Hypoglycemia in Anorexia

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Hypoglycemia in anorexia is a serious, potentially life-threatening symptom of starvation

Hypoglycemia in eating disorders can occur as a result of: 

A person with an eating disorder is more susceptible to hypoglycemia because glycogen stores in the liver have been used up as a result of long-term starvation. 

This article explores symptoms of hypoglycemia that can occur in an eating disorder, risks of hypoglycemia, and treatment of hypoglycemia. 

What Is Hypoglycemia

Hypoglycemia is low plasma glucose (sugar) concentration. While hypoglycemia is often a condition thought to impact people with diabetes, hypoglycemia can occur in anyone. 

Symptoms of hypoglycemia include: 

  • Shakiness
  • Hunger
  • Nausea
  • Dizziness
  • Headaches
  • Irregular heartbeat
  • Night sweats
  • Weakness
  • Tingling in lips, tongue, cheeks, fingers or toes
  • Difficulty speaking
  • Loss of coordination
  • Blurred vision
  • Nightmares

Some people are more prone to experience hypoglycemia than others.  It’s important to know that if you are a person that experiences frequent hypoglycemia your body may stop responding to low blood sugars.  However, even if you are not experiencing symptoms, the risk associated with low blood sugar is just as high. 

risks of hypoglycemia with eating disorders

Causes of Hypoglycemia

Hypoglycemia is often caused by: 

  • Not eating regularly throughout the day
  • Low-calorie intake over a long period
  • Inappropriate insulin dosing 
  • Surgeries that interfere with stomach function 
  • Medications
  • Hypermetabolism in anorexia

Some people are genetically more prone to experiencing hypoglycemia.  However, almost everyone will experience hypoglycemia at some point with prolonged starvation. 

Can Starvation Cause Hypoglycemia

Yes.  

If you have an eating disorder your body is not taking in appropriate calories or carbohydrates. In addition, your body does not have appropriate glycogen stores to draw from when you’re taking in inadequate carbohydrates and calories from the diet.  

Very low-calorie diets or even going for prolonged periods of the day without eating while the total caloric intake is adequate will likely lead to low blood sugars. 

In addition to starvation, you will also typically see hypoglycemia if you binge and restrict

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Risks of Hypoglycemia in EDs

There are many risks associated with hypoglycemia.  Symptoms of hypoglycemia such as loss of motor function, confusion, or fainting can lead to injuries, car accidents, and other environmental risks. 

Untreated hypoglycemia can lead to: 

  • Seizures
  • Convulsions
  • Heart Failure
  • Brain damage
  • Coma
  • Death

Frequent bouts of hypoglycemia are also correlated with an increased prevalence of dementia in older adults. Even if you are not seeing immediate life-threatening impacts from hypoglycemia, there can be long-term consequences. 

Preventing and Treating Hypoglycemia Anorexia

Preventing Hypoglycemia In Eating Disorders

A full and lasting eating disorder recovery is the best method of prevention from hypoglycemia in your eating disorder.  

However, ED recovery can be a long and winding road.  So what can you do in the meantime?  

Preventing hypoglycemia with an eating disorder includes: 

  1. Following a carefully tailored eating disorder meal plan
  2. Balance your meals and snacks 
  3. Don’t skip meals  
  4. Fully weight restore
  5. Eat enough carbohydrates  
infographic on causes of hypoglycemia in eating disorders

Treating Hypoglycemia in Eating Disorders

The best treatment for hypoglycemia is preventing it from happening in the first place however, if hypoglycemia does happen to you, its time to take action immediately.  

Options for treating hypoglycemia in eating disorders by: 

  1. Having at least 8 oz of juice or soda
  2. Having at least 8 glucose tablets, gummy or hard candies
  3. Having at least 2 tbsp of honey or sugar

When treating hypoglycemia, you should not eat anything containing protein, fat, or fiber (such as a candy bar, bread, fruit or peanut butter).  The goal is to get your blood sugars up as quickly as possible.  Protein, fat, and fiber will all impair your body’s ability to raise its blood sugar quickly.

The best way to get blood sugars up quickly is through simple sugars like juice, soda, or candy After you treat the hypoglycemia, wait 15 minutes before having a normal meal or snack.  

For severe hypoglycemia that includes loss of coordination or slurred speech, do not eat or drink anything as this may cause choking. Instead, treat with a glucagon injection or powder. 

If a glucometer (a tool to test blood sugars) is available check your blood sugars after 15 minutes to ensure that blood sugar is above 70mg/dL.

A trip to the emergency room may be necessary if symptoms do not go away. 

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Shena Jaramillo. Registered Dietitian
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