Feeling shaky and sick when waking up often stems from low blood sugar, dehydration, anxiety, or effects from caffeine/alcohol, but can also involve acid reflux, medication side effects, or sleep issues like sleep apnea, with common fixes including hydration, avoiding late-night stimulants/heavy meals, and stress management; however, persistent symptoms warrant a doctor's visit.
Going too long without eating can cause low blood sugar (hypoglycemia), which may lead to morning nausea, lightheadedness, and shakiness. If you skipped dinner or didn't eat enough protein and carbs the night before, your body may be running on empty by morning.
In rare cases, it's possible for a person who doesn't have diabetes to experience hypoglycaemia. It can be triggered by malnutrition, binge drinking or certain conditions, such as Addison's disease.
Five key signs your blood sugar (glucose) is too low (hypoglycemia) include feeling shaky/weak, sweaty/pale, dizzy/lightheaded, experiencing a fast or pounding heartbeat, and having trouble concentrating, feeling irritable, or suddenly very hungry, all signaling the body needs quick energy.
The most obvious might be a dry mouth but you may have suspected something was amiss if you had already spent the night getting up frequently to pass urine and feeling thirsty. The thirst and increased urination of diabetes are well known and occur when blood glucose is really high.
Five early signs of diabetes include frequent urination, increased thirst and hunger, fatigue, blurry vision, and slow-healing sores or frequent infections, stemming from high blood sugar levels that affect the body's ability to use glucose for energy, leading to these common symptoms.
If you've had low blood sugar during the night, you may wake up tired or with a headache. And you may have nightmares.
Hypoglycemia involves low blood sugar levels. Various other conditions, including anxiety and menopause, can cause similar symptoms, such as headaches, fatigue, and shakiness. Dehydration, salt deficiency, and heat exhaustion can mimic hypoglycemia symptoms.
Symptoms of hyperglycaemia
Polyphagia (hyperphagia) is a feeling of extreme, insatiable hunger. It's a common sign of diabetes, but it can have other medical causes, such as hyperthyroidism and atypical depression. It's important to see a healthcare provider if you're experiencing polyphagia.
The most common way to do so is by using a blood glucose meter. If you have hypoglycemia unawareness or have low blood glucose often, a continuous glucose monitor (CGM) may be a good option. The CGM measures your blood glucose level at regular times and can sound an alarm if it drops below your target range.
Therefore, meals that are high in simple carbohydrates can contribute to reactive hypoglycemia. Concentrated sweets such as candy, table sugar, soft drinks, cookies, cakes, and ice cream are mainly simple carbohydrates. Avoid these foods unless they are made with sugar substitutes.
Low blood glucose at night
When blood glucose levels fall below 70 mg/dl while sleeping at night, the person experiences a condition called nocturnal hypoglycemia. Studies suggest that almost half of all episodes of low blood glucose — and more than half of all severe episodes — occur at night during sleep.
An imbalance in essential electrolytes like potassium, magnesium, or calcium can interfere with muscle and nerve function, leading to body shakes when waking up. This is often caused by dehydration, illness, or poor dietary habits.
Causes of morning nausea, aside from pregnancy. Morning nausea or sickness can be a sign of pregnancy, but there are other possible causes of feeling nauseous in the morning. These include low blood sugar, dehydration, anxiety, and more. Many conditions, ranging from benign to severe, may cause morning nausea.
Low Blood Sugar Level (Hypoglycemia)
Low blood sugar, also known as hypoglycemia, is a common reason why people feel shaking inside when they wake up. It's especially frequent in those with diabetes, but it can also happen to anyone who skips meals or follows a very restrictive diet.
Ten key warning signs of diabetes include increased thirst and urination, extreme hunger, fatigue, blurred vision, slow-healing sores, unexplained weight loss, tingling/numbness in hands or feet, frequent infections, and sometimes dark skin patches (acanthosis nigricans), all indicating high blood sugar levels needing medical attention.
Many conditions that mimic diabetes, such as PCOS, hypothyroidism, and Cushing's syndrome, share insulin resistance as a defining feature. The most common cause of insulin resistance is obesity.
Constantly low blood pressure can be dangerous if it causes signs and symptoms such as:
Another way to determine whether it's low blood sugar or anxiety is to consider the context and timing of symptoms. Hypoglycemia improves rapidly after eating or consuming sugar, while anxiety symptoms may persist.
Severe hypoglycemia is known to cause a “stroke mimic” with focal neurological signs such as hemiparesis and aphasia.
Common signs and symptoms of low blood glucose
Before you go to bed, consider all of the causes of nighttime hypoglycemia, and if you think you're at risk, have a snack before heading to bed. Try to be consistent with your meals and/or snacks; skipping dinner or snacks you usually have can put you at risk. Eat a meal or snack when consuming alcohol.
If the patient is a known diabetic, consider IM glucagon (0.5 mg if <25kg and 1mg if >25kg) to assist with hypoglycemia. You can use the memory aid of the “rule of 50” or the “5/2/1 rule” – the concentration of dextrose and the volume per kilogram should equal 50.