Insulinoma or other insulin-producing tumor: This condition leads to an autonomous production of insulin, causing hypoglycemia that is not adequately managed by intermittent glucose administration. The continuous production of insulin would require more than just glucose supplementation to manage.

Adrenal Insufficiency: This condition can lead to hypoglycemia due to the lack of cortisol, a hormone that helps regulate blood sugar levels. Glucose administration may temporarily correct the blood sugar, but the underlying deficiency would cause recurrent hypoglycemia.
Hypopituitarism: Similar to adrenal insufficiency, hypopituitarism can lead to deficiencies in hormones that regulate blood sugar, such as growth hormone and adrenocorticotropic hormone (ACTH), resulting in persistent hypoglycemia despite glucose supplementation.
Severe Liver Disease: The liver plays a crucial role in glucose metabolism. Severe liver disease can impair the liver's ability to release glucose into the bloodstream, leading to hypoglycemia that may not be fully corrected by hourly glucose administration.

Factitious Hypoglycemia (e.g., Munchausen Syndrome by Proxy): This is a condition where hypoglycemia is intentionally induced, often by the administration of insulin or other hypoglycemic agents. It's crucial to consider this diagnosis to prevent further harm.
Sepsis: Sepsis can cause hypoglycemia due to increased glucose consumption by the body's tissues and impaired glucose production. It's a life-threatening condition that requires immediate attention.
Panic Disorder or Other Psychiatric Conditions Leading to Factitious Disorder: Similar to factitious hypoglycemia, some psychiatric conditions can lead to the fabrication or induction of symptoms, including hypoglycemia, which would not respond to standard treatments.

Glycogen Storage Diseases: These are genetic disorders that affect the body's ability to store and release glucose from glycogen. Some types can lead to hypoglycemia, especially after fasting periods or when glucose supplementation is inadequate.
Glucose-6-Phosphatase Deficiency (Von Gierke's Disease): A rare genetic disorder that affects the liver's ability to release glucose into the bloodstream, leading to severe hypoglycemia.
Congenital Hyperinsulinism: A rare condition where the pancreas produces too much insulin, leading to persistent hypoglycemia that is not easily managed with glucose administration alone.