From the Guidelines
Hypoglycemia in the absence of insulin therapy can occur due to various causes, including altered nutritional state, heart failure, renal or liver disease, malignancy, infection, or sepsis, as well as sudden reduction of corticosteroid dose, altered ability of the patient to self-report symptoms, reduction of oral intake, emesis, new NPO status, and unexpected interruption of enteral feedings or parenteral nutrition 1.
Causes of Hypoglycemia
Some of the key causes of hypoglycemia without insulin use include:
- Altered nutritional state
- Heart failure
- Renal or liver disease
- Malignancy
- Infection or sepsis
- Sudden reduction of corticosteroid dose
- Altered ability of the patient to self-report symptoms
- Reduction of oral intake
- Emesis
- New NPO status
- Unexpected interruption of enteral feedings or parenteral nutrition These causes can lead to hypoglycemia in patients with or without diabetes, and it is essential to identify and address the underlying cause to provide appropriate treatment 1.
Clinical Considerations
In clinical practice, it is crucial to consider these causes when evaluating patients with hypoglycemia, especially in the hospital setting where multiple risk factors may be present 1. A thorough medical history, physical examination, and laboratory tests can help identify the underlying cause of hypoglycemia and guide treatment decisions.
Key Takeaway
Identifying and addressing the underlying cause of hypoglycemia is critical to providing effective treatment and preventing recurrent episodes 1.
From the Research
Causes of Hypoglycemia
The causes of hypoglycemia in the absence of insulin therapy are varied and can be attributed to several factors. Some of the causes include:
- Medications or toxins capable of decreasing blood glucose 2
- Disorders associated with fasting hypoglycemia, such as cortisol insufficiency, hypopituitarism, or glucagon deficiency 3
- Postprandial hypoglycemic disorders, such as those caused by excessive insulin effect or subtle abnormalities of insulin response to food 2
- Genetic causes, including endogenous hyperinsulinism and inborn errors of metabolism (IEM) 3
- Paraneoplastic causes, such as Non-Islet-Cell Tumour Hypoglycemia (NICTH) caused by Big-IGF2 secretion by a large tumour 3
- Autoimmune causes, such as antibodies against insulin or the insulin receptor 3
- Critical illness, alcohol consumption, or fasting 3, 4
- Bariatric or gastric surgery, pancreas transplantation, or other medical procedures 3
Risk Factors
Certain risk factors can increase the likelihood of hypoglycemia in individuals without insulin therapy. These include:
- Advanced age 5, 4
- Multiple or advanced comorbidities 5
- Long diabetes duration 5
- Prior history of hypoglycemia 5
- Food insecurity or delayed/missed meals 5, 4
- Physical exercise or alcohol consumption 4
Diagnosis and Treatment
Diagnosis of hypoglycemia is typically made based on symptoms and blood glucose levels. Treatment depends on the underlying cause, but may involve: