What are the causes of hypoglycemia (low blood sugar)?

From the Guidelines

Hypoglycemia is primarily caused by an imbalance between insulin or insulin-secretor treatment and insufficient carbohydrate supply, and can be triggered by various factors including diabetes medications, inadequate food intake, and certain medical conditions. According to the most recent and highest quality study 1, hypoglycemia can occur in individuals with diabetes due to excessive glucose removal from the bloodstream or insufficient carbohydrate intake. The study highlights that hypoglycemia is a frequent consequence of treatment with insulin secretors or insulin therapy, and can be particularly high in hospitalized diabetic patients due to more severe glycaemic variations.

Some of the key factors that contribute to hypoglycemia include:

• Insulin or certain diabetes medications causing excessive glucose removal from the bloodstream
• Inadequate carbohydrate intake
• Prolonged fasting or irregular food intake
• Certain medical conditions such as kidney failure or end-stage kidney disease
• Older age, multimorbidity, cognitive impairment, and chronic kidney disease

The study also notes that some hypoglycaemic episodes may not be easily apparent, particularly when hypoglycaemia occurs frequently, diabetes is already a long-lasting disease, or when dysautonomia is present. It is essential to be vigilant about the administration of drugs that have a direct hypoglycaemic effect and to monitor blood glucose levels regularly to prevent and manage hypoglycemia. Additionally, individualized glycemic goals, patient education, nutrition intervention, physical activity management, medication adjustment, glucose monitoring, and routine clinical surveillance may improve outcomes 1.

In terms of prevention and management, regular blood glucose monitoring, consistent meal timing, and medication adjustment can help prevent episodes of hypoglycemia. It is also crucial to identify and address any underlying medical conditions that may be contributing to hypoglycemia. Furthermore, the use of continuous glucose monitoring (CGM) and automated low glucose suspend has been shown to be effective in reducing hypoglycemia in type 1 diabetes 1.

Overall, hypoglycemia is a serious condition that requires prompt attention and management to prevent complications and improve outcomes. By understanding the causes of hypoglycemia and taking steps to prevent and manage it, individuals with diabetes can reduce their risk of hypoglycemic episodes and improve their overall quality of life.

From the FDA Drug Label

Hypoglycemia may occur as a result of an excess of insulin relative to food intake, energy expenditure, or both. Hypoglycemic reactions may be associated with the administration of LEVEMIR. The time of occurrence of hypoglycemia depends on the action profile of the insulins used and may, therefore, change when the treatment regimen or timing of dosing is changed Insulin requirements may be altered during intercurrent conditions such as illness, emotional disturbances, or other stresses. Adjustment of dosage of any insulin may be necessary if patients change their physical activity or their usual meal plan.

The causes of hypoglycemia (low blood sugar) include:

• Excess insulin: relative to food intake or energy expenditure
• Changes in treatment regimen: such as timing of dosing or type of insulin used
• Intercurrent conditions: such as illness, emotional disturbances, or other stresses
• Changes in physical activity: or usual meal plan 2, 2

From the Research

Causes of Hypoglycemia

• Overdosage of insulin or oral hypoglycaemic agents is a primary cause of hypoglycemia, as stated in the study 3
• Impairments in counterregulatory responses and hypoglycemia unawareness constitute the main risk factors for severe hypoglycemia, according to the study 4
• Therapies for diabetes, such as insulins and insulin secretagogues, including the glinides and sulfonylureas, increase the risk of hypoglycaemia, as mentioned in the study 5

Risk Factors

• Patients with type 1 diabetes are at a higher risk of non-severe and severe hypoglycaemia, as noted in the study 5
• Those with insulin-treated type 2 diabetes are also at risk of hypoglycaemia, as stated in the study 5
• The fear of hypoglycemia constitutes a barrier that impairs the patient's ability to reach good glycemic control, according to the study 4

Prevention and Treatment

• Education and regular review are essential between people with diabetes and their caregivers and healthcare professionals about symptoms, prevention, and treatment, as emphasized in the study 5
• Awareness of the potential dangers of hypoglycaemia is fundamental to the optimal management of diabetes, as stated in the study 5
• Patient education regarding risk factors, warning signs, and treatment of hypoglycemia at an early stage, together with setting personalized goals for glycemic control, can help prevent hypoglycemia, as mentioned in the study 4