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Diseases » Hypoglycemia » Causes
 

Causes of Hypoglycemia

Contents
  1. Hypoglycemia: Introduction
  2. List of Causes
  3. Drugs/substances (17 causes)
  4. Drug interaction (1690 causes)
  5. Hidden causes
  6. Excerpts from book chapters
  7. Complication causes
  8. Causes of symptoms
  9. News
  10. Statistics about causes
  11. Related cause information

List of causes of Hypoglycemia

Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Hypoglycemia) that could possibly cause Hypoglycemia includes:

More causes: see full list of causes for Hypoglycemia

Causes of Hypoglycemia (Diseases Database):

The follow list shows some of the possible medical causes of Hypoglycemia that are listed by the Diseases Database:

Source: Diseases Database

Hypoglycemia Causes: Book Excerpts

Hypoglycemia as a complication of other conditions:

Other conditions that might have Hypoglycemia as a complication may, potentially, be an underlying cause of Hypoglycemia. Our database lists the following as having Hypoglycemia as a complication of that condition:

Hypoglycemia as a symptom:

Conditions listing Hypoglycemia as a symptom may also be potential underlying causes of Hypoglycemia. Our database lists the following as having Hypoglycemia as a symptom of that condition:

Medications or substances causing Hypoglycemia:

The following drugs, medications, substances or toxins are some of the possible causes of Hypoglycemia as a symptom. This list is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

  • Diabetes treatments - because they aim to reduce blood sugar levels, any diabetes treatment can easily lead to hypoglycemia if they go too far (and then often do).
  • Beta blocker medications
  • Alcohol
  • more drugs...»

See full list of 17 medications causing Hypoglycemia


Drug interactions causing Hypoglycemia:

When combined, certain drugs, medications, substances or toxins may react causing Hypoglycemia as a symptom.

The list below is incomplete and various other drugs or substances may cause your symptoms. Always advise your doctor of any medications or treatments you are using, including prescription, over-the-counter, supplements, herbal or alternative treatments.

  • Diflucan and tolbutamide interaction
  • Nizoral and tolbutamide interaction
  • Diflucan and glyburide interaction
  • Nizoral and glyburide interaction
  • Diflucan and glypizide interaction
  • more interactions...»

See full list of 1690 drug interactions causing Hypoglycemia

Medical news summaries relating to Hypoglycemia:

The following medical news items are relevant to causes of Hypoglycemia:

Cause statistics for Hypoglycemia:

The following are statistics from various sources about the causes of Hypoglycemia:

  • 4.2% of adults attending specialist diabetes services had a severe hypoglycaemic episode in Australia 2002 (Australia’s Health 2004, AIHW)
  • more statistics...»

Related information on causes of Hypoglycemia:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Hypoglycemia may be found in:

Causes of Hypoglycemia: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Hypoglycemia.

Hypoglycemia: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • Exogenous insulin administration is the most common cause of hypoglycemia
    –Most commonly occurs in patients with known diabetes mellitus
    –May occur with inadequate food ingestion or excessive exercise after an insulin injection
    –May occur with delayed absorption of food (e.g., diabetic gastroparesis)
    –Rarely, may occur as part of attention seeking behavior (i.e., factitious)
  • Oral hypoglycemic medications (e.g., sulfonylurea)
    –This is especially common with severe liver disease, which prevents gluconeogenesis
  • Other medications (e.g., salicylates, sulfonamides, tetracyclines, warfarin, MAO inhibitors, phenothiazines)
  • Reactive hypoglycemia occurs 2–4 hours after meals, due to delayed and exaggerated insulin release (associated with a family history of type II diabetes)
  • Hypothyroidism
  • Malnutrition/fasting
  • Insulinoma/islet cell hyperplasia
  • Alcohol consumption
  • Sepsis
  • Renal failure
  • Sarcomas
  • Pituitary or adrenal insufficiency
  • Congenital hormone or enzyme defects
  • Severe hepatic dysfunction (e.g., hepatitis, hepatic toxins, hepatic necrosis)

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Low Back Pain/Swelling: Differential Diagnosis
(In a Page: Signs and Symptoms)

  • Lumbosacral muscle strain
    –Most common etiology of low back pain
    –Most common cause of disability in adults <45 years old
    –Aggravated by movement, better with rest
  • Lumbar disc herniation
    –Especially of L4-L5 and L5-S1
    –Usually with unilateral radiation down the leg in a dermatomal pattern
    –Increased pain with sitting
    • Spinal stenosis
      –Back and bilateral buttock and thigh pain in older patients relieved by rest (pseudoclaudication)
      –Increased pain with standing
    • Sacral-iliac joint dysfunction
      –Especially in young, thin women or in pregnancy
      –Unilateral upper buttock pain, relieved with movement
    • Vertebral fracture
      –Often associated with trauma or osteoporosis
    • Spondylolisthesis
      –Especially in young athletes
    • Secondary gain (e.g., drug seeking, disability or liability issue)
    • Extraspinal causes (e.g., radiation from kidney stones)
    • Systemic causes (<1%)
      –Inflammation (e.g., ankylosing spondylitis): Morning stiffness, limited mobility
      –Infection: Osteomyelitis, abscess
      –Abdominal aortic aneurysm
      –Cancer (especially metastases from prostate, lung, colon, and breast or myeloma); constant, worsening pain, wakes up from sleep
      –Cauda equina syndrome
      –Paget's disease
    '>>

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Hypoglycemia: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

  • Normal neonates (in first 24 hours of life)
  • Ketotic hypoglycemia
  • Insulin excess
    –Exogenous insulin
    –Sulfonylurea ingestion
    –Infant of a diabetic mother
    –Perinatal stress-induced hyperinsulinism
    –Congenital hyperinsulinism
    –Beckwith-Wiedemann syndrome
  • Hormone deficiency
    –Panhypopituitarism
    –Growth hormone deficiency
    –ACTH or cortisol deficiency
  • Defects of glycogenolysis
    –Glycogen storage diseases
  • Defects of gluconeogenesis
    –Glycogen storage disease type 1
    –Fructose-1,6-diphosphatase deficiency
    –Pyruvate carboxylase deficiency
    –PEPCK deficiency
    • Fatty oxidation and ketogenesis defects
      –Medium-chain acyl-CoA dehydrogenase deficiency (most commonly)
      –Carnitine transport and metabolism
      –Electron transfer
      –HMG CoA synthase deficiency
      –HMG CoA lyase deficiency
  • Liver disease
  • Galactosemia
  • Hereditary fructose intolerance
  • Disorders of amino acid metabolism
    –Maple syrup urine disease
    –Methylmalonic acidemia
    –Tyrosinemia
  • Dumping syndrome
    –Associated with Nissen fundoplication
  • Reye syndrome
  • Ethanol intoxication
    –Impaired gluconeogensis
  • Salicylate intoxication
  • Diarrhea and malnutrition
  • Malaria
  • Jamaican vomiting sickness
  • Measurement error
    –Glucometer measurements are inaccurate in low range
    –Plasma glucose levels gradually fall if samples are not immediately tested

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Low birth weight: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

This section lists some fetal and placental causes of low birth weight as well as the associated signs and symptoms pres-ent in the neonate at birth.

Chromosomal aberrations

Abnormalities in the number, size, or configuration of chromosomes can cause low birth weight and possibly multiple congenital anomalies in a premature or SGA neonate

For example, a neonate with trisomy 21 (Down syndrome) may be SGA and have prominent epicanthal folds, a flat-bridged nose, a protruding tongue, palmar simian creases, muscular hypotonia, and an umbilical hernia.

Cytomegalovirus infection

Although low birth weight in cytomegalovirus infection is usually associated with premature birth, the neonate may be SGA

Assessment at birth may reveal these classic signs: petechiae and ecchymoses, jaundice, and hepatosplenomegaly, which increases for several days. The neonate may also have a high fever, lymphadenopathy, tachypnea, and dyspnea, along with prolonged bleeding at puncture sites.

Placental dysfunction

Low birth weight and a wasted appearance occur in an SGA neonate

He may be symmetrically short or may appear relatively long for his low weight. Additional findings reflect the underlying cause. For example, if maternal hyperparathyroidism caused placental dysfunction, the neonate may exhibit muscle jerking and twitching, carpopedal spasm, ankle clonus, vomiting, tachycardia, and tachypnea.

Rubella (congenital)

Usually, the low-birth-weight neonate with this congenital rubellais born at term but is SGA

A characteristic “blueberry muffin” rash accompanies cataracts, purpuric lesions, hepatosplenomegaly, and a large anterior fontanel

Abnormal heart sounds, if present, vary with the type of associated congenital heart defect.

Varicella (congenital)

Low birth weight is accompanied by cataracts and skin vesicles.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Hypoglycemia: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Reactive hypoglycemia may take several forms. In a diabetic patient, it may result from administration of too much insulin or, less commonly, too much oral antidiabetic medication. In a mildly diabetic patient (or one in the early stages of diabetes mellitus), reactive hypoglycemia may result from delayed and excessive insulin production after carbohydrate ingestion. Similarly, a nondiabetic patient may suffer reactive hypoglycemia from a sharp increase in insulin output after a meal. Sometimes called postprandial hypoglycemia, this type of reactive hypoglycemia usually disappears when the patient eats something sweet. In some patients, reactive hypoglycemia has no known cause (idiopathic reactive) or may result from gastric dumping syndrome and from impaired glucose tolerance.

Fasting hypoglycemia usually results from an excess of insulin or insulin-like substance or from a decrease in counterregulatory hormones. It can be exogenous, resulting from such external factors as alcohol or drug ingestion, or endogenous, resulting from organic problems.

Endogenous hypoglycemia may result from tumors or liver disease. Insulinomas, small islet cell tumors in the pancreas, secrete excessive amounts of insulin, which inhibit hepatic glucose production. They’re generally benign (in 90% of patients). Extrapancreatic tumors, though uncommon, can also cause hypoglycemia by increasing glucose utilization and inhibiting glucose output. Such tumors occur primarily in the mesenchyma, liver, adrenal cortex, GI system, and lymphatic system. They may be benign or malignant. Among nonendocrine causes of fasting hypoglycemia are severe liver diseases, including hepatitis, cancer, cirrhosis, and liver congestion associated with heart failure. All of these conditions reduce the uptake and release of glycogen from the liver. Some endocrine causes include adrenocortical insufficiency, which contributes to hypoglycemia by reducing the production of cortisol and cortisone needed for gluconeogenesis; and pituitary insufficiency, which reduces corticotropin and growth hormone levels.

Hypoglycemia is at least as common in neonates and children as it is in adults and affects 1 out of 1,000 people. Usually, infants develop hypoglycemia because of an increased number of cells per unit of body weight and because of increased demands on stored liver glycogen to support respirations, thermoregulation, and muscular activity. In full-term neonates, hypoglycemia may occur 24 to 72 hours after birth and is usually transient. In neonates who are premature or small for gestational age, onset of hypoglycemia is much more rapid (it can occur as soon as 6 hours after birth) because of their small, immature livers, which produce much less glycogen. Maternal disorders that can produce hypoglycemia in neonates within 24 hours after birth include diabetes mellitus, toxemia, erythroblastosis, and glycogen storage disease.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Low birth weight: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

This section lists some fetal and placental causes of low birth weight as well as the associated signs and symptoms present in the neonate at birth.

Chromosomal aberrations

Abnormalities in the number, size, or configuration of chromosomes can cause low birth weight and possibly multiple congenital anomalies in a premature or SGA neonate. For example, a neonate with trisomy 21 (Down syndrome) may be SGA and have prominent epicanthal folds, a flat-bridged nose, a protruding tongue, palmar simian creases, muscular hypotonia, and an umbilical hernia.

Cytomegalovirus infection

Although low birth weight in this disorder is usually associated with premature birth, some neonates may be SGA. Assessment at birth may reveal these classic signs: petechiae and ecchymoses, jaundice, and hepatosplenomegaly, which increases for several days. The neonate may also have a high fever, lymphadenopathy, tachypnea, and dyspnea, along with prolonged bleeding at puncture sites.

Placental dysfunction

Low birth weight and a wasted appearance occur in an SGA neonate. The neonate may be symmetrically short or may appear relatively long for his low weight. Additional findings reflect the underlying cause. For example, if maternal hyperparathyroidism caused placental dysfunction, the neonate may exhibit muscle jerking and twitching, carpopedal spasm, ankle clonus, vomiting, tachycardia, and tachypnea.

Rubella (congenital)

Usually, the low-birth-weight neonate with this disease is born at term but is SGA. A characteristic “blueberry muffin” rash accompanies cataracts, purpuric lesions, hepatosplenomegaly, and a large anterior fontanel. Abnormal heart sounds, if present, vary with the type of associated congenital heart defect.

Toxoplasmosis (congenital)

The low-birth-weight neonate may be either premature or SGA and may have hydrocephalus or microcephalus. Associated findings include fever, seizures, lymphadenopathy, hepatosplenomegaly, jaundice, and rash. Other defects, which may occur months or years later, include strabismus, blindness, epilepsy, and mental retardation.

Varicella (congenital)

Low birth weight is accompanied by cataracts and skin vesicles.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Low Back Pain: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Musculoligamentous strain

❑ Lumbar disc herniation

❑ Osteoarthritis

❑ Compression fracture

❑ Pyelonephritis

❑ Secondary gain

❑ Scoliosis

❑ Spondylolisthesis

❑ Metastatic cancer

❑ Spinal stenosis

❑ Transverse process fracture

❑ Pancreatic cancer

❑ Ankylosing spondylitis

❑ Sacroiliitis

❑ Aortic dissection

❑ Cauda equina syndrome

❑ Vertebral osteomyelitis

❑ Epidural abscess

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Hypoglycemia: Causes
(Handbook of Diseases)

The two forms of hypoglycemia have different causes and occur in different types of patients.

Reactive hypoglycemia

Several forms of reactive hypoglycemia occur. In a diabetic patient, it may result from administration of too much insulin or, less commonly, too much oral antidiabetic medication. In a mildly diabetic patient (or one in the early stages of diabetes mellitus), reactive hypoglycemia may result from delayed and excessive insulin production after carbohydrate ingestion.

Similarly, a nondiabetic patient may suffer reactive hypoglycemia from a sharp increase in insulin output after a meal. Sometimes called postprandial hypoglycemia, this type of reactive hypoglycemia usually disappears when the patient eats something sweet.

In some patients, reactive hypoglycemia may have no known cause (idiopathic reactive) or may result from total parenteral nutrition due to gastric dumping syndrome or from impaired glucose tolerance.

Fasting hypoglycemia

Fasting hypoglycemia usually results from an excess of insulin or insulin-like substance or from a decrease in counterregulatory hormones. It can be exogenous, resulting from such external factors as alcohol or drug ingestion, or endogenous, resulting from organic problems.

Endogenous hypoglycemia may result from tumors or liver disease. Insulinomas, small islet cell tumors in the pancreas, secrete excessive amounts of insulin, which inhibits hepatic glucose production. They’re generally benign (in 90% of patients).

Extrapancreatic tumors, although uncommon, can also cause hypoglycemia by increasing glucose utilization and inhibiting glucose output. Such tumors occur primarily in the mesenchyma, liver, adrenal cortex, GI system, and lymphatic system. They may be benign or malignant.

Among nonendocrine causes of fasting hypoglycemia are severe liver diseases, including hepatitis, cancer, cirrhosis, and liver congestion associated with heart failure. All these conditions reduce the uptake and release of glycogen from the liver.

Some endocrine causes include destruction of pancreatic islet cells; adrenocortical insufficiency, which contributes to hypoglycemia by reducing the production of cortisol and cortisone needed for gluconeogenesis; and pituitary insufficiency, which reduces corticotropin and growth hormone levels.

Causes in infants and children

Hypoglycemia is at least as common in neonates and children as it’s in adults. Usually, infants develop hypoglycemia because of an increased number of cells per unit of body weight and because of increased demands on stored liver glycogen to support respirations, thermoregulation, and muscle activity.

In full-term neonates, hypoglycemia may occur 24 to 72 hours after birth and is usually transient. In neonates who are premature or small for gestational age, onset of hypoglycemia is much more rapid — it can occur as soon as 6 hours after birth — due to their small, immature livers, which produce much less glycogen. A rare cause of hypoglycemia in infants is nesidioblastosis, a benign condition of the insulin-producing islet cells. The treatment is surgical.

Maternal disorders that can produce hypoglycemia in infants within 24 hours after birth include diabetes mellitus, pregnancy-induced hypertension, erythroblastosis, and glycogen storage disease.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Low birth weight: Medical causes
(Nursing: Interpreting Signs and Symptoms)

This section lists some fetal and placental causes of low birth weight as well as the associated signs and symptoms present in the neonate at birth.

Chromosomal aberrations.Abnormalities in the number, size, or configuration of chromosomes can cause low birth weight and possibly multiple congenital anomalies in a premature or SGA neonate. For example, a neonate with trisomy 21 (Down syndrome) may be SGA and have prominent epicanthal folds, a flat-bridged nose, a protruding tongue, palmar simian creases, muscular hypotonia, and an umbilical hernia.

Cytomegalovirus infection.Although low birth weight in cytomegalovirus infection is usually associated with premature birth, the neonate may be SGA. Assessment at birth may reveal these classic signs: petechiae and ecchymoses, jaundice, and hepatosplenomegaly, which increases for several days. The neonate may also have a high fever, lymphadenopathy, tachypnea, and dyspnea, along with prolonged bleeding at puncture sites.

Placental dysfunction.With placental dysfunction, low birth weight and a wasted appearance occur in an SGA neonate. He may be symmetrically short or may appear relatively long for his low weight. Additional findings reflect the underlying cause. For example, if maternal hyperparathyroidism caused placental dysfunction, the neonate may exhibit muscle jerking and twitching, carpopedal spasm, ankle clonus, vomiting, tachycardia, and tachypnea.

Rubella (congenital).Usually, the low-birth-weight neonate with congenital rubella is born at term but is SGA. A characteristic “blueberry muffin” rash accompanies cataracts, purpuric lesions, hepatosplenomegaly, and a large anterior fontanel. Abnormal heart sounds, if present, vary with the type of associated congenital heart defect.

Varicella (congenital).With congenital varicella, low birth weight is accompanied by cataracts and skin vesicles.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Hyperinsulinism/Hypoglycemia: Hyperinsulinism/Hypoglycemia - pathophysiology
(The 5-Minute Pediatric Consult)

  • These mutations result in uncoupling of insulin secretion from the glucose-sensing machinery of the pancreatic beta cell, and inappropriate insulin secretion even in the face of low blood glucose.
  • The most common and severe forms of HI arise from mutations in the KATP channel, which can manifest in focal or diffuse disease
  • In hyperinsulinism/hyperammonemia syndrome, protein inappropriately stimulates insulin secretion and causes persistently elevated ammonia level. This is due to mutations in glutamate dehydrogenase.

Hyperinsulinism/Hypoglycemia - etiology

  • Mutations in 5 genes have been associated with congenital HI: Genes coding for either of the 2 subunits of the beta cell KATP channel [SUR1, sulfonylurea receptor (ABCC8); Kir6.2, inwardly rectifying potassium channel (KCNJ11)], glucokinase (GCK), glutamate dehydrogenase (GLUD-1), and SCHAD (HADHSC).
  • A transient form of HI has been associated with perinatal stress (small for gestational age [SGA] birth weight, maternal hypertension, precipitous delivery, or hypoxia), but the mechanism has not been elucidated.

» READ BOOK EXCERPT ONLINE »

Source: The 5-Minute Pediatric Consult, 2008


 » Next page: Risk Factors for Hypoglycemia

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