Drug-induced hypoglycemia

Hypoglycemia is a clinical syndrome with diverse causes in which low levels of plasma glucose eventually lead to neuroglycopenia. Hypoglycemia is the most common endocrine emergency faced by practicing physicians. Though hypoglycemia is a very common medical problem both in adults and children seeking medical help, most of it is iatrogenic. Treatment with oral hypoglycemic agents, alone or in combination, and/or insulin is an ongoing threat for diabetic patients and still accounts for the majority of cases of hypoglycemia. Numerous other drugs have been reported to induce hypoglycemia, sometimes in seemingly healthy individuals in whom it may masquerade as spontaneous hypoglycemia. Predisposing factors to drug-induced hypoglycemia include restricted carbohydrate intake, extremes of age and abnormal liver and kidney function. In drug-induced hypoglycemia, the offending drug should be eliminated immediately and patients should receive other supportive measures to raise and maintain blood sugar levels. It is also important to avoid future recurrences. Enhanced therapeutic monitoring may be warranted when drugs with hypoglycemic potential are administered. The risk for possible drug interactions that may cause hypoglycemia increases exponentially as the number of medications in a patient's regimen increases. Although most physicians are familiar with the treatment of hypoglycemia, appropriate evaluation and follow-up of the problem require knowledge of several relatively rare diagnostic considerations.