Tingling in hands might be a sign of poorly controlled diabetes, vitamin deficiency, and even panic attacks. Here’s what you can do.

Possible Causes: Vitamin B imbalance, diabetic neuropathy, panic attacks

There are a few serious causes of tingling fingers, says functional-medicine practitioner Myrto Ashe, MD. One is excessive vitamin B6, sometimes from supplements. The other is vitamin B12 deficiency, which must be treated before it leads to permanent neurological damage. Tingling can also result from long-standing poorly controlled diabetes.

Panic attacks can also trigger this symptom. “When you breathe too fast, as during a panic attack, the carbon dioxide in your bloodstream is exhaled through your lungs, and that rapid drop in CO2 causes tingling,” says Ashe.

What You Can Do: “If your hands are tingling and you are taking a B vitamin, get off it immediately to see if your symptoms improve,” recommends Ashe. Consider having your B6 tested even if you don’t use supplements; some people have naturally high B6 levels and have never taken a vitamin.

Some multivitamins contain a lot of B6, she notes, so if you’re taking one, stop and see if symptoms improve. You may also consider blood tests for both B6 and B12. To ensure an accurate B12 reading, ask your doctor for both a B12 level and a methylmalonic acid test. If a vitamin problem is at fault, you may have to be patient: It can take several months for tingling to wane.

The best way to regulate carbon dioxide during a panic attack is to breathe into a paper bag. After that, she says, “the work is figuring out why a person is having a panic attack in the first place.”