Can infection cause hypoglycemia (low blood sugar)?

From the Guidelines

Infection can indeed cause hypoglycemia, particularly in severe cases such as sepsis, where the body's metabolic demands increase and normal glucose regulation is disrupted. During severe infections, the body's metabolic demands increase significantly as it fights the infection, which can deplete glucose stores. Additionally, infections can impair normal glucose production in the liver and increase peripheral glucose utilization, creating an imbalance that leads to hypoglycemia 1. This is particularly common in sepsis, where inflammatory mediators disrupt normal glucose regulation. Certain infections like malaria and bacterial sepsis are especially associated with hypoglycemia. People with diabetes may be at higher risk, as infections can alter their insulin requirements and medication effectiveness. Malnourished individuals and those with liver disease also face increased risk during infections.

Some key points to consider include:

• Infections can lead to hypoglycemia due to increased metabolic demands and disrupted glucose regulation 1
• Sepsis is a particularly high-risk condition for hypoglycemia, with 16.3% of septic patients experiencing hypoglycemia upon hospital admission 1
• Certain infections, such as malaria, are associated with an increased risk of hypoglycemia, particularly in children and patients with limited glycogen stores 1
• Patients with diabetes, malnutrition, or liver disease are at higher risk of hypoglycemia during infections 1

If you experience symptoms like shakiness, confusion, sweating, or weakness during an infection, it is essential to check your blood sugar if possible and seek medical attention, as severe hypoglycemia requires prompt treatment, typically with glucose administration.

From the FDA Drug Label

Hypoglycemia (too little glucose in the blood) is one of the most frequent adverse events experienced by insulin users. It can be brought about by: ... An infection or illness associated with diarrhea or vomiting.

Hypoglycemia is the most common adverse reaction of all insulin therapies, including Humulin R U-100. ... Insulin requirements may be altered during illness, emotional disturbances, or other stresses.

Hyperglycemia, diabetic ketoacidosis, or hyperosmolar coma may develop if the patient takes less Humulin R U-100 than needed to control blood glucose levels This could be due to increases in insulin demand during illness or infection, neglect of diet, omission or improper administration of prescribed insulin doses or use of drugs that affect glucose metabolism or insulin sensitivity.

Yes, infection can cause hypoglycemia. Infections, especially those associated with diarrhea or vomiting, can alter insulin requirements and increase the risk of hypoglycemia. Additionally, increases in insulin demand during illness or infection can lead to hyperglycemia, diabetic ketoacidosis, or hyperosmolar coma if not properly managed 2, 2, 2.

• Key points:
  • Infection can increase insulin demand
  • Infection can alter insulin requirements
  • Proper management of insulin doses and blood glucose levels is crucial during illness or infection to prevent hypoglycemia and hyperglycemia.

From the Research

Infection and Hypoglycemia

• Infection can cause hypoglycemia (low blood sugar) in certain cases, as evidenced by a study published in The American journal of medicine in 1980 3.
• This study found that hypoglycemia can be a manifestation of sepsis, a life-threatening condition that occurs when the body's response to an infection becomes uncontrolled.
• The mechanisms behind infection-induced hypoglycemia are not fully understood but may involve depleted glycogen stores, impaired gluconeogenesis, and increased peripheral glucose utilization 3.

Relationship between Infection and Blood Sugar Levels

• Hyperglycemia (high blood sugar) is a common problem in hospitalized patients, especially in critically ill patients and those with diabetes mellitus 4.
• Uncontrolled hyperglycemia may be associated with complications such as fluid and electrolyte disturbances and increased infection risk 4.
• However, hypoglycemia can also occur in patients with infection, particularly in those with severe sepsis 3.

Diabetes and Hypoglycemia

• Hypoglycemia is a common complication in patients with diabetes, mainly in those treated with insulin, sulfonylurea, or glinide 5, 6, 7.
• Impairments in counterregulatory responses and hypoglycemia unawareness constitute the main risk factors for severe hypoglycemia in patients with diabetes 6.
• Patient education regarding risk factors, warning signs, and treatment of hypoglycemia is crucial to prevent hypoglycemia in patients with diabetes 5, 6, 7.