Other Factors

There are other factors that need to be considered:

Chronic kidney disease

In chronic kidney disease insulin clearance is reduced and excretion of some medications is slower.

Hormone deficiency

Hormone deficiency in Addison’s disease and hypopituitarism exacerbate hypoglycaemia, as cortisol and growth hormone are both counter-regulatory hormones involved in the late recovery from hypoglycaemia.

Drugs

Some drugs enhance the effect of insulin in both diabetics and non diabetics e.g. quinine, quinolones, pentamidine. Beta blockers may mask warning symptoms and non selective beta blockers also block the actions of glucagon in the liver. Longer acting oral hypoglycaemics continue to cause problems especially in the elderly with the added risk of polypharmacy.

Learning Bite

The risk factors for drug induced hypoglycaemia include: restricted carbohydrate intake, age – the elderly and children, liver or renal impairment [10].

Alcohol

Alcohol blunts the appreciation of some of the warning signs in hypoglycaemia e.g. tremor, anxiety, and may be mistaken as the cause of neuroglycopenic effects. It also inhibits gluconeogenesis.

Exercise and heat

Exercise and heat may increase absorption of insulin from injection sites.