Non-Diabetic Hypoglycemia: Symptoms, Causes, and Treatments

Low blood sugar without diabetes isn't as common as hypoglycemia in people with diabetes. Yet non-diabetic hypoglycemia can occur due to certain medications, medical conditions, and other causes.

A diagnosis is based on symptoms (like hunger, shakiness, and sweating), your blood sugar levels, and how your symptoms respond when you eat sugar.

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 Is Hypoglycemia?

Hypoglycemia occurs when your blood sugar levels drop. When these levels are too low (below 70 milligrams per deciliter, or mg/dL) you may experience:

• Shakiness
• Sudden sweating
• Hunger
• Headache
• Mood changes
• Rapid heartbeat
• Change in vision

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

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

What Causes Hypoglycemia

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

After a Meal

Reactive hypoglycemia typically happens within a few hours of eating a meal. Also known as postprandial hypoglycemia, it is a poorly understood condition associated with excessive insulin production. 

While the cause of reactive hypoglycemia in most people isn’t clear, it also may be related to a specific food that you ate or a variation in how food moves through the digestive tract.

Not Eating Enough

It's possible that your nutrition is responsible for episodes of non-diabetic hypoglycemia. A balanced diet with well-timed meals may help to reduce symptoms and keep your blood sugar levels on target.

A diet for hypoglycemia may help. It emphasizes small meals more often (including an all-important breakfast) with limits on processed foods, caffeine, and more. Lean meats, whole grains, vegetables, and some fruits are healthy options.

Alcohol

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.

Gland Problems

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.

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.

Dumping Syndrome

Non-diabetic hypoglycemia can be caused by dumping syndrome, which occurs in people whose digestive system handles food too quickly. Symptoms like nausea and abdominal pain can occur within just a few minutes after eating, or a few hours later in some cases.

The pattern of dumping syndrome causes your body's insulin production to spike, leading to hypoglycemia when the blood sugar level falls. People who have undergone recent bariatric surgery often experience hypoglycemia related to dumping syndrome.

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

Disorders of the Liver

An underlying illness may contribute to low blood sugar levels. Your liver is central to maintaining balanced glucose levels, and any disruption of liver function can cause hypoglycemia.

Conditions that can lead to these disruptions include:

• Liver disease
• Hepatitis
• Liver cancer

A genetic condition called glycogen storage disease produces an enlarged liver and hypoglycemia that's caused by the inability to break down glycogen for energy.

Risk Factors

Those at greater risk of developing non-diabetic hypoglycemia include people who are older in age and those who have other health conditions, like liver or kidney disease. Risk factors also include:

• A family history of diabetes
• Use of certain medications, like beta blockers
• Challenges with adequate nutrition
• A history of recent fasting

Recent history of bariatric surgery also may increase the likelihood of experiencing non-diabetic hypoglycemia episodes.

Complications

Hypoglycemia can lead to other medical conditions, including cardiovascular (heart) problems and cerebrovascular (stroke and brain injury) risks. In extreme cases, it can lead to seizures and progress to severe injury or death.

But even in more routine cases of low blood sugar levels, people can be at greater risk of falls or accidents. It's important to be sure the underlying cause of non-diabetic hypoglycemia is diagnosed to help you avoid additional risks and complications.

Treatment

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 including consuming complex carbohydrates, such as whole grains and beans, and choosing balanced meals with fiber and protein
• Eating every three hours 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, either 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.
• 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.