Drug-induced hypoglycemia

• Causes, incidence, and risk factors

  All of the following can cause blood sugar (glucose) levels to drop:

  • Drinking alcohol
  • Getting too much activity
  • Intentionally or unintentionally overdosing on the medications used to treat diabetes
  • Missing meals

  Even when diabetes is managed very carefully, the medications used to treat diabetes can result in drug-induced hypoglycemia. The condition may also occur when someone without diabetes takes a medicine used to treat diabetes. In rare cases, non-diabetes-related medicines may cause hypoglycemia.

  Medications that can cause drug-induced hypoglycemia include:

  • Bactrim (an antibiotic)
  • Beta-blockers
  • Haloperidol
  • Insulin
  • MAO inhibitors
  • Metformin when used with sulfonylureas
  • Pentamidine
  • Quinidine
  • Quinine
  • Sulfonylureas
• Symptoms
  • Anxiety
  • Hunger
  • Irritability
  • Nightmares
  • Palpitations
  • Shakiness
  • Sweating

  Symptoms of long-term (chronic) hypoglycemia can include:

  • Coma
  • Confusion
  • Convulsions
  • Extreme tiredness (lethargy)
  • Movement difficulties (ataxia)
• Signs and tests

  A blood test will show a glucose level of less than 45 mg/dL.

  In cases where people without diabetes have taken drugs for the condition, blood tests may show a high insulin level and low C-peptide level. The urine may test positive for sulfonylureas.

• Treatment

  You will be given glucose. The doctor will review your diabetes treatment plan to help prevent future problems.

• Expectations (prognosis)

  The outlook is good if the hypoglycemia is promptly detected and treated. However, long-term and repeated episodes of hypoglycemia may damage the brain and nerves.

• Complications

  Complications of severe or long-term hypoglycemia include:

  • Brain and nervous system (neurologic) damage
  • Coma
  • Convulsions
• Calling your health care provider

  Call your health care provider if you have symptoms of hypoglycemia. Be sure to mention any medications you believe may be affecting the condition.

• Prevention

  For people with diabetes, strict control of blood sugar is important. This can be done with:

  • Home blood sugar testing
  • Exercise
  • Proper diet

  Discuss any planned changes in diet, exercise, travel, weight, or routine with your health care provider. Your treatment plan may be adjusted ahead of time to prevent hypoglycemia.

• References

  Guettier JM. Hypoglycemia. Endocrinol Metab Clin North Am. Dec 2006; 35(4): 753-66, viii-ix.

  Goldman L, Ausiello D. Cecil Textbook of Medicine, 22nd ed. Philadelphia, Pa: WB Saunders; 2004:1444-1445.

  Cryer, PE. Glucose Homeostasis and Hypoglycemia. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Kronenberg: Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 33.

Review Date: 6/17/2008

Reviewed By: Elizabeth H. Holt, MD, PhD, Assistant Professor of Medicine, Section of Endocrinology and Metabolism, Yale University. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.