Diabetes Mellitus with Excess Insulin or Oral Hypoglycemic Agents: This is a common condition in the elderly population, and the use of insulin or oral hypoglycemic agents can lead to recurrent hypoglycemia, especially if dosages are not properly adjusted for the patient's dietary intake and physical activity level.

Adrenal Insufficiency: This condition can cause hypoglycemia due to the lack of cortisol, a hormone that helps regulate blood sugar levels. Elderly patients may have adrenal insufficiency due to various reasons, including long-term steroid use.
Hypopituitarism: A deficiency in pituitary hormones, such as growth hormone and adrenocorticotropic hormone (ACTH), can lead to hypoglycemia. This condition may be more common in the elderly due to age-related decline in pituitary function or due to other underlying health issues.
Chronic Kidney Disease: Impaired kidney function can affect glucose metabolism and lead to hypoglycemia, especially in patients with advanced disease. The elderly are at higher risk for chronic kidney disease due to age-related decline in kidney function and other comorbid conditions.
Liver Disease: Liver dysfunction can impair glucose production, leading to hypoglycemia. Elderly patients may have liver disease due to various causes, including alcohol abuse, viral hepatitis, or non-alcoholic fatty liver disease.

Insulinoma: A rare tumor of the pancreas that produces excess insulin, leading to recurrent hypoglycemia. Although rare, missing this diagnosis can lead to severe and potentially life-threatening hypoglycemic episodes.
Factitious Hypoglycemia: Intentional or accidental ingestion of insulin or oral hypoglycemic agents by healthcare workers or family members, which can cause recurrent hypoglycemia. This diagnosis is critical to consider, especially in patients with unexplained or recurrent hypoglycemia without a clear medical cause.
Sepsis: Severe infection can cause hypoglycemia due to increased glucose consumption by inflammatory cells and impaired glucose production. Sepsis is a life-threatening condition that requires prompt recognition and treatment.

Glucagonoma: A rare tumor of the pancreas that produces excess glucagon, leading to hyperglycemia, but can also cause hypoglycemia due to rebound hyperinsulinism.
Lactic Acidosis: A rare condition characterized by elevated lactic acid levels, which can cause hypoglycemia due to impaired glucose metabolism.
Glycogen Storage Diseases: Rare genetic disorders that affect glycogen metabolism, leading to hypoglycemia. Although more common in children, some forms of glycogen storage diseases can present in adulthood.