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Hypoglycemia Without Diabetes?

Sep 15, 2018

A look into health conditions, other than diabetes, that may cause hypoglycemia.

In people without diabetes, the body may produce too much insulin after a meal and cause glucose levels to drop. This is called reactive hypoglycemia, which may be an early sign of diabetes. There are many other issues that may cause hypoglycemia, which include alcohol, certain medications, eating disorders, liver and kidney disorders, and thyroid disorders.


When a person’s glucose levels become low, glucagon is released from the pancreas, which tells the liver to break down its stored energy and release glucose back into the bloodstream. This process, called gluconeogenesis, allows for normalized glucose levels. If the liver is unable to function due to excessive alcohol intake, glucagon isn’t released and the process is interrupted, causing temporary hypoglycemia.

Anorexia and hepatitis have also been associated with hypoglycemia, due to liver dysfunction. In a recent study published in Digestive Diseases in Science, researchers found that malnutrition was linked to depleted glycogen stores and impaired gluconeogenesis, causing hypoglycemia. Scientists noted that hypoglycemia is reversible in certain patients with anorexia and hepatitis using supervised judicious refeeding.

Taking another patient’s diabetes medications may cause hypoglycemia. Non-diabetes medications have also been associated with hypoglycemia, such as fluoroquinolones. Moxifloxacin (11%) and levofloxacin (6%) were found to have higher incidences in a study published by Wissam Kabbara and colleagues. Artemisinin, a drug used for malaria, has also been associated with hypoglycemic effects. Patients with kidney failure tend have an increased risk of medication-induced hypoglycemia due to reduced excretion and the build-up of medication in the bloodstream.

If a patient presents with signs and symptoms of hypoglycemia (e.g., shaky, dizzy, confused, moody, hungry) short-term treatment may be used. This includes: taking glucose tablets, drinking fruit juice with a high sugar content, and eating carbohydrates.

Non-diabetic hypoglycemia diets can keep glucose levels normalized. The following suggestions can help prevent hypoglycemia:

  • Eating small meals regularly, rather than three large meals
  • Eating every 3 hours
  • Eating more protein, healthy fats, and fiber
  • Avoiding foods high in sugar

Ultimately, if a patient is having numerous signs and symptoms of hypoglycemia, it is best to treat the underlying cause.

Practice Pearls:

  • Hypoglycemia has been associated with multiple conditions other than diabetes, including alcoholism, certain medications, anorexia, liver and kidney disorders, and thyroid disorders.
  • Symptoms of hypoglycemia include: dizziness, confusion, hunger, inability to concentrate and moodiness. This may be quickly treated by taking glucose tablets, drinking fruit juice, or eating carbohydrates.
  • Ultimately, the best way to treat non-diabetic hypoglycemia is to treat the underlying cause.


Desimone, M. E., & Weinstock, R. S. (2017, September 23). Non-diabetic hypoglycemia. Endotext. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK355894/

Kabbara, Wissam K et al. “Evaluation of the Appropriate Use of Commonly Prescribed Fluoroquinolones and the Risk of Dysglycemia.” Therapeutics and Clinical Risk Management 11 (2015): 639–647. PMC. Web. 16 Aug. 2018.

Rosen, E., Bakshi, N., Watters, A. et al. Dig Dis Sci (2017) 62: 2977. https://doi-org.ezproxy.hsc.usf.edu/10.1007/s10620-017-4766-9

Melissa Bailey, Pharm.D. Candidate, USF College of Pharmacy