Hypoglycemia in Eating Disorder Recovery
The use of Continuous Glucose Monitors (CGMs) have become more prevalent in Eating Disorder recovery over the past few years. Since low blood sugar can be extremely dangerous, these tools offer insight into patterns and potential problems that can be solved through re-nourishment. If you have a CGM or are considering getting one, it’s important to understand what these patterns mean and what can be done to improve your levels.
Here are some common things we’ve heard from our clients that use CGMs:
“My blood sugar stays stable as long as I don’t eat, but as soon as I start eating, it drops.”
“I pair my carbs with protein and fat, but I still crash 30 minutes later.”
“My CGM goes off so often, I’ve stopped paying attention.”
If any of these sound familiar, you’re not alone, and you’re not broken. For many people in eating disorder recovery, blood sugar regulation can get worse before it gets better. Let’s explore why, and what this means for healing.
When you don’t eat, your body “flattens” its glucose curve
When you’re malnourished or restricting your body of nutrition, your body adapts to survive. It uses stress hormones like cortisol and adrenaline to keep blood sugar artificially stable.
That “flat line” on a glucose monitor doesn’t indicate good regulation, it signals that your body is in survival mode.
In periods of prolonged restriction or excessive exercise, the body begins drawing down its stored energy reserves. Glycogen stores in the liver become depleted, and the body’s ability to make glucose (through a process called gluconeogenesis) becomes impaired. This can lead to abnormal blood sugar regulation and, in more severe or prolonged restriction, true hypoglycemia.
In milder cases of undernourishment, blood sugar may appear “stable” but is actually being maintained through stress hormones rather than proper metabolism. In more advanced malnutrition, however, blood sugar can fall dangerously low, signaling that the body’s ability to regulate glucose safely is compromised. (Mehler & Brown, 2015)
Once you begin eating again, those stress systems back off, but not gracefully. Your body is still adjusting, and glucose levels may begin to swing.
Why does blood sugar drop after eating?
After periods of restriction, the pancreas, which produces insulin, the hormone that lowers blood sugar, can overshoot when you start eating again. A normal meal may trigger a sharp drop in glucose 30-45 minutes later.
Some studies have even described cases of reactive hypoglycemia in early refeeding for individuals with anorexia nervosa, meaning that the body’s insulin response can briefly overcompensate as it adjusts to normal food intake again. (Mehler & Brown, 2015)
This is a continuous glucose monitor reading from one of our clients. The glucose level raises after eating, then drops back down quickly instead of maintaining a slow downward curve as expected.
When glucose drops sharply, you might feel shaky, dizzy, anxious, or foggy. This is often mistaken for “not tolerating carbs,” but it’s actually your body relearning balance after restriction.
My Blood Sugar Is Low, But I Feel Fine. Is it still a problem?
In chronic under-eating, the body can develop a state similar to hypoglycemia unawareness.
Normally, low blood sugar triggers adrenaline, causing shakiness, sweating, or a racing heart.
Over time, repeated low blood sugars blunt these warning signals, so you may not feel symptoms even when your glucose is low.
Even if you don’t notice symptoms, low blood sugar can be very dangerous. Prolonged hypoglycemia deprives the brain and heart of the glucose they need, which can lead to serious complications including fainting, coma, permanent brain injury, or even death. Sadly, the medical community doesn’t always recognize that anorexia nervosa carries this risk, and hypoglycemia may be the underlying cause in the tragic cases where someone with severe restriction doesn’t wake up. (Gaudiani Clinic, 2015)
In recovery, this can feel confusing. It doesn’t mean you’re okay, it’s a sign of physiologic distress, and awareness usually returns as your body learns to trust consistent nourishment again.
Why pairing carbs with protein and fat helps, but not always immediately
Pairing carbohydrates with protein and fat helps slow digestion and prevent spikes, but early in recovery it may not completely prevent crashes.
Your glycogen stores are depleted, your muscles are insulin resistant, and your pancreas is still recalibrating.
It’s not that your meals are wrong, your body simply needs time, consistency, and nourishment to rebuild trust in food.
How can I protect myself from nighttime blood sugar lows?
Many people in recovery experience their lowest blood sugars overnight. A Continuous Glucose Monitor (CGM) can reveal these patterns, but it’s a double-edged sword.
For some, CGMs become obsessive or triggering, leading to food avoidance (“I’ll only eat if I’m low enough”).
For others, CGMs are a useful tool, if used with support and compassion.
If you use a CGM, let it inform you, not control you. A 3 a.m. low isn’t failure, it’s your body asking for more fuel and care.
The Good News: Blood Sugar Regulation Improves
As your body restores energy stores, hormone balance, and glycogen, blood sugar regulation normalizes.
Crashes become less frequent
Energy steadies
Meals stop feeling like a gamble
Your body isn’t bad at handling carbs… it’s simply learning to trust food again.
The journey from undernourishment to blood sugar balance
Hypoglycemia during recovery is a sign of healing in progress, not a setback. The path to stability is paved with:
Consistent eating
Adequate rest
Self-compassion
Patience
If you’re struggling with blood sugar swings in recovery, our registered dietitians can help you stabilize energy, rebuild confidence with food, and heal your metabolism safely.
Rebecca Adams RD, LD, CEDS-C is a Registered Dietitian specializing in Eating Disorders and the Owner of Balanced Nutrition Therapy. She has over 15 years’ experience working with all types of Eating Disorders from residential to outpatient settings. Rebecca’s thoughtful, compassionate, and science-backed approach has helped hundreds of people heal their relationship with food.
Sources:
Gaudiani Clinic. (2015, November 23). Hypoglycemia may be the cause of death in anorexia nervosa. Retrieved from https://www.gaudianiclinic.com/gaudiani-clinic-blog/2015/11/23/hypoglycemia-may-be-the-cause-of-death-in-anorexia-nervosa
Mehler, P. S., & Brown, C. (2015). Anorexia nervosa – medical complications. Journal of Eating Disorders, 3(11). https://doi.org/10.1186/s40337-015-0040-8
