Hypoglycemia causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Causes

Causes by Organ System

Cardiovascular	No underlying causes
Chemical / poisoning	1,1-Dichloroethene, clove, ethanol, ginsen, jamaican vomiting sickness, systemic monochloroacetate poisoning
Dermatologic	No underlying causes
Drug Side Effect	Acetohexamide, amprenavir, chloramphenicol, chlorpromazine, chlorpropamide, cidofovir, cibenzoline, dipeptidyl peptidase-4 inhibitor, empagliflozin, ethanol, ethionamide, fluorodeoxyglucose, gatifloxacin, ginseng, glibenclamide, gliclazide, glimepiride, glipizide, gliquidone, glisolamide, glisoxepide, glyburide, insulin aspart, insulin detemir, insulin glargine, insulin-like growth factor, lanreotide, levomepromazine, levobunolol hydrochloride, linagliptin, lorcaserin, mecasermin, meropenem, mitiglinide, nateglinide, nitisinone, oxcarbazepine, pazopanib, pegvisomant, penicillamine, pentamidine isethionate, perazine, pipothiazine, pramipexole, pramlintide, quinine, repaglinide, rifaximin, ritonavir, saxagliptin, saquinavir, sertraline, somatostatin, sulfamethoxazole, temafloxacin, thalidomide, tolazamide, tolbutamide, trimethoprim, vildagliptin, zonisamide
Ear Nose Throat	No underlying causes
Endocrine	Addison's disease, ACTH deficiency, adrenal cancer, adrenal cortex insufficiency, adrenal insufficiency, autoimmune adrenalitis, congenital hyperinsulinism, diabetes mellitus type 1, diabetes mellitus type 2, diabetic gastroparesis, functioning pancreatic endocrine tumor, glucocorticoid deficiency 1, growth hormone deficiency, hyperinsulinism, hyperinsulinism due to glutamodehydrogenase deficiency,hypopituitarism, hypoglycemia, hypothyroidism, hypopituitarism, islet cell adenoma, insulin, insulinoma, idiopathic growth hormone deficiency, ketotic hypoglycemia, multiple endocrine neoplasia type 1, myxedema coma, nesidioblastosis, pancreatic cancer, pituitary dwarfism II, sheehan's syndrome, timme syndrome, tyrosinemia, Wilms tumor
Environmental	No underlying causes
Gastroenterologic	Acute fatty liver of pregnancy, acute liver failure, cirrhosis, diabetic gastroparesis, diarrhea, dumping syndrome, functioning pancreatic endocrine tumor, gastric dumping syndrome, hepatic congestion, hepatic failure, idiopathic postprandial syndrome, Insulinoma, liver cancer, malabsorption, maldigestion, reactive hypoglycemia, severe hepatitis
Genetic	2-methylbutyryl-coenzyme A dehydrogenase deficiency, 3-alpha-hydroxyacyl-CoA dehydrogenase deficiency, 3-Methylcrotonyl-CoA carboxylase deficiency, ACAD9 deficiency, adrenal hypoplasia congenital, X-linked, acetohexamide, aldolase A deficiency, alpers syndrome, Beckwith-Weidemann Syndrome carbohydrate-deficient glycoprotein syndrome type 1b, carnitine palmitoyltransferase 1 deficiency, carnitine-acylcarnitine translocase deficiency, Coenzyme Q cytochrome c reductase deficiency, cleft lip palate pituitary deficiency, debrancher deficiency, dicarboxylicaminoaciduria, dihydrolipoamide dehydrogenase deficiency, Donohue syndrome, dopamine beta hydroxylase deficiency, familial glucocorticoid deficiency, familial hyperinsulinemic hypoglycemia type 3, familial hyperinsulinemic hypoglycemia type 5, familial hyperinsulinemic hypoglycemia type 7, fructose-1,6-bisphosphatase deficiency, fructose-1-phosphate aldolase deficiency, galactose-1-phosphate uridyltransferase deficiency, glucose 6 phosphate dehydrogenase deficiency, glutaric acidemia type 2, glucokinase mutations, glycogenosis type 1a, glycogenosis type 1b, glycogenosis type 3, glycogenosis type 6, glycogenosis type 9a, glycogenosis type 9b, glycogenosis type 9c, glycogenosis type V, growth hormone deficiency, hereditary ACTH resistance, hepatocyte nuclear factor 1a, HMG-CoA lyase deficiency, hydroxymethylglutaryl-CoA lyase deficiency, hyperinsulinism-hyperammonemia syndrome, KATP channel defects, Laron dwarfism, leucine-induced hypoglycaemia, liver glycogen synthase deficiency, malonyl-CoA decarboxylase deficiency, maple syrup urine disease, medium chain acyl-CoA dehydrogenase deficiency, methylmalonic acidemia, mitochondrial DNA depletion syndrome, hepatocerebral form, mitochondrial trifunctional protein deficiency, monocarboxylate transporter 1,navajo neurohepatopathy, nesidioblastosis, paternal uniparental disomy, Plasma membrane carnitine transporter deficiency, Propionyl-CoA carboxylase deficiency PCCA type, propionic acidemia, primary carnitine deficiency, pyruvate carboxylase deficiency, Short chain acyl-CoA dehydrogenase deficiency, triple A syndrome, tyrosinaemia type 1, uncoupling protein 2, very long-chain acyl-CoA dehydrogenase deficiency, septic shock
Hematologic	Hemolytic disease of the newborn
Iatrogenic	Gastrojejunostomy, gastric dumping syndrome, postgastrectomy syndrome, pyloroplasty, Reye syndrome
Infectious Disease	Acute meningitis, malaria, neonatal bacterial meningitis, Reye's syndrome, sepsis, visceral leishmaniasis
Musculoskeletal / Ortho	No underlying causes
Neurologic	Acute meningitis, autonomic dystonia, autonomic neuropathy, elevated vagal tone, Reye's syndrome
Nutritional / Metabolic	Acetohexamide, ACAD9 deficiency, binge drinking, coenzyme Q cytochrome c reductase deficiency, deficiency in enzymes of fat oxidation, diabetes mellitus, diabetic gastroparesis, dicarboxylic aminoaciduria, fructose intolerance, galactosemia, glycogen debranching deficiency, glucose-6-phosphatase deficiency, hypoketonemic hypoglycemia, Ketotic hypoglycemia of infancy, Mcquarrie type infantile idiopathic hypoglycemia, organic acidemia, pyruvate carboxylase deficiency, phosphoenolpyruvate carboxykinase (PEPCK) deficiency, urea cycle disorder, glucagon deficiency, fructose-1, 6-diphosphatase deficiency, fructose intolerance, Fructose-1,6-bisphosphatase deficiency, hereditary, galactosemia,fructose-1-phosphate aldolase deficiency, glucose 6 phosphate dehydrogenase deficiency, glutaric acidemia type 2, glycogenosis type 1a, glycogenosis type 1b, glycogenosis type 3, glycogenosis type 6, glycogenosis type 9a, glycogenosis type 9b, glycogenosis type 9c, glycogenosis type V, HMG-CoA lyase deficiency, HMG CoA synthetase deficiency,hydroxymethylglutaryl-CoA lyase deficiency, inborn urea cycle disorder, leucinosis, long chain hydroxyacyl-CoA dehydrogenase deficiency, malabsorption, malonic aciduria,malonyl-CoA decarboxylase deficiency, maple syrup urine disease, medium chain acyl-CoA dehydrogenase deficiency, methylmalonic acidemia, nesidioblastosis, organic acidemia, propionic acidemia, propionyl-CoA carboxylase deficiency PCCA type, reactive hypoglycemia, short chain acyl-CoA dehydrogenase deficiency, tyrosinaemia type 1, very long-chain acyl-CoA dehydrogenase deficiency
Obstetric/Gynecologic	Diabetic mother, gestational diabetes, intrauterine growth retardation, pregnancy, premature labour and/or delivery, sheehan syndrome, acute fatty liver of pregnancy,hemolytic disease of the newborn
Oncologic	Adrenal cancer, breast cancer, Doege-potter syndrome, IGF producing tumors, tumors, pancreatic cancer, insulinoma, liver cancer, mesothelioma, metastatic insulinoma
Opthalmologic	No underlying causes
Overdose / Toxicity	Acetohexamide, amprenavir, chloramphenicol, chlorpromazine, chlorpropamide, cibenzoline, clove, ethanol, ethionamide, fluorodeoxyglucose, gatifloxacin, ginseng, glibenclamide, gliclazide, glimepiride, glipizide, gliquidone, glisolamide, glisoxepide, insulin, insulin like growth factor , lanreotide, levomepromazine, mitiglinide, nateglinide, pazopanib, pentamidine, perazine, pipothiazine, pramlintide, quinine, repaglinide, ritonavir, saquinavir, somatostatin, sulfamethoxazole, temafloxacin, tolazamide, tolbutamide, trimethoprim
Psychiatric	Anorexia nervosa, bullimia nervosa, Munchausen syndrome, factitious hypoglycemia
Pulmonary	Mesothelioma
Renal / Electrolyte	Benign glucosuria, renal failure, renal hypoglycemia, uremia
Rheum / Immune / Allergy	Autoimmune adrenalitis, hemolytic disease of the newborn, immunopathologic hypoglycemia, insulin receptor antibodies
Sexual	No underlying causes
Trauma	Burns
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	Alcoholism, binge drinking, burns, cachexia, chronic hypoglycemia, delayed separation blood sample, drip arm sample, fasting, heavy exercise, hepatic failure, hypothermia, idiopathic hypoglycemia, insulin shock, malnutrition, Mcquarrie type infantile idiopathic hypoglycemia, pregnancy, sepsis, starvation, strenuous exercise, shock

Causes in Alphabetical Order

ACTH Deficiency

2-Methylbutyryl-Coenzyme A Dehydrogenase Deficiency

3-Alpha-Hydroxyacyl-Coa Dehydrogenase Deficiency

3-Methylcrotonyl-Coa Carboxylase Deficiency

6-Diphosphatase Deficiency

Acad9 Deficiency

Acetohexamide

Acute Fatty Liver Of Pregnancy

Acute Fatty Liver Of Pregnancy,Hemolytic Disease Of The Newborn

Acute Liver Failure

Acute Meningitis

Addison's Disease

Adrenal Cancer

Adrenal Cortex Insufficiency

Adrenal Hypoplasia Congenital

Adrenal Insufficiency

Alcoholism

Aldolase A Deficiency

Alpers Syndrome

Amprenavir

Anorexia Nervosa

Aspart

Autoimmune Adrenalitis

Beckwith-Weidemann Syndrome Carbohydrate-Deficient Glycoprotein Syndrome Type 1b

Benign Glucosuria

Binge Drinking

Breast Cancer

Bullimia Nervosa

Burns

Cachexia

Carnitine Palmitoyltransferase 1 Deficiency

Carnitine-Acylcarnitine Translocase Deficiency

Chloramphenicol

Chlorpromazine

Chlorpropamide

Chronic Hypoglycemia

Cibenzoline

Cidofovir

Cirrhosis

Cleft Lip Palate Pituitary Deficiency

Clove

Coenzyme Q Cytochrome C Reductase Deficiency

Congenital Hyperinsulinism

Debrancher Deficiency

Deficiency In Enzymes Of Fat Oxidation

Delayed Separation Blood Sample

Detemir

Diabetes Mellitus

Diabetes Mellitus Type 1

Diabetes Mellitus Type 2

Diabetic Gastroparesis

Diabetic Mother

Diarrhea

Dicarboxylic Aminoaciduria

Dihydrolipoamide Dehydrogenase Deficiency

Dipeptidyl

Doege-Potter Syndrome

Donohue Syndrome

Dopamine Beta Hydroxylase Deficiency | Dopamine Beta Hydroxylase Deficiency

Drip Arm Sample

Dumping Syndrome

Empagliflozin

Ethanol

Ethionamide

Factitious Hypoglycemia

Factor

Familial Glucocorticoid Deficiency

Familial Hyperinsulinemic Hypoglycemia Type 3

Familial Hyperinsulinemic Hypoglycemia Type 5

Familial Hyperinsulinemic Hypoglycemia Type 7

Fasting

Fluorodeoxyglucose

Fructose Intolerance

Fructose-1

Fructose-1-Phosphate Aldolase Deficiency

Fructose-1,6-Bisphosphatase Deficiency

Functioning Pancreatic Endocrine Tumor

Galactose-1-Phosphate Uridyltransferase Deficiency

Galactosemia

Galactosemia,Fructose-1-Phosphate Aldolase Deficiency

Gastric Dumping Syndrome

Gastrojejunostomy

Gatifloxacin

Gestational diabetes

Ginseng

Glargine

Glibenclamide

Gliclazide

Glimepiride

Glipizide

Gliquidone

Glisolamide

Glisoxepide

Glucagon deficiency

Glucocorticoid deficiency 1

Glucokinase mutations

Glucose 6 phosphatase deficiency

Glutaric acidemia type 2

Glyburide

Glycogen debranching deficiency

Glycogenosis Type 1a

Glycogenosis Type 1b

Glycogenosis Type 3

Glycogenosis Type 6

Glycogenosis Type 9a

Glycogenosis Type 9b

Glycogenosis Type 9c

Glycogenosis Type V

Growth hormone deficiency

Heavy exercise

Hemolytic disease of the newborn

Hepatic congestion

Hepatic failure

Hepatocyte nuclear factor 1a

Hereditary ACTH resistance

Hmg Coa synthetase deficiency

Hydroxymethylglutaryl-Coa lyase deficiency

Hmg-Coa lyase deficiency

Hydrochloride

Hydroxymethylglutaryl-Coa lyase deficiency

Hyperinsulinism

Hyperinsulinism-hyperammonemia syndrome

Hypoglycemia

Hypoketonemic hypoglycemia

Hypopituitarism

Hypothermia

Hypothyroidism

Idiopathic growth hormone deficiency

Idiopathic hypoglycemia

Idiopathic postprandial syndrome

Igf producing tumors

Immunopathologic hypoglycemia

Inborn urea cycle disorder

Insulin

Insulin like growth factor

Insulin receptor antibodies

Insulinoma

Intrauterine growth retardation

Isethionate

Islet cell adenoma

KATP channel defects

Ketotic hypoglycemia

Ketotic hypoglycemia of infancy

Lanreotide

Laron dwarfism

Leucine-Induced hypoglycaemia

Leucinosis

Levobunolol

Levomepromazine

Linagliptin

Liver cancer

Liver glycogen synthase deficiency

Long Chain hydroxyacyl-Coa dehydrogenase deficiency

Lorcaserin

Malabsorption

Malaria

Maldigestion

Malnutrition

Malonic aciduria malonyl-Coa decarboxylase deficiency

Malonyl-Coa decarboxylase deficiency

Maple syrup urine disease

Mcquarrie type infantile idiopathic hypoglycemia

Mecasermin

Medium Chain Acyl-Coa Dehydrogenase Deficiency

Meropenem

Mesothelioma

Metastatic insulinoma

Methylmalonic acidemia

Mitiglinide

Mitochondrial DNA depletion syndrome

Mitochondrial trifunctional protein deficiency

Multiple endocrine neoplasia type 1

Munchausen syndrome

Myxedema coma

Nateglinide

Neonatal bacterial meningitis

Nesidioblastosis

Nesidioblastosis

Nitisinone

Organic acidemia

Oxcarbazepine

Pancreatic cancer

Paternal uniparental disomy

Pazopanib

Pegvisomant

Penicillamine

Pentamidine

Peptidase-4

Perazine

Phosphoenolpyruvate carboxykinase deficiency

Pipothiazine

Pituitary Dwarfism

Plasma Membrane Carnitine Transporter Deficiency

Postgastrectomy Syndrome

Pramipexole

Pramlintide

Pregnancy

Premature Labour And/Or Delivery

Primary Carnitine Deficiency

Propionic Acidemia

Propionyl-Coa Carboxylase Deficiency Pcca Type

Pyloroplasty

Pyruvate Carboxylase Deficiency

Pyruvate Carboxylase Deficiency

Quinine

Reactive Hypoglycemia

Renal Failure

Renal Hypoglycemia

Repaglinide

Reye Syndrome

Rifaximin

Ritonavir

Saquinavir

Saxagliptin

Sepsis

Septic Shock

Sertraline

Severe Hepatitis

Sheehan's Syndrome

Shock

Short Chain Acyl-Coa Dehydrogenase Deficiency

Somatostatin

Starvation

Strenuous Exercise

Sulfamethoxazole

Temafloxacin

Thalidomide

Timme Syndrome

Tolazamide

Tolbutamide

Trimethoprim

Triple A Syndrome

Tumors

Tyrosinaemia Type 1

Tyrosinemia

Uncoupling Protein 2

Urea Cycle Disorder

Uremia

Very Long-Chain Acyl-Coa Dehydrogenase Deficiency

Vildagliptin

Visceral Leishmaniasis

Wilms Tumor

Causes

Common Causes

Hypoglycemia in Newborn Infants

Hypoglycemia is a common problem in critically ill or extremely low birthweight infants. If not due to maternal hyperglycemia, in most cases it is multifactorial, transient and easily supported. In a minority of cases hypoglycemia turns out to be due to significant hyperinsulinism, hypopituitarism or an inborn error of metabolism and presents more of a management challenge.

• Transient neonatal hypoglycemia
  • Prematurity, intrauterine growth retardation, perinatal asphyxia
  • Maternal hyperglycemia due to diabetes or iatrogenic glucose administration
  • Sepsis
  • Prolonged fasting (e.g., due to inadequate breast milk or condition interfering with feeding)
• Congenital hypopituitarism
• Congenital hyperinsulinism, several types, both transient and persistent
• Inborn errors of carbohydrate metabolism such as glycogen storage disease

Hypoglycemia in Young Children

Single episodes of hypoglycemia due to gastroenteritis or fasting, but recurrent episodes nearly always indicate either an inborn error of metabolism, congenital hypopituitarism, or congenital hyperinsulinism

• Prolonged fasting
  • Diarrheal illness in young children, especially rotavirus gastroenteritis
• Idiopathic ketotic hypoglycemia
• Isolated growth hormone deficiency, hypopituitarism
• Insulin excess
  • Hyperinsulinism due to several congenital disorders of insulin secretion
  • Insulin injected for type 1 diabetes
• Gastric dumping syndrome (after gastrointestinal surgery)
• Other congenital metabolic diseases; some of the common include
  • Maple syrup urine disease and other organic acidurias
  • Type 1 glycogen storage disease
  • Disorders of fatty acid oxidation
  • Medium chain acylCoA dehydrogenase deficiency (MCAD)
• Accidental ingestions
  • Sulfonylureas, propranolol and others
  • Ethanol (mouthwash, "leftover morning-after-the-party drinks")

Hypoglycemia in Older Children and Young Adults

By far the most common cause of severe hypoglycemia in this age range is insulin injected for type 1 diabetes. Circumstances should provide clues fairly quickly for the new diseases causing severe hypoglycemia. All of the congenital metabolic defects, congenital forms of hyperinsulinism, and congenital hypopituitarism are likely to have already been diagnosed or are unlikely to start causing new hypoglycemia at this age. Body mass is large enough to make starvation hypoglycemia and idiopathic ketotic hypoglycemia quite uncommon. Recurrent mild hypoglycemia may fit a reactive hypoglycemia pattern, but this is also the peak age for idiopathic postprandial syndrome, and recurrent "spells" in this age group can be traced to orthostatic hypotension or hyperventilation as often as demonstrable hypoglycemia.

• Insulin-induced hypoglycemia
  • Insulin injected for type 1 diabetes
  • Factitious insulin injection (Munchausen syndrome)
  • Insulin-secreting pancreatic tumor
  • Reactive hypoglycemia and idiopathic postprandial syndrome
• Addison's disease
• Sepsis

Hypoglycemia in Older Adults

The incidence of hypoglycemia due to complex drug interactions, especially involving oral hypoglycemic agents and insulin for diabetes rises with age. Though much rarer, the incidence of insulin-producing tumors also rises with advancing age. Most tumors causing hypoglycemia by mechanisms other than insulin excess occur in adults.

• Insulin-induced hypoglycemia
  • Insulin injected for diabetes
  • Factitious insulin injection (Munchausen syndrome)
  • Excessive effects of oral diabetes drugs, beta-blockers, or drug interactions, Tiagabine
  • Insulin-secreting pancreatic tumor
  • Alimentary (rapid jejunal emptying with exaggerated insulin response)
    • After gastrectomy dumping syndrome or bowel bypass surgery or resection
  • Reactive hypoglycemia and idiopathic postprandial syndrome
• Tumor hypoglycemia, Doege-Potter syndrome
• Acquired adrenal insufficiency
• Acquired hypopituitarism
• Immunopathologic hypoglycemia

References

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