From the Guidelines
Ongoing insulin activity or insulin secretagogues can lead to recurrent hypoglycemia even after consuming sugar. Several factors can contribute to persistent low blood sugar (hypoglycemia) despite sugar intake.
- Medications, particularly insulin and sulfonylureas, can continue to lower blood sugar for hours after administration 1.
- Alcohol consumption can block the liver's ability to release glucose, causing prolonged hypoglycemia.
- Certain medical conditions like adrenal insufficiency, severe liver disease, or insulinomas can disrupt normal glucose regulation.
- Excessive exercise depletes glucose stores and can cause delayed hypoglycemia.
- Malnutrition or prolonged fasting reduces glycogen reserves needed to maintain blood sugar.
- Reactive hypoglycemia occurs when the body overproduces insulin after eating, causing blood sugar to drop 1-3 hours after meals. It's essential to note that hypoglycemia may increase the risk of harm to self or others, such as with driving, and patients should understand situations that increase their risk of hypoglycemia, such as when fasting for tests or procedures, when meals are delayed, during and after the consumption of alcohol, during and after intense exercise, and during sleep 1. Patients with one or more episodes of clinically significant hypoglycemia may benefit from at least short-term relaxation of glycemic targets and availability of glucagon. If experiencing recurrent hypoglycemia despite sugar intake, it's crucial to seek medical attention promptly, as this could indicate a serious underlying condition requiring proper diagnosis and treatment.
From the FDA Drug Label
Hypoglycemia may be difficult to recognize in the elderly and in people who are taking beta-adrenergic blocking drugs. Hypoglycemia is more likely to occur when caloric intake is deficient, after severe or prolonged exercise, when alcohol is ingested, or when more than one glucose lowering drug is used. The risk of hypoglycemia may be increased with combination therapy Renal or hepatic insufficiency may cause elevated drug levels of glyburide and the latter may also diminish gluconeogenic capacity, both of which increase the risk of serious hypoglycemic reactions.
The following factors can make your blood sugar keep dropping even after sugar:
- Caloric intake deficiency
- Severe or prolonged exercise
- Alcohol ingestion
- Combination therapy with multiple glucose-lowering drugs
- Renal or hepatic insufficiency
- Elderly, debilitated or malnourished patients, and those with adrenal or pituitary insufficiency 2
From the Research
Factors Contributing to Low Blood Sugar
- Certain medications, such as sulfonylureas and meglitinides, can increase the risk of hypoglycemia 3, 4, 5
- The use of antibiotics, including fluoroquinolones, clarithromycin, linezolid, tigecycline, cefditoren, doxycycline, and trimethoprim-sulfamethoxazole, can also contribute to hypoglycemia, especially when taken with sulfonylureas or meglitinides 6
- The mechanism of sulfonylureas and glinides involves stimulating the release of insulin from pancreatic cells, which can lead to hypoglycemia if not properly managed 7, 5
Medications Associated with Hypoglycemia
- Sulfonylureas, such as glyburide, glimepiride, and glipizide, are associated with a higher risk of hypoglycemia 3, 4
- Meglitinides, such as repaglinide and nateglinide, also increase the risk of hypoglycemia 4
- Antibiotics, including cefditoren, tigecycline, ertapenem, and clarithromycin, can contribute to hypoglycemia, even when not taken with sulfonylureas or meglitinides 6
Characteristics of Sulfonylureas and Glinides
- Sulfonylureas and glinides are effective first-line drugs for the treatment of type 2 diabetes mellitus 5
- They have a rapid onset of action and can improve blood sugar control 5
- However, they also carry the risk of hypoglycemia, weight gain, and cardiovascular disease, which can be mitigated with reasonable use 5