From the Guidelines
Hypoglycemia is primarily caused by medication used to treat diabetes, particularly insulin and insulin secretagogues, as well as other factors such as excessive alcohol consumption, severe illness, endocrine disorders, nutritional factors, and intense physical activity without adequate carbohydrate intake, as supported by the most recent evidence 1. The most common causes of hypoglycemia include:
- Medication used to treat diabetes, particularly insulin and insulin secretagogues like sulfonylureas and meglitinides
- Other medications that can cause hypoglycemia, such as quinine, pentamidine, and certain antibiotics
- Excessive alcohol consumption, which inhibits gluconeogenesis in the liver
- Severe illness, particularly liver or kidney disease, which can impair glucose production and clearance of medications
- Endocrine disorders, such as adrenal insufficiency, growth hormone deficiency, and insulinomas
- Nutritional factors, like prolonged fasting, malnutrition, or missing meals, which can trigger low blood sugar, especially in people with diabetes
- Intense physical activity without adequate carbohydrate intake, which can deplete glucose stores According to the most recent study 1, individuals taking insulin and/or insulin secretagogues may need to ingest some added carbohydrate if pre-exercise glucose levels are <90 mg/dL, depending on the intensity and duration of the activity. In some patients, hypoglycemia after exercise may occur and last for several hours due to increased insulin sensitivity, as noted in 1. It is essential to identify the specific cause of hypoglycemia for effective management and prevention of recurrent episodes, as emphasized in 1 and 1.
From the FDA Drug Label
The risk of hypoglycemia after an injection is related to the duration of action of the insulin and, in general, is highest when the glucose lowering effect of the insulin is maximal Other factors which may increase the risk of hypoglycemia include changes in meal pattern (e.g., macronutrient content or timing of meals), changes in level of physical activity, or changes to concomitant drugs Patients with renal or hepatic impairment may be at higher risk of hypoglycemia Changes in an insulin regimen (e.g., insulin strength, manufacturer, type, injection site or method of administration) may affect glycemic control and predispose to hypoglycemia Repeated insulin injections into areas of lipodystrophy or localized cutaneous amyloidosis have been reported to result in hyperglycemia; and a sudden change in the injection site (to unaffected area) has been reported to result in hypoglycemia
The causes of hypoglycemia include:
- Changes in insulin regimen: Changes in insulin strength, manufacturer, type, injection site, or method of administration
- Changes in meal pattern: Changes in macronutrient content or timing of meals
- Changes in physical activity: Increase or decrease in physical activity
- Concomitant drugs: Certain medications may increase the risk of hypoglycemia
- Renal or hepatic impairment: Patients with kidney or liver disease may be at higher risk of hypoglycemia
- Lipodystrophy or localized cutaneous amyloidosis: Repeated injections into these areas can increase the risk of hypoglycemia 2, 3
From the Research
Causes of Hypoglycemia
- Hypoglycemia is a common complication in patients with diabetes, mainly in those treated with insulin, sulfonylurea, or glinide 4
- Impairments in counterregulatory responses and hypoglycemia unawareness constitute the main risk factors for severe hypoglycemia 4
- Increased hypoglycemia risk is observed with the use of insulin and/or sulphonylureas 5
- Vulnerable patients with type 2 diabetes (T2D) at dual risk of severe hypoglycemia and cardiovascular outcomes show features of "frailty" 5
- Hypoglycemia can occur at higher blood glucose levels in individuals with poor glycaemic control 5
Risk Factors
- Use of certain medications such as sulfonylureas and meglitinides 6
- Poor glycaemic control 5
- Impairments in counterregulatory responses 4
- Hypoglycemia unawareness 4, 5
- Physical activity without proper precautions 5
- Pregnancy 5
Prevention and Treatment
- Patient education regarding risk factors, warning signs, and treatment of hypoglycemia at an early stage 4
- Setting personalized goals for glycemic control 4
- Use of continuous glucose monitoring (CGM) for individuals with increased risk for hypoglycemia 5
- Optimizing insulin doses and carbohydrate intake 5
- Administration of rapid-acting insulin analogues rather than human insulin during pregnancy 5