Yes, diabetes can cause shaking, and the most common reason is low blood sugar (hypoglycemia), which occurs when blood glucose drops below 70 mg/dL. Shaking is one of the earliest and most recognizable warning signs that your blood sugar has fallen too low. Less commonly, diabetes-related nerve damage can also produce tremors that have nothing to do with blood sugar levels at the moment.
Why Low Blood Sugar Causes Shaking
When your blood sugar drops, your body treats it as an emergency. It releases adrenaline and related stress hormones to push glucose back into your bloodstream. Those hormones are the same ones that flood your system during a fight-or-flight response, and they cause a predictable cluster of symptoms: shaking, sweating, a rapid heartbeat, and anxiety. The trembling you feel is essentially your body’s alarm system firing.
This adrenaline surge typically kicks in when blood sugar falls below about 70 mg/dL. The shaking tends to come on quickly and is usually one of the first things you notice, often alongside hunger and dizziness. If blood sugar continues to drop below 54 mg/dL, symptoms can become severe, progressing to confusion, difficulty speaking, or loss of consciousness.
Medications That Make Shaking More Likely
Not every person with diabetes experiences low blood sugar. It depends largely on what medications you take. Insulin is the most common cause because it directly lowers blood sugar, and even a small mismatch between your dose, food intake, and activity level can tip you into hypoglycemia. Sulfonylureas, an older class of oral diabetes pills, carry the same risk because they stimulate the pancreas to produce more insulin regardless of what your blood sugar is doing at the time.
Newer medications like GLP-1 receptor agonists have a lower risk of causing low blood sugar on their own, but that risk climbs significantly when they’re combined with insulin or sulfonylureas. If you take more than one blood sugar-lowering medication, you’re more likely to experience episodes of shaking and other hypoglycemic symptoms.
Metformin, the most widely prescribed diabetes drug, rarely causes hypoglycemia by itself. So if metformin is your only medication and you’re experiencing shaking, something else is likely going on.
Shaking at Night or Upon Waking
Some people with diabetes wake up shaking, sweating, or feeling anxious without knowing why. This often points to nocturnal hypoglycemia, where blood sugar drops during sleep. You might not wake up during the low itself but instead notice the aftereffects: damp sheets, a headache, or feeling unusually tired in the morning.
A related pattern called the Somogyi effect can make this confusing. Your blood sugar drops overnight, your body releases stress hormones to compensate, and by morning your blood sugar reads high. You might assume the problem was high blood sugar all along, when the real trigger was a low that happened hours earlier. If you regularly wake up feeling shaky or with unexpectedly high morning readings, checking your blood sugar at 2 or 3 a.m. for a few nights can help clarify the pattern.
What to Do When You’re Shaking
If you suspect low blood sugar, check your level with a glucose meter or continuous monitor. If it’s below 70 mg/dL, follow the 15-15 rule recommended by the CDC: eat or drink 15 grams of fast-acting carbohydrates, wait 15 minutes, then check again. If your blood sugar is still under 70, repeat the process. Good options for those 15 grams include four glucose tablets, half a cup of juice, or a tablespoon of honey. Once your blood sugar is back in your target range, eat a balanced snack or small meal that includes protein to keep it stable.
Avoid the temptation to eat everything in sight when you feel shaky. Overcorrecting can send your blood sugar soaring in the opposite direction, starting a frustrating cycle of highs and lows.
Does High Blood Sugar Cause Shaking?
High blood sugar (hyperglycemia) is not typically associated with shaking. Its symptoms are different: increased thirst, frequent urination, headaches, and fatigue. These tend to build gradually rather than hitting suddenly the way low blood sugar does. If your blood sugar is high and you’re also trembling, it’s more likely that your body recently recovered from a low, or that another cause is at play entirely.
Nerve Damage and Tremors
There’s a second, less obvious way diabetes can cause shaking. Long-standing diabetes can damage peripheral nerves, a condition called diabetic neuropathy. Research published in the journal Neurology found that tremor accompanies 60 to 70 percent of people with polyneuropathy. This type of tremor is usually postural, meaning it appears when you hold your hands out in front of you rather than when they’re resting in your lap. It tends to be mild, low-frequency, and concentrated in the hands and upper limbs.
Neuropathy-related tremor looks a lot like essential tremor, the most common movement disorder in adults, and the two are frequently confused. The key difference is context: if you have diabetes with known nerve damage in your feet or hands and you’ve developed a new tremor, neuropathy is a plausible explanation. But because the overlap with essential tremor and even early Parkinson’s disease is significant, a neurological evaluation can help sort it out. The severity of the neuropathy, whether it affects the nerve’s insulation or the nerve fiber itself, doesn’t predict whether a tremor will develop.
Other Reasons for Shaking
Not every episode of shaking in someone with diabetes is caused by diabetes. Caffeine, anxiety, sleep deprivation, and certain medications (like asthma inhalers or some antidepressants) can all produce tremors. Thyroid disorders, which are more common in people with type 1 diabetes, are another frequent cause. If your blood sugar is consistently in range during episodes of shaking, it’s worth looking beyond diabetes for an explanation.