Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Reactive hypoglycemia is the result of the delayed insulin release after a meal has been absorbed and occurs 4-6 hours after eating.
Cancer causing poor oral intake or cancer involving the liver
Congenital, genetic defects in the regulation of insulin release (congenital hyperinsulinism)
Congenital conditions associated with increased insulin release (infant born to a diabetic mother, birth trauma, reduced oxygen delivery during birth, major birth stress, Beckwith-Wiedemann syndrome, and rarer genetic conditions)
What follows are expansions on the points noted above and should be incorporated within those points (such as cancer, diabetes drugs, organ failures).
Most cases of hypoglycemia in adults happen in people with diabetes mellitus. Diabetes has two forms, type 1 (loss of all insulin production) and type 2 (inadequate insulin production due to resistance to the actions of insulin). People with type 1 diabetes must take insulin to control their glucose level; if they skip meals or have a decreased appetite without changing their insulin dose, they may develop hypoglycemia. Insulin is also used to treat some people with type 2 diabetes.
If a person with type 1 diabetes accidentally takes too much insulin, or a person with type 2 diabetes accidentally takes too much of their oral medications or insulin, he or she may develop hypoglycemia. Even when a diabetic patient takes medications correctly, improper meals, odd mealtimes, or excessive exercise may result in hypoglycemia.
Often a person who has more than one medical problem may become confused about how much of a certain medication they should take, or their medications may interact to cause hypoglycemia.
Hypoglycemia also may occur in people with cancer, which often causes loss of appetite. Many such people skip meals because they are not hungry or because chemotherapy causes
foods to taste differently. To prevent this, people on chemotherapy should be encouraged by their doctors and loved ones to try to stay on special diets and take medications to keep them from feeling sick. If this does not work, special medications to help with appetite are available.
Adrenal insufficiency results from diseases that impair the adrenal glands, which are located above the kidneys. These small structures make certain hormones and substances, mainly cortisol and epinephrine, which also help elevate glucose in addition to their other functions. If these substances are not made, low blood pressure, hypoglycemia, or both can result.
The pituitary gland makes growth hormone, which also helps to maintain the balance of glucose. Deficiency of growth hormone causes hypoglycemia, especially in young infants and children.
Kidney failure causes hypoglycemia in three separate ways. The kidneys help to generate new glucose from amino acids (called gluconeogenesis). Gluconeogenesis is impaired in kidney failure. Also, insulin circulates for a longer period of time and is cleared slowly when kidney function is poor. The third important reason is that kidney failure reduces the appetite and consequently, oral intake of food.
The liver stores glucose in a form called glycogen. In the presence of liver failure, the abilities of the liver to generate new glucose and to release glucose are impaired.
Insulin-producing tumors of the pancreas (called insulinomas) cause hypoglycemia by releasing inappropriately high amounts of insulin. Certain tumors of the liver called hepatomas or other tumors such as fibrosarcomas and mesotheliomas can also cause hypoglycemia by producing insulin-like factors.