Understanding Low Glucose Levels in diabetes

Hypoglycemia or low glucose levels is a common problem---many people experience symptoms of hypoglycemia. In women fasting glucose level < 40 mg/dL (2.2 mmol/L) and in men < 50 mg/dL (2.8 mmol/L) along with symptoms of hypoglycemia indicates that you have an insulinoma. It is a tumor which produces high amounts of insulin.

Some other causes of low glucose levels include;

• In people with diabetes overmedication with insulin or other oral antidiabetic medications
• Certain medications can cause hypoglycemia such as beta blockers, pentamidine, and sulfamethoxazole and trimethoprim.
• Excessive use of alcohol
• Missed meals or if you remain hungry for prolonged period
• Severe infection (sepsis)
• Poor oral intake due to infection, any chronic disease like cancer
• Endocrinal disease like adrenal insufficiency (Addison's disease)
• Kidney or liver failure
• Inborn error or congenital, genetic defects of insulin release and blood glucose metabolism (congenital hyperinsulinism)
• Certain conditions that can increase insulin release (like infant born to a diabetic mother, birth trauma, reduced oxygen delivery during birth, Beckwith-Wiedemann syndrome, and certain rarer genetic conditions)
• Certain other tumors such as  hepatoma, mesothelioma, and fibrosarcoma (these tumors may produce insulin-like factors which can lead to hypoglycemia)

A single episode of low blood sugar is not alarming. But repeated episodes of documented hypoglycemia or low glucose level in people not on medications to treat diabetes needs to be evaluated carefully by an endocrinologist.

Dr Poonam Sachdeva, our in-house medical expert talks about the why what and how in diabetes.