Non-Diabetic Hypoglycemia

While far more common in people with diabetes, hypoglycemia—or blood sugar below 70 milligrams per deciliter (mg/dL)—can occur in people who don't have the disease, too. Non-diabetic hypoglycemia can be caused by a variety of factors, including medications, alcohol use, medical conditions, low levels of certain hormones, or insulin overproduction.

This rare condition is usually diagnosed based on symptoms, blood sugar levels, and how your symptoms respond when you eat sugar. Symptoms of non-diabetic hypoglycemia can range from mild to severe and may include anxiety, dizziness, headache, hunger, shakiness, sweating, unconsciousness, and more.

This article discusses the causes, risk factors, and symptoms associated with non-diabetic hypoglycemia. It also covers how it is diagnosed and treated, possible complications, and prevention tips.

What Causes Hypoglycemia in a Non-Diabetic Person?

Non-diabetic hypoglycemia causes vary, and it's possible that more than one may be at play.

Those at greatest risk include people who:

• Are older in age
• Have other health conditions
• Engage in long-term fasting
• Have a family history of diabetes
• Recently had bariatric surgery

Medication

Medications are the most common cause of hypoglycemia. The medications that can cause non-diabetic hypoglycemia include:

• Beta blockers, like atenolol
• Drugs that fight infection, such as gatifloxacin, pentamidine, quinine, or trimethoprim-sulfamethoxazole
• Heart arrhythmia medications, like quinidine and cibenzoline
• Indomethacin, a pain reliever
• Sulfonylureas
• Metformin or thiazolidinediones, when used with sulfonylureas

Alcohol Intake

Alcohol interferes with normal blood sugar regulation and can produce highs and lows that contribute to alcohol use disorder in some people.

If you notice that you’re more sensitive to the effects of alcohol than others, you may be experiencing a hypoglycemic reaction. Passing out or dozing off after a couple of drinks could indicate hypoglycemia, which may leave you more vulnerable to the hazards of drinking.

Underlying Illness

An underlying illness may contribute to low blood sugar levels. Renal failure, or kidney disease, can cause hypoglycemia in multiple ways, including:

• Decreasing the kidney’s ability to clear insulin
• Reducing the process of renal gluconeogenesis
• Slowing down the metabolism of hypoglycemia-causing medications
• Decreasing your appetite, causing you to eat less and making it more difficult to maintain adequate glucose levels

Because the liver is also central to maintaining balanced glucose levels, any disruption of liver function such as liver disease, hepatitis, or liver cancer can cause spontaneous hypoglycemia. A genetic condition called glycogen storage disease produces an enlarged liver and hypoglycemia caused by the inability to break down glycogen for energy.

Hormonal Deficiency

Aside from insulin, various hormones impact glucose regulation. Growth hormone from the pituitary gland and cortisol from the adrenal glands help maintain balanced blood sugar levels. Adrenal disorders, such as Addison’s disease, or pituitary disorders can cause hypoglycemia due to a lack of these blood sugar-stabilizing hormones.

The hormonal shifts in hypothyroidism (low thyroid hormone levels) may also lead to low blood sugars. This effect is seen in both children and adults with hypothyroidism and should be monitored as part of a comprehensive treatment plan.

Overproduction of Insulin

A rare pancreatic tumor called an insulinoma may produce more insulin than the body needs, causing hypoglycemia. Doctors aren’t sure exactly what causes insulinomas to grow, but they don’t tend to spread to other parts of the body.

Assigned females between the ages of 40 and 60 are most commonly affected by insulinomas. It can take a while to get a correct diagnosis, but your symptoms should resolve once an insulinoma is removed.

Insulin overproduction can also be a problem for people who have undergone recent bariatric surgery. Your body may still be releasing the amount of insulin used during your pre-surgery eating habits. Your healthcare professional should warn you if this is a potential side effect of your procedure and give you guidance on treating it at home.

Insulin Autoimmune Syndrome

Insulin autoimmune syndrome is a rare condition where the body creates antibodies that attack insulin. When insulin is under attack, it has to work extra hard to regulate blood sugar levels.

The syndrome typically develops in adulthood. Long term, it may result in permanent damage to the pancreas, so getting an accurate diagnosis and treatment is vital.

Reactive Hypoglycemia

Reactive hypoglycemia, or postprandial hypoglycemia, typically happens within a few hours of eating a meal and is caused by insulin overproduction. The cause of reactive hypoglycemia in most people isn’t clear, but it may be related to a specific food that you ate or in variations of the timing of the food moving through the digestive tract.

Non-Diabetic Hypoglycemia Symptoms

Early warning signs and symptoms of hypoglycemia include:

• Anxiety
• Dizziness
• Headache
• Hunger
• Inability to concentrate
• Irritability
• Shakiness
• Sweating

However, it's also possible that you may not experience the milder symptoms associated with low blood sugar. This is known as hypoglycemia unawareness.

Is Non-Diabetic Hypoglycemia Dangerous?

When left untreated, severe hypoglycemia can be dangerous. Serious symptoms include:

• Jerky movements
• Inability to eat or drink
• Muscle weakness
• Slurred speech
• Blurry or double vision
• Seizures
• Unconsciousness

Several of these can lead to injuries and accidents.

In addition, hypoglycemia is associated with long-term health concerns, such as an increased risk of cardiovascular events and, in rare cases, death.

Diagnosis

When diagnosing non-diabetic hypoglycemia, your healthcare provider will do a physical exam, take your medical history, and ask you about your symptoms.

If you keep a symptom diary that notes what you've eaten, your specific symptoms, and when they occur in relation to your meals, bring it with you to your appointment.

Your healthcare provider may also order blood tests, such as a fasting test or a mixed-meal tolerance test. Before and during these tests, you may be asked to follow specific eating and drinking instructions and your blood may be drawn more than once to track your glucose or insulin levels.

How Is Non-Diabetic Hypoglycemia Treated?

Treatment of non-diabetic hypoglycemia involves addressing the cause, working to keep blood sugar stable throughout the day, and getting blood sugar back up fast when it dips too low.

Keeping Blood Sugar Stable

To keep your blood sugar more consistent on a regular basis, your healthcare provider may recommend:

• Adjustment to your current medications, if they are a contributing factor
• Management of an underlying illness causing hypoglycemia, if applicable
• Dietary changes: This includes consuming complex carbohydrates, such as whole grains and beans, and choosing balanced meals with fiber and protein.
• Eating every three hours and to prevent blood sugar highs and lows.

Treating Sudden Dips

When your blood sugar dips and you need to raise it quickly, it may be recommended that you:

• Consume a 15-gram serving of carbohydrates through hard candy, dried fruit, or juice
• Have a sports drink or snack after doing an intense workout on an empty stomach (no further medical help is needed)
• Use glucagon, a prescription medication that is either inhaled through the nose or injected (recommended in severe cases)

Prevention

To help prevent non-diabetic hypoglycemia:

• Speak with your healthcare provider about potential underlying conditions or medications that may be causing your hypoglycemia.
• Be sure to eat meals regularly.
• Carry snacks with you when you leave your house.
• Try to incorporate complex carbs consistently into your diet.

Summary

Non-diabetic hypoglycemia is a rare condition that is most commonly caused by specific medications. However, it can also be due to other causes.

Symptoms can range from mild to severe. Your healthcare provider may order specific blood tests to diagnose this condition. Treatment varies, but may include medication adjustments, dietary changes, and prescription medications.

If left untreated, non-diabetic hypoglycemia can lead to serious side effects and complications, however, there are steps you can take to help prevent this condition.

A Word From Verywell

Non-diabetic hypoglycemia is usually a symptom of another health problem or lifestyle imbalance that should be addressed. Paying attention to how your body feels and communicating with your healthcare professional will help ensure that your body is able to work properly.