      Prediabetic usually have no hypoglycemic symptoms and the big clinical picture is very different. An AFS literate doctor would be able to tell with detailed history . Sometimes you can have both.

      Dr Lam

  • Clark says:

    How do meal replacements fair when dealing with hypoglycemia ? Some times using them is just easier then cooking.

  • Christine says:

    My son is 5 yrs old and has recently had a blood test to test for diabetes but his level came back as normal at 4.5 mmol/L. When my son gets hungry he either says he is tired and lyes on the floor or his bed doing nothing (he doesnt actually fall asleep just kind of goes into his own world) or becomes very irritable, crying and throwing a huge tantrum often over something very minor. Once we manage to get some food into him he is like a different kid – well he becomes his normal self again. It is a marked difference to us. Sometimes he says he cant eat even though I know he is hungry as he says his tummy hurts. On these occassions I give him a tiny bit of juice and then I offer him the same food as before and he will have no problem eating it. Hypoglycemia runs in my family but it seems he does not have that as his blood test said he was normal. So the Drs are saying it is behavioural. Do you have any ideas? My gut is that it is not behavioural that there is something going on, but the medical stuff says otherwise.

    • Dr.Lam says:

      I am not an expert in pediatrics so unable to comment. Very sorry.

      Dr Lam

    • Linda says:

      I am hypoglycemic. Your son’s behavior sounds like me when my sugar is low. Celery with peanut butter, cheese and crackers or just a glass of milk help stabilize me.

      My routine bloodwork always comes back normal. The glucose tolerance test determined I was hypoglycemic.

    • emily says:

      hi i have to eat every 3 hours or i start getting hypoglycemic symptoms but the lowest my blood sugar ever gets is 4.6mmol/L – 82mg/dl even if i feel like im about to faint. its gets better within 5 minutes of eating. i can not have a fasting blood test at the moment for other health reason
      i’m so confused what else could this be

  • Cole says:

    Is hypoglycemia reversible?

    • Dr.Lam says:

      In the setting of AFS, yes in most cases if properly addressed. It can also get worse if not approached properly.

      Dr Lam

  • Phil says:

    I believe i do have an acute form of hypoglycemia from reading your article. I will try the carbohydrates with juice for a quick fix, but how can i decrease any hypoglycemic episodes?

    • Dorine Lam RDN says:

      In order for you hypoglycemia to improve, you need to look at the underlying issue, what is causing the hypoglycemia. If the underlying issue is Adrenal Fatigue Syndrome, then you need to improve your adrenal glands first.

      Dorine Lam, RDN, MS, MPH
      Registered Dietitian and Senior Holistic Nutritionist

  • Colleen says:

    I’ve heard nuts are helpful snacks for those suffering from hypoglycemia. Unfortunately, I am allergic to nuts. Are there alternative snacks that you recommend?

    • Dorine Lam RDN says:

      You need some sort of protein and fats in your snack. You can even use the food you have from your previous meals. Eggs and cheese, meat are good alternative.

      Dorine Lam, RDN, MS, MPH
      Registered Dietitian and Senior Holistic Nutritionist

  • Karla Putnam says:

    My 20 year oldaughter almost always feels hungry after she eats. She eats a lot of simple carbs so I think she isn’t balancing her meals. She was still concerned so she saw her doctor today. They checked her blood pressure while laying down, sitting and standing and they were all about the same. So she had blood drawn to check glucose, anemia and thyroid and they were all normal. She is going to focus on diet changes, if that doesn’t seem to help any other suggestions? Thank you.

    • Dr.Lam says:

      Loa blood pressure can be a sign of adrenal fatigue. But we dont want to jump to conclusion until everything else has been ruled out.
      Click Adrenal Fatigue & Blood Pressure for more information.

      Dr Lam

      • Karla says:

        Her BP was 102/60. Do you consider that low?

        • Karla says:

          Also all blood work came back within normal limits. She was advised to stay hydrated. No further work up. I failed to mention when she gets hungry after just eating she get tired and nauseous like she is about to faint. If she eats then she feels better.

        • Dr.Lam says:

          There is really no formal definition of low blood pressure. Most conventional docs would want you to be able to stand up and not feeling dizzy, and have no problem with urination. ( remember that the blood pressure needs to be at a certain level for uring stream to form). Generally speaking 102/60 alone is not considered low unless there are other symptoms.

          Dr Lam

  • Daniel says:

    I’m always hungry. If I don’t eat every 2 hours I get dizzy, nausea, heart palpitations and just feel like crap all around. Now I know why… Now time help my body instead of hurting it by ignoring it’s signals. Thank you Dr. Lam.

    • Dr.Lam says:

      Reactive hypoglycemia can be a problem and symptoms are similar to what you mentioned. The key is to understand that the body’s underlying metabolism is not well. So you need to focus on that. Click NeuroEndoMetabolic Symptoms of Stress for more information.

      Dr Lam

      • Dawn Zimmermamn says:

        Thank you so much for this wonderful comprehensive article. Iv been searching for this qnswer for months. I was literaaly killing myself with stress over the past three years and started hving these hypoglycaemia episodes. I stopped the bus in January and thought everything would get better but i hv crazy episodes of hypoglycaemia and was terrified it was a sign of diabetes. Iv asked many natural practitioners but not one has adequately been able to explain my symptoms…they mention adrenal fatigue but dont actually give this explanation. I now know that Im on the right path and fully understand mow. Thank you so much.

  • Becky says:

    I feel as though my blood sugar drops even right after I eat sometimes, and my vision blurs badly. This hasn’t shown up on tests as hypoglycemia or diabetes. I’m pretty sure it is adrenal fatigue. I’m quite ill but tests are “normal”. I had to have an oopherectomy at a young age and now am 60. Of course i had to be on estrogen. Can estrogen replacement cause hypoglycemia ? Or worsen my adrenal fatigue? I have cut the dose a good bit. I seem to be more and more sensitive to estrogen yet when I try to stop totally it is very dangerous with blood pressure spikes.

    • Dr.Lam says:

      If you have reactive hypoglycemia, your blood sugar would be normal while you are symptomatic. Estrogen is usually not related to this type of hypoglycemia, but AFS is. The complexity arises when AFS is associated with estrogen dominance, and that in turn can cause metabolic imbalances. Something is not right. I dont have enough details to have a handle on what is going on based on your description.

      Dr Lam.

  • michael says:

    I quit using tobacco and two weeks after I crashed and have still not recovered. Constant thyroid symptoms and severe anxiety and panic attacks and my body has reverted to basic form. MY stomach does not digest food almost at all. Need your help

  • Emily says:

    Are there any supps that I can take to prevent my blood sugar from dropping? I feel like my sugar tends to drop in my sleep and wakes me in the middle of the night.

    • Dr. Lam says:

      Chromium is a supplement that have sugar balancing properties. Eating some snack before bedtime is also a good strategy.

      Dr Lam