Experiencing low blood sugar when you don't have diabetes can be both surprising and unsettling.
The symptoms of low blood sugar without diabetes are similar to those of Hypoglycemia with diabetes. They generally include body weakness, sweating, cold flashes, extreme hunger, irritability, anxiety, faster heartbeat, dizziness, a lack of focus, etc. 1
Even though non-diabetic Hypoglycemia is rare, there are several reasons why one might have low blood sugar even without having diabetes.
Likewise, side effects of some medicines, unhealthy diets, alcohol overconsumption, after-effects of surgery, and several other infections and diseases are generally the common causes of low blood sugar without diabetes.
Do You Know?
- Although rare, Hypoglycemia (low blood sugar) without diabetes is generally seen in individuals aged more than 65 years. A study on a set number of patients who did not have diabetes but who were going through some other medical condition has proven this 2.
- Insulinoma (insulin-related tumour) is another similar condition arising from low blood sugar without diabetes. The prevalence is higher in women, as almost 59% of cases of insulinoma affect women.
- Apart from these, the risk of hospitalisation due to non-diabetic Hypoglycemia increases by almost 2-7 times when a person has gone through bariatric surgery.
Therefore, if not controlled timely, non-diabetic Hypoglycemia has the potential to develop into prediabetes. That is why it is essential to understand the causes of low blood sugar without diabetes so that this risk can be eliminated on time.
What Causes Low Blood Sugar Without Diabetes? 6 Possible Reasons
The causes of low blood sugar without diabetes can range from unhealthy food choices to drinking too much alcohol. It can also happen as a result of some medicines or as an adverse effect of surgery (particularly weight loss surgery) that you have recently undergone.
Other causes of low blood sugar in people who do not have diabetes include issues that are related to the kidneys, liver, adrenal and pituitary glands, infections (in case of severe infections), etc.
Below, we have discussed each of these causes in detail.
1. Eating Foods That Contain Simple Carbohydrates
Non-diabetic Hypoglycemia (or low blood sugar that occurs without diabetes) is of the following two types:
- Reactive Hypoglycemia
- Fasting Hypoglycemia
These are the main causes of low blood sugar in people without diabetes. Among these, reactive Hypoglycemia is a food-related cause.
Reactive Hypoglycemia
Even though there is no proper research on what exactly causes reactive Hypoglycemia, eating certain types of food items might be the reason behind it.
Some foods, especially those that are rich in carbohydrates, particularly the ones that contain simple carbohydrates or simple sugars, cause your blood sugar levels to rise and then suddenly fall.
Examples of such foods include:
- White rice
- Potatoes
- White bread
- Cake
- Pastries
Taking an online blood test at home can help you determine your blood sugar levels. Following the test results, you can identify the warning signs and symptoms of diabetes (if any) and ask your medical practitioner about what steps to take next.
2. Side Effects of Weight Loss Surgery
Surgical procedures that aim to help a person lose extra body fat and deal with obesity are medically known as bariatric surgeries. Your doctor will recommend bariatric surgery when you fail to lose weight using traditional methods like exercise and dieting. 3
When you undergo weight loss or bariatric surgery, your body's capacity to absorb sugar increases. This ultimately leads to increased insulin production. Consequently, it causes low blood sugar in people without diabetes and is also one of the main causes of reactive Hypoglycemia.
Here is a list of examples of some bariatric surgeries that can lead to low blood sugar symptoms without diabetes:
- Gastric bypass
- Sleeve gastrectomy
- Gastric band
- Duodenal switch
3. Medicines
Another prominent cause of low blood sugar without diabetes is the use of certain medicines. There are some medicines that can affect the release of insulin in your body and cause non-diabetic Hypoglycemia. These medicines might not be intended to cure diabetes. 4
Here is a list of such medicines:
- Quinolones (bactericidal antibiotics)
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Antipsychotics
- α and β blockers
- Pentamidine
Taking a high dose of these medicines can lead to low blood sugar symptoms without diabetes.
You can book a sugar test at home to get an idea of your blood sugar levels if you are taking any of the above-mentioned medications.
4. Skipping Your Meals
Skipping meals for extended periods can cause your blood sugar levels to drop too low, even if you don't have diabetes. It results in low blood sugar symptoms such as:
- Anxiety
- Light-headedness
- Feeling shaky
- Crankiness
- Irritability
To deal with this, you can eat an apple or a banana to bring your sugar levels back to the normal range. 5
Remember that Hypoglycemia is not normal for non-diabetics. That is why, for most people, fasting may not always cause Hypoglycemia.
5. Alcohol Overconsumption
As mentioned above, fasting Hypoglycemia is the second type of Hypoglycemia that happens without diabetes.
In the case of people who drink a lot of alcohol, the body becomes incapable of producing enough glucose cells. During this time, your body will use the glucose that is already in storage. However, when you start skipping meals along with increased alcohol intake, it might cause low blood sugar without diabetes.
This happens because alcohol disrupts the blood sugar processing of your body, leading to non-diabetic Hypoglycemia (or fasting Hypoglycemia).
6. Severe Disorders/Diseases
When a person is not suffering from diabetes but has some other critical illness, then there is a high chance that their blood sugar levels can decrease. Likewise, diseases like those that are related to the kidneys and liver can cause low blood sugar without diabetes.
Some examples of diseases which can result in non-diabetic Hypoglycemia include the following:
Sepsis (Severe Infection)
It is normal to go through common fungal and bacterial infections. During this time, your body will try to fight back against these infections. Sepsis happens when your body reacts excessively, causing low blood sugar levels in people without diabetes. 6
Primary Adrenal Failure
These medical conditions are related to adrenal gland dysfunction. They occur due to a deficiency of glucocorticoid hormones and result in:
- Reduction in the amount of glucose that your body produces
- The cells become less sensitive to insulin
Cerebral Malaria
Cerebral malaria causes low blood sugar in people who don't have diabetes as an after-effect of a medicine called quinine that is used to treat it 7.
Glycogen Storage Disease (GSD)
It is a rare condition that disrupts the body's ability to properly use and store glycogen, a form of sugar, leading to a range of health problems. Glycogen storage disease causes hypoglycemia because the liver cannot regulate glucose normally.
Kidney Failure (Renal Failure)
Although rare, people who have undergone kidney failure can also experience Hypoglycemia.
The possible causes of low blood sugar without diabetes in patients with kidney problems include the following:
- Malnutrition
- Decreased (or slow) insulin clearance from the body
- Slow metabolism of medicines due to damaged kidneys
Apart from these, when a person experiences kidney failure, the kidneys are damaged to the extent that glucose is not produced sufficiently. As a result, low blood sugar symptoms can be observed even without diabetes.
Other diseases that can cause low blood sugar in people who don't have diabetes include:
- Acute liver failure
- Congestive heart failure
- Anterior pituitary failure (problems that are related to the pituitary gland)
Risk Factors for Non-Diabetic Hypoglycemia
The main risk factors for Hypoglycemia that occur without diabetes include poor nutrition, overdosing on some medicines, kidney failure, and old age. Each of these factors contributes differently to the likelihood of experiencing low blood sugar levels without a diabetes diagnosis, making awareness and careful management of these risks essential for those potentially affected.
1. High Medication Doses
As already mentioned above, there are certain medicines that can cause low blood sugar symptoms without diabetes due to the mechanism by which they function in your body.
A high dose of such medicines can put you at a higher risk of complications associated with non-diabetic Hypoglycemia.
Here is a list of medicines that can cause low blood sugar:
- Overdosing of drugs like atenolol or propranolol (beta-blockers)
- Drugs that are used to treat heart arrhythmias (examples include quinidine and cibenzoline)
- Pain relievers such as indomethacin
- Insulin
- Anti-infection medicines such as quinine, pentamidine, gatifloxacin, and levofloxacin) 8
2. Concomitant Kidney (Renal) Failure
When a person is going through severe kidney problems that have the potential to cause kidney failure, their kidneys stop producing enough glucose. It also hampers the normal glucose regulation in the kidneys, which ultimately leads to Hypoglycemia.
3. Older Age
As a person grows older, their body undergoes various changes that can cause low blood sugar without diabetes.
Examples of such changes include:
- Metabolic changes
- Increased sensitivity towards the use of medicines
- Occurrence of several other diseases or disorders
Diagnosis And Treatment of Non-Diabetic Hypoglycemia
Effectively managing non-diabetic Hypoglycemia involves first correctly diagnosing it and then customising treatment based on what's causing it. It's important to understand that this type of low blood sugar isn't caused by diabetes, but rather by other health problems or lifestyle choices. Knowing the specific triggers helps in treating and controlling them properly.
Hence, it is important to get yourself checked when you have consistently low blood sugar levels to find out what level of blood sugar is dangerous for you.
Diagnosis
Diagnosis begins with identifying symptoms consistent with Hypoglycemia, such as confusion, dizziness, and sweating, followed by detailed testing to confirm low blood sugar levels and pinpoint the cause.
A glycosylated haemoglobin test is an example that can help you determine whether your blood sugar is low or not.
Other methods that can be used to diagnose non-diabetic Hypoglycemia include:
- Blood Sugar Tests
- Imaging Tests
- MMTT or Mixed-Meal Tolerance Test (in case of reactive Hypoglycemia)
Treatment
The treatment for non-diabetic Hypoglycemia depends on the cause of low blood sugar in people who don't have diabetes. Effective management aims to prevent further episodes of Hypoglycemia while addressing any contributing health issues or lifestyle factors.
Common treatment methods include:
- Stopping the use of drugs that cause low blood sugar or Hypoglycemia
- If the Hypoglycemia is caused due to gastric bypass surgery (a type of bariatric surgery), then taking a low glycaemic index (GI) diet can be a good solution. A low GI diet cuts down on unhealthy sugars and complex carbohydrates
- If you consume a lot of alcohol, then it is best to avoid it or at least minimise its use
- Limit the consumption of caffeine
- Avoid foods that are rich in simple sugars and have high carbohydrates
Prevention And Management Tips for Hypoglycemia
When you have low blood sugar symptoms or Hypoglycemia, here is what you can do to prevent and manage it effectively:
The best way to manage and treat Hypoglycemia (in case of mild to moderate severity) is to eat 15 grams of fast-acting carbohydrates. Some food items that can provide this include the following:
- Half a banana
- Sugar or honey (1 tablespoon)
- Glucose tablets (do not eat more than 4)
Remember that 15 grams of carbohydrates is an ideal adult dose to manage Hypoglycemia. In the case of children, these quantities will not be the same. If the low blood sugar symptoms still persist then it is best to contact your healthcare provider for better advice.
All in all, it is essential to treat non-diabetic Hypoglycemia on time so that it does not develop into future complications that are associated with diabetes. There are two types of diabetes: type 1 and type 2 diabetes. Type 2 diabetes is hereditary. 9
If you are suspicious that you might be having any of these, then there is a long list of lab tests for diabetes patients that you can take. Following the test results, you can take the right precautions accordingly.
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