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Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 17527
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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I am sometimes in the afternoons( maybe 2-3 hours after a

Customer Question

I am sometimes in the afternoons( maybe 2-3 hours after a meal) or even longer feeling quite shaky like if my blood sugar would be low. No sweating, or palpitations. Just a feeling of shakiness and hunger
I did get myself a glucometer and when that happens my blood sugar is 77-82( that is like 4-5 hours after eating)
Nursing school is at one high level stress right now with only 6 mo left til graduation. I am trying to eat healthy but sometimes I am not: I am trying to exercise too- maybe 2-3 times in a week by going on a treadmill for 30 minutes.
My last hg a1c was 5.0 on May 2015.
Any thoughts of what's wrong with me or what should I do?
I have a feeling stress is involved somehow..
Submitted: 9 months ago.
Category: Medical
Expert:  Dr. D. Love replied 9 months ago.

Hello from JustAnswer.

You have done the correct actions to prove that you are not having hypoglycemia, because checking a blood sugar during symptoms is the best correct step to exclude the diagnosis.

It is true that stress/anxiety can cause symptoms that mimic hypoglycemia. However, there is no test that can be done to prove that this is the cause. A definitive diagnosis is usually dependent upon excluding other possible causes of the symptoms. However, if the symptoms are worse on more stressful days, that is strongly suggestive. And if the stress/anxiety can be relieved and the symptoms resolve, that is also good evidence that the symptoms are due to stress/anxiety, although it is frequently not easy to relieve stressful life situations.

As for other possible causes of these symptoms, there are some people that can have profound symptoms due to hunger, even though the blood sugar is not how. Eating healthy snacks between meals can help prevent these symptoms. Some people try the snacks before checking their blood sugar and interpret an improvement in symptoms as a sign that they suffer from hypoglycemia, when in reality, they are merely managing symptoms that can occur from hunger.

Other medical conditions that can mimic hypoglycemia are much less common, but include reactions to certain foods, particularly caffeine or alcohol, and certain hormonal conditions, such as adrenal disease or pituitary diease.

So, it would be reasonable to try healthy snacks in the mid-afternoon to see if the symptoms can be prevented. If you can relieve some of the stress and the symptoms improve, then that would support that it is due to the stress, such as with self-relaxation exercises or yoga, but realistically, the stress may not be eased until graduation. If symptoms persist, then it would be appropriate to see your doctor for an evaluation for the less common medical conditions noted above.

If I can provide any additional information, please let me know.

Customer: replied 9 months ago.
I do drink a lot of coffee!! Ha I wasn't thinking about this. I often feel this way when I drink more than usual coffee because I often feel that it helps with the hunger( inhibits it)
Also it is relieved by eating- usually a string cheese and one Apple does the trick
Expert:  Dr. D. Love replied 9 months ago.

Actually, if eating helps, it can be a combination of caffeine and hunger, as the two conditions can compound each other. If you can decrease the amount of caffeine intake, particularly anything beyond a cup or two of coffee or tea in the morning and eat a mid-afternoon healthy snack, such as some fruit, then there is a good chance that the symptoms can be prevented. If the symptoms are eased, then no further evaluation or intervention would be needed.

Customer: replied 9 months ago.
Ok. Cause I probably drink right around 4 cups in the morning but I sip from that amount through the day.
Ok so then for beginners, just decrease that coffe, and have an afternoon snack to prevent this?
Or like before going to the gym.
I need to eat before going to the gym or I will come home with same symptoms
Expert:  Dr. D. Love replied 9 months ago.

Yes, there is a good chance that these steps will prevent the symptoms, as this is statistically a very likely cause, and if these interventions work, there is no further concern.

Expert:  Dr. D. Love replied 9 months ago.

Please let me know if I can provide any further assistance.

If you would like my help with any future questions, I can be reached through my profile at www.justanswer.com/medical/expert-DrDLove/

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