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Drug-induced hypoglycemia

Definition

Drug-induced hypoglycemia is low blood sugar that results from medication.

Figures

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
Numbness or tingling of skin
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 70 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, eds. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier;2008:chap 33.

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