“Does anyone else experience hypoglycemia with their lupus?” asked a MyLupusTeam member. That’s a fair question: Hypoglycemia (low blood sugar) might not be generally linked with lupus, but if you have this autoimmune condition, you know it can affect any part of your body. So, if you’re having trouble regulating your glucose (blood sugar) levels, you may wonder if it’s related to lupus.

Another member responded with a yes: “I have been struggling with hypoglycemia for the last two years. It is so difficult to get a handle on because mine is caused by exercise, which is sometimes just moving around too much, which may not be much at all.”

Problems with blood sugar tend to be associated with diabetes, a chronic (long-term) condition that affects the body’s use of glucose. But people who don’t have diabetes can also be vulnerable to blood sugar problems such as hypoglycemia. If you have lupus, your condition or its treatment could lead to low blood sugar.

What Is Hypoglycemia?

For most people, hypoglycemia means having a blood glucose level of less than 70 milligrams mg per deciliter (mg/dL) after fasting (not eating for eight or more hours). However, you probably won’t learn from a blood test that your sugar level has dipped — sudden dizziness, shakiness, or other symptoms are more likely to alert you that something’s wrong.

Glucose serves as your body’s main form of energy, and your supply comes from the carbohydrates found in what you eat and drink. During digestion, your body breaks carbs down into sugar, which is then released to the blood. Your pancreas is responsible for how your body uses glucose. This organ releases a hormone called insulin, which helps your cells use glucose for energy. When your blood sugar is high, the hormone binds to insulin receptors on your cells, which prompts them to take up glucose. In general, when your insulin levels go up, your blood sugar goes down.

What Does Hypoglycemia Feel Like?

Normally, you probably won’t be aware of your glucose levels rising and falling throughout the day, responding to when and what you eat. But if your level dips too low, you might experience hypoglycemia.

Common symptoms of hypoglycemia include:

• Shakiness
• Sweating
• Hunger (more than usual)
• Rapid heart rate
• Light-headedness or dizziness
• Paler skin color
• Irritability or nervousness

If you ignore or don’t feel the initial warning signs of hypoglycemia, symptoms can worsen. More severe signs of hypoglycemia can include:

• Tunnel vision or blurred vision
• Clumsiness
• Confusion or unusual behavior
• Slurred speech
• Loss of consciousness

The signs of hypoglycemia act as a warning sign for you to get something to eat. Not everyone experiences hypoglycemia the same way, and the symptoms may even vary for the same person at different times.

What Causes Hypoglycemia?

Hypoglycemia is most common in people with diabetes who use medication to manage their insulin levels. People with diabetes either don’t make enough insulin (type 1 diabetes) or are less responsive to it (type 2 diabetes). Synthetic insulin and medications that increase the hormone are often used to treat diabetes. If a person with diabetes ends up with too much insulin in their blood, it can lead to hypoglycemia.

In people without diabetes, hypoglycemia occurs when the body can’t correct low blood sugar on its own. There are two types of hypoglycemia: reactive and fasting.

Reactive hypoglycemia occurs two to four hours after a meal. Researchers aren’t exactly sure what causes reactive hypoglycemia, but it seems to be linked to eating foods with simple (fast-digesting) carbohydrates, like bread, rice, and sugary snacks.

Fasting hypoglycemia happens after not eating for a long time. However, your body generally can call on hormones and stored glucose to keep blood sugar steady. Therefore, fasting hypoglycemia likely has another contributing factor, such as:

• Critical illness — People with severe illnesses such as kidney failure and end-stage liver disease may have trouble regulating blood sugar.
• Adrenal insufficiency — Your adrenal gland doesn’t make enough of the hormone cortisol, which usually increases blood sugar.
• Tumors — Both cancerous and noncancerous tumors can cause your pancreas to release too much insulin.
• Medications — Some medications unrelated to diabetes, such as beta-blockers and certain antibiotics, can reduce blood sugar.
• Excessive alcohol use — Several days of drinking a lot of alcohol but not eating much food can make it hard for your body to regulate blood sugar.

Can Lupus Cause Low Blood Sugar?

Having lupus can contribute to low blood sugar in several ways, which are related to the condition itself and to its treatment.

Autoantibodies

The immune system normally makes proteins called antibodies that protect the body from foreign invaders such as bacteria and viruses. However, people with systemic lupus erythematosus (SLE) can make antibodies that target their own healthy tissue, known as autoantibodies. If your immune system makes autoantibodies that target insulin receptors, it can cause hypoglycemia.

Antimalarial Medications

Hypoglycemia is a possible side effect of antimalarials like hydroxychloroquine (Plaquenil) that are used to treat lupus. MyLupusTeam members have wondered about this side effect. One asked, “Does anyone know if hydroxychloroquine can cause hypoglycemia?”

Adrenal Insufficiency

Corticosteroids (steroids), like prednisone and methylprednisolone, help reduce inflammation and are often used to treat lupus. Stopping corticosteroids after taking them for a long time can lead to adrenal insufficiency. That’s because corticosteroids are similar to cortisol, the natural hormone, and usually raise your blood sugar. If you take steroids for more than a few weeks, your adrenal gland starts making less cortisol. If you suddenly stop taking steroids, you may experience low blood sugar from the lack of cortisol.

How Else Can Lupus Affect Blood Sugar?

If you have lupus, you could also experience the opposite of hypoglycemia, which is known as hyperglycemia (high blood sugar). For most people, a fasting blood glucose level of 125 mg/dL is considered hyperglycemia. People with lupus may have high blood sugar from lupus medication or associated conditions.

Corticosteroids

Although suddenly stopping steroids can cause blood sugar to fall, the drugs may do the opposite while you’re taking them. Hyperglycemia is one of the most common side effects of steroids. Researchers have found that more than half of people who get high doses of steroids in the hospital experience hyperglycemia.

Diabetes

If you have hyperglycemia that isn’t caused by medication, it usually means you have diabetes mellitus. Having lupus can increase your risk of developing diabetes. A 2022 study found that people with lupus were 22 percent more likely to develop type 2 diabetes within three years of being diagnosed with lupus than people without lupus.

Both corticosteroid use and lupus disease activity can cause insulin resistance (when insulin doesn’t work as well) and higher blood sugars. “I think lupus is the reason I have diabetes,” shared one MyLupusTeam member.

Tips for Managing Your Blood Sugar

If you’re worried about your blood sugar levels, talk with your doctor about the best treatment options for you. They may ask you to keep track of your blood sugar with a glucose monitor. For some people, blood sugar monitoring is part of their regular lupus care.

If you feel the symptoms of low blood sugar, you can treat it by eating or drinking 15 grams of fast-acting carbohydrates, such as:

• A piece of fruit
• 4 ounces of juice or nondiet soda
• 1 tablespoon of sugar or honey
• Glucose tablets or gel, per the package instructions

You can help prevent low blood sugar with the following strategies:

• Have several small meals throughout the day, and never skip eating.
• Aim for a balance of carbohydrates, fats, and protein at meals.
• Keep snacks handy both at home and away.
• Avoid drinking alcohol without eating.

It’s also important to take steps to prevent high blood sugar, especially if you’re taking corticosteroids. To stay healthy during your lupus treatment, eat a balanced diet with plenty of fruits and vegetables, and try to get as much regular exercise as your condition allows.

Talk With Others Who Understand

MyLupusTeam is the social network for people with lupus and their loved ones. On MyLupusTeam, more than 223,000 members come together to ask questions, give advice, and share their stories with others who understand life with lupus.

Have you experienced hypoglycemia? What type of food or drink helps you raise your blood sugar if you feel it dipping? Share your experience in the comments below, or start a conversation by posting on your Activities page.