This list of causes of hypoglycemia is separated from the main article because of its length. Despite its length, it is not exhaustive, as new causes are reported regularly in the medical literature. In many individual instances of hypoglycemia, more than one contributing factor may be identifiable. In this list are some factors not usually sufficient to cause hypoglycemia by themselves. Some of these causes are represented by single case reports.
Additional recommended knowledge
Causes of Transient Neonatal Hypoglycemia
Starvation, Inadequate Intake Or Absorption
Major Organ Failure & Critical Illness
Extrapancreatic Tumors
- Mechanisms
- Tumors associated with hypoglycemia
Hyperinsulinism
- Hypoglycemia due to endogenous insulin
- Congenital hyperinsulinism
- Transient neonatal hyperinsulinism
- Due to maternal factors
- Due to infant factors
- Iatrogenic
- Malposition of umbilical catheter
- Focal congenital hyperinsulinism
- Diffuse congenital hyperinsulinism
- Autosomal recessive forms
- SUR1 mutations
- Kir6.2 mutations
- Autosomal dominant forms
- Glucokinase gain-of-function mutations
- Hyperammonemic hyperinsulinism (glutamate dehydrogenase gain-of-function mutations)
- Loss of heterozygosity of 11p15 (Beckwith-Wiedemann syndrome)
- Donohue syndrome (leprechaunism)
- Acquired tumors and hyperplasias of pancreatic beta cells
- Autoimmune insulin syndrome
- Reactive hypoglycemia (postprandial hypoglycemia syndrome)
- Dumping syndrome
- Drug induced hyperinsulinism
- Hypoglycemia due to exogenous (injected) insulin
- Insulin self-injected for treatment of diabetes
- Excessive insulin dosage or accelerated absorption
- Excessive activity
- Inadequate food or delayed or decreased absorption
- Alcohol
- Drugs which contribute synergistically
- Development of concurrent disease
- Acquired endocrinopathies
- Renal, cardiac or liver failure
- Factitious & malicious insulin injection
- Insulin tolerance test for pituitary or adrenergic response assessment
- Treatment of hyperkalemia
- Insulin potentiation treatment (cancer quackery)
- Insulin-induced coma for depression or psychosis treatment (insulin shock)
Hormone Deficiencies
Metabolic Defects
- Defective glycogenolysis or glycogen accumulation
- Glucose-6-phosphatase deficiency (glycogenosis type I, von Gierke dis)
- Pseudoglycogenosis type I
- Amylo-1,6-glucosidase (debrancher) deficiency (glycogenosis type III)
- Hepatic phosphorylase deficiency (glycogenosis type VI)
- Hepatic phosphorylase kinase deficiency (glycogenosis type IXb)
- Glycogen synthase deficiency (glycogenosis type 0)
- Galactose-1-phosphate uridyl transferase deficiency (galactosemia)
- Defects of gluconeogenesis or substrate supply
- Defects of mitochondrial beta-oxidation and fatty acid metabolism
- Systemic carnitine deficiencies
- Butyryl CoA dehydrogenase
- Hydroxymethylglutaryl CoA lyase
- Methylcrotonyl CoA carboxylase
- Medium chain acyl CoA dehydrogenase
- Short chain acyl CoA dehydrogenase
- Long chain acyl CoA dehydrogenase
- Multiple acyl CoA dehydrogenase (glutaric aciduria type II)
- Long-chain 3-hydroxyacyl-CoA dehydrogenase
- Short-chain 3-hydroxyacyl CoA dehydrogenase
- Carnitine/acylcarnitine translocase
- Enoyl CoA hydratase
- Ketothiolase
- Succinyl CoA:acetoacetate transferase
- Defects of amino acid metabolism
- Miscellaneous metabolic defects
- Defective type I glucose transporter in brain
- Methylglutaconic aciduria
- Sucrosuria
- Glycerol intolerance
- Rare variants of galactose intolerance
- Other rare or poorly defined congenital metabolic defects
Drugs And Toxic substances
- Insulin, antidiabetic agents (see above)
- Drugs associated with hypoglycemia alone
- Drugs which lower glucose in diabetics
- Enalapril and captopril
- Coumarin
- Phenylbutazone
- Antihistamines
- Sulfa antibiotics, including SMX/TMP (especially in renal failure)
- Monoamine oxidase inhibitors
- Medicines not available in U.S.
- Azapropazone, buformin, carbutamide, cibenzoline, cycloheptolamide, glibornuride, gliclazide, mebanazine, metahexamide, perhexiline, sulphadimidine, sulphaphenazole, Nigerian cow urine medicine
- Environmental toxins
- Amanita phalloides toxin
- Abractylis gummifera (Mediterranean plant)
- Hypoglycin from unripe Ackee fruit (Jamaican vomiting illness)
- Parathion
- Vacor rat poison
Idiopathic And Miscellaneous
- Ketotic hypoglycemia
- Identifiable hormone and enzyme deficiencies
- Idiopathic
- Idiopathic hypoglycemias, etiologies undetermined
- Autoimmune
- Antibodies to insulin
- Antibodies to insulin receptor
- Stimulating antibodies to islet cells
- Thyrotoxicosis (extremely rare)
- Infection
- Extreme exercise
- Artifactual
- In vitro glucose consumption after blood drawing
- Leukemic WBC's may consume glucose in vitro
- Polycythemia of infancy (RBCs consume glucose in vitro)
- Inaccuracies of blood drop strips
- Inherent variation inaccuracy at low end
- Inadequate drop
- Excessive wiping
- Short time interval
Reactive, Functional, Postprandial, Etc.
- Prediabetes (both categories controversial & may not be valid)
- Juvenile diabetes (rare, anecdotal reports)
- Adult onset diabetes (in early stages)
- After intravenous glucose load
- Abrupt discontinuation of parenteral nutrition or i.v. glucose
- After exchange transfusion with ACD preserved blood in neonate
- Alimentary (rapid jejunal emptying with exaggerated insulin response)
- Post fundoplication for gastroesophageal reflux
- Post gastrectomy dumping syndrome
- Short bowel syndrome
- Idiopathic gastrointestinal motility disturbance
- Alternate day growth hormone therapy
- Idiopathic reactive or postprandial hypoglycemia (hypoglycemia documented at time of symptoms: rare)
- Idiopathic postprandial syndrome (hypoglycemia never documented: common)
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