POTS can reduce your insulin sensitivity, which means it’s harder for your body to process blood sugar. While POTS is different from hypoglycemia, the symptoms can look similar.

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Postural orthostatic tachycardia syndrome (POTS) can make you feel dizzy, fatigued, or faint after eating high carb meals. While this may be a result of issues with blood sugar regulation, some experts wonder if there’s more to it.

Because symptoms of both conditions are relatively similar, sometimes a person’s condition is misdiagnosed. There’s also a connection between POTS and type 2 diabetes. POTS is considered a secondary condition, which means you’re more likely to develop it if you already have diabetes.

Is there a direct link between POTS and hypoglycemia (low blood sugar), or do the symptoms just seem similar? Let’s explore the topic to understand these conditions better.

The relationship between POTS and hypoglycemia isn’t straightforward. While some individuals with POTS experience episodes of low blood sugar caused by altered hormone levels or blood glucose regulation, not all individuals with POTS have this issue.

Some people with POTS have low insulin sensitivity, or insulin resistance. This sensitivity can cause your body to not process blood glucose properly, leading to high blood sugar.

Insulin resistance isn’t the same as hypoglycemia. Hypoglycemia is a condition characterized by abnormally low levels of blood glucose. It’s often caused by factors such as excessive insulin production, certain medications, or medical conditions that affect glucose metabolism.

According to a case study from 2012, the symptoms of POTS can resemble those of low blood sugar, causing symptoms like lightheadedness, weakness, and heart palpitations. Although the symptoms are similar, it’s important to distinguish between the two conditions.

In POTS, these symptoms are caused by “dysautonomia,” a dysfunction of the autonomic nervous system. In low blood sugar, the symptoms result from actual low blood sugar levels.

Language matters

You’ll notice that the language used to share stats and other data points in some of the paragraphs below is pretty binary, especially with the use of the terms “women,” “girl,” and the pronoun “she.”

Although we typically avoid language like this, specificity is key when reporting on research participants and clinical findings.

Unfortunately, the studies and surveys referenced in this article didn’t report data on, or include, participants who were transgender, nonbinary, gender nonconforming, genderqueer, agender, or genderless.

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Individuals with POTS often have lower insulin sensitivity, which means their bodies may have difficulty processing glucose efficiently, especially after eating carbs. Eating foods high in carbohydrates can make their symptoms worse.

When you consume glucose, it triggers the release of a “glucose-dependent insulinotropic polypeptide,” a hormone that causes blood vessels in the gut to expand. This expansion reduces the amount of blood pumped by the heart per beat.

As a result, the heart must beat faster to compensate for this reduced blood flow, which can exacerbate symptoms like rapid heart rate and difficulty standing in people with POTS.

One 2022 study found that women with POTS had higher heart rates and hormone levels when standing than women without POTS. After consuming a sugary solution, their heart rates increased even further while standing, and the amount of blood pumped per heartbeat decreased.

Both POTS and hypoglycemia can share some similar symptoms, including:

While both conditions can share some similar symptoms, the underlying mechanisms and causes are different.

POTS is believed to be caused by a dysfunction in the autonomic nervous system, which controls involuntary bodily functions, such as heart rate. Hypoglycemia occurs when blood sugar levels drop below normal levels.

Possible misdiagnosis

Misdiagnosis of POTS and hypoglycemia can happen for several reasons.

Both conditions can present with symptoms that overlap with other medical conditions, such as lightheadedness, palpitations, fatigue, and sweating. This overlap can make it challenging for a doctor to tell the difference from POTS, hypoglycemia, or other similar conditions.

Another factor contributing to misdiagnosis is the lack of awareness or familiarity with POTS. Healthcare professionals may not always consider POTS as a potential diagnosis, and this lack of awareness can result in misdiagnosis or delayed diagnosis.

The diagnostic criteria for POTS and hypoglycemia can also be complex and require specialized testing, which may not always be readily available. This complexity can lead to errors in diagnosis or misinterpretation of test results.

According to research from 2015, POTS can be a secondary condition to diabetes.

In diabetes, a dysfunction of the autonomic nervous system can disrupt the body’s ability to regulate functions such as heart rate and blood pressure. This dysfunction, known as “dysautonomia,” is a key feature of POTS.

For instance, in a 2009 case study, a 20-year-old girl with type 1 diabetes presented with lethargy, fatigue, and orthostatic intolerance (symptoms, particularly dizziness, made worse upon standing). She had a significant increase in heart rate upon standing, along with symptoms of lightheadedness.

If you have POTS, you may want to consider contacting a doctor if you experience significant or prolonged symptoms such as:

  • dizziness or lightheadedness, especially when standing up
  • heart palpitations or rapid heart rate
  • weakness or fatigue, especially after standing for long periods
  • fainting or near-fainting episodes
  • chest pain or shortness of breath
  • symptoms that interfere with your daily activities or quality of life

A doctor will diagnose POTS through a medical history, physical exam, and tests like the tilt table test. On the other hand, hypoglycemia is diagnosed through tests that measure glucose levels.

To differentiate between the two conditions, doctors also consider the timing of symptoms.

POTS symptoms typically manifest when standing and improve when lying down, while hypoglycemia symptoms are linked to meals. Although POTS symptoms can be worse after eating, they’re primarily related to changes in posture.

Both POTS and hypoglycemia can cause symptoms such as fatigue and dizziness, which may be worse after eating.

The underlying causes of the conditions differ: POTS stems from autonomic nervous system dysfunction affecting blood flow regulation, while hypoglycemia results from low blood sugar levels.

If you’re experiencing these symptoms, consider reaching out to a healthcare professional for an accurate diagnosis and appropriate management plan.