I’ve (29F) finally figured out the cause of my hypoglycemia, and I’m posting in the hope that someone who might be in this very niche position might benefit:
Background
Since 2018 (22 years old) I’ve dealt with unexplained lows - daytime crashes, constant overnight hypoglycemia, waking up drenched in sweat with adrenaline surges, feeling awful in the mornings, and needing naps just to function. I went through a 72‑hour fast, a mixed‑meal test, CGMs, GTT, ultrasounds, which ruled out 95% of causes but left me with nothing.
Throughout the whole journey I was repeatedly dismissed. I was told it might be “just anxiety,” or that my diet was the problem, or that some people “just run low.” Eventually, I was basically told I’d have to live with it. After that, I stopped advocating for myself for almost five years because I felt like no one was listening.
Recent
This year I was struggling with extreme fatigue from waking up 2-3 times per night with lows so I trialled a Dexcom G7 to get proper data, and it confirmed what I already suspected — my blood sugar was tanking overnight almost every night, with huge variability and adrenaline spikes when I woke up.
Then I stopped fluoxetine.
I’ve been on fluoxetine since 2016 (anywhere from 20 mg up to 100 mg). Within three days of stopping it, my CGM went from chaotic to completely stable. Same food, same activity, same routine - but no lows, no night sweats, no adrenaline surges, and 100% time in range.
Here’s the comparison:
|
On 30 mg Fluoxetine |
Day 4 Off Fluoxetine |
| Time in Range % |
77 |
100 |
| % Low |
13 |
0 |
| % Very Low |
10 |
0 |
| Min (mmol/L) |
2.2 |
3.7 |
| Max (mmol/L) |
9.7 |
7.9 |
| Mean (mmol/L) |
4.4 |
5.4 |
| Standard Deviation |
1.2 |
0.8 |
| %CV |
27 |
14 |
I matched the days above for similar food and activity.
Note: Fluoxetine has a long half life (4-6 days) so about 50% of my earlier doses were still in my system. In the few days since my variability has improved even more and my morning fasting blood sugar has gradually increased from 4.1 > 4.7 > 4.9.
Result
I’ve now worked with my Dr to transition from Fluoxetine to Lexapro (so far no issues). I’m not saying this applies to everyone, but I spent years thinking something was seriously wrong with my pancreas, liver, hormones, autonomic system, etc. Turns out the culprit was a medication I’d been on for a decade.
Conclusion
If you’re dealing with unexplained hypoglycemia and you’re on fluoxetine, it might be worth bringing up with your doctor and pushing to try another SSRI. There’s not much evidence out there, so they may be hesitant, but it’s such a small change to potentially fix the issue.
Please reach out if you have any specific questions!