UMEM Educational Pearls

Drug-induced hypoglycemia is an often severe and symptomatic. It is a potentially preventable cause of significant morbidity. In one large study, it accounted for 23% for hospital admissions due to adverse drug events and 4.4% of overall admissions. The majority of hypoglycemic events occur with insulin and sulfonylureas. However, multiple drugs can affect glucose homeostasis and have been cited to cause hypoglycemia in therapeutic dose alone or in combination with other medications or illness. Factors that predispose to low blood sugar include reduced food intake, age, hepatic and renal disease, and severe infection. Beware of the possibility of inducing hypoglycemia in patients taking the following:

  • Ethanol
  • Insulin
  • Pentamidine
  • Quinine
  • Quinolones (Gatifloxin others rare)
  • Sulfonylureas

Agents with lesser quality evidence as predisposing medications or illnesses were present:

  • Ace Inhibitors (with diabetic agents)
  • Propanolol ( less likely in other beta blockers)
  • Trimethoprim/sulfamethoxazole (in renal compromise)
  • Salicylates (high dose or intoxication)

Drugs induced hypoglycemia should always be considered in the differential diagnosis of every patient presenting with low blood glucose. Octreotide antagonizes pancreatic insulin secretion and should be considered for first-line therapy in the treatment of sulfonylurea-induced hypoglycemia particularly when glucose levels cannot be maintained by dextrose infusions. Octreotide is administered 50 mcg subcutaneously (1-10 mcg in children) every 12 hours.


Drug-induced Hypoglycemia. Seltzer HS. A Review of 1418 cases. Endocrinol Metab North Am. 1989. March:18(1): 163-83.
Drug-induced Hypoglycemia: A Systematic Review. Murad H, F Coto-Yglesias, et al. J Clin Endocrinl Metab: 2009. 94:3, 741-745.