Hypoglycemia risk factors

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]

Risk factors of hypoglycemia include diabetic patients with excessive insulin doses especially after missed meals or after exercise. Nocturnal fasting and alcohol intake are less common risk factors in diabetic patients.

Risk factors of hypoglycemia include:^[1][2]

• Excessive amounts of Insulin or insulin secretagogues drugs, inappropriate timing or type of administration
• Decreased glucose intake (missed meals and overnight)
• Increased glucose need during exercise
• Decreased endogenous glucose production after alcohol intake
• Sensitivity to insulin is increased due to:
  • Weight loss
  • Improved glycemic control
  • Physiologically in the middle of the night
• Renal failure may cause decreased Insulin clearance

There are three defense mechanisms against hypoglycemia:^[3][4]

• Decrease in insulin levels
• Increase in glucagon production
• Increase in epinephrine levels

Failure of any of these defense mechanisms increase the chance of hypoglycemia. This occurs rapidly in type 1 diabetes and more gradually in type 2 diabetes mainly due to:^[5]

• Absolute endogenous insulin deficiency in type1 DM
• A history of severe hypoglycemia, hypoglycemia unawareness, or both
• Aggressive glycemic therapy (lower HbA1C levels, lower glycemic goals)