From the Guidelines
Newly diagnosed diabetic patients experiencing hypoglycemia without medications should seek immediate medical attention, as this condition may indicate serious underlying issues such as an insulinoma, adrenal insufficiency, or severe liver disease. Hypoglycemia in this context is unusual and requires prompt evaluation to determine the cause. According to the American Diabetes Association standards of medical care in diabetes 1, hypoglycemia can result in acute harm to the patient and others, especially if it causes falls or motor vehicle accidents. Patients with repeated episodes of hypoglycemia may develop hypoglycemia unawareness, which can progress to loss of consciousness, seizure, coma, or death. Some key points to consider in this situation include:
- Consuming 15 grams of fast-acting carbohydrates (like juice or glucose tablets) to raise blood sugar quickly if hypoglycemic symptoms occur
- Seeking emergency medical care immediately after addressing the hypoglycemic episode
- Undergoing blood tests during a hypoglycemic episode to measure insulin, C-peptide, and other hormone levels to determine the cause
- Recognizing that this situation differs significantly from typical Type 2 diabetes, where high blood sugar is the primary concern, and requires thorough investigation to identify the underlying cause. Prevention is critical, and patients should be educated about times when they may be at increased risk for hypoglycemia, such as while fasting for tests, with delayed meals, during or after exercise, and during sleep, as noted in the 2017 American Diabetes Association standards of medical care in diabetes 1.
From the FDA Drug Label
Metformin hydrochloride tablets rarely cause hypoglycemia (low blood sugar) by themselves. However, hypoglycemia can happen if you do not eat enough, if you drink alcohol, or if you take other medicines to lower blood sugar.
The answer to whether new diabetes patients can have hypoglycemia without taking medication is yes, as hypoglycemia can occur due to other factors such as not eating enough or drinking alcohol, even if metformin hydrochloride tablets are not the direct cause 2.
From the Research
Hypoglycemia in New Diabetes Patients Without Medication
- Hypoglycemia is a complication associated with the management of both type 1 and type 2 diabetes, and it can occur even in patients who are not taking any medication 3.
- The exact cause of hypoglycemia in new diabetes patients without medication is not well understood, but it may be related to various factors such as adrenal insufficiency, malnutrition, or other underlying medical conditions 4.
- A study found that adrenal insufficiency was a common cause of hypoglycemia in patients presenting to the emergency department, and it is recommended to check for adrenal function using a rapid adrenocorticotropic hormone (ACTH) test in cases of unknown etiology 4.
Management of Hypoglycemia
- Rapid-acting glucose is the preferred treatment for conscious patients with hypoglycemia, regardless of the setting 3.
- For unconscious patients, glucagon is preferred if the patient does not have intravenous (IV) access, and dextrose can be used for patients with IV access 3.
- Continuous glucose monitoring and sensor-augmented insulin pump therapy with low glucose suspend technology can also prevent hypoglycemia, although concerns about cost and patient satisfaction remain 5.
Risk Factors for Hypoglycemia
- People with type 1 diabetes are primarily affected by hypoglycemic episodes, which are associated with direct physical harms and indirect psychosocial consequences 5.
- Patients experiencing frequent or severe hypoglycemic events may develop a pathological fear of hypoglycemia and adopt aberrant behaviors intending to maintain higher blood glucose levels 5.
- Modern pharmaceutical options with a safer profile in terms of hypoglycemia are available, including novel basal insulins with lower rates of nocturnal hypoglycemia and ultra-rapid-acting insulin analogs with a shorter duration of action 5.