Literature review: drug and alcohol-induced hypoglycaemia

Objective: Narrative literature review of medication and alcohol related hypoglycaemia. Background: Drugs and alcohol are the commonest causes of hypoglycaemia and account for a significant number of emergency department attendances and hospital admissions. Methods: Hypoglycaemia risk with various drug classes and alcohol is discussed along with underlying mechanisms, characteristics and caveats around the diagnosis and management. Conclusions: Hypoglycaemia is most common with insulin treatment in type 1 diabetes but insulin in type 2 diabetes, sulphonylureas, other anti-hyperglycaemic medications and medications from other classes like beta-blockers, angiotensin converting enzyme inhibitors, fibrates, psychotropic medications, antimalarial drugs, antibiotics, anti-arrhythmic drugs, non-steroidal anti-inflammatory agents, and a few other classes of medications may also increase hypoglycaemia risk. The risk, depending on the drug class, may be as monotherapy or when used in combination with anti-hyperglycaemic medications and may either be in the therapeutic doses or only in overdose. Alcohol has profound effects on glucose metabolism. However, the incidence of alcohol-induced hypoglycaemia in healthy individuals with good glycogen reserve is low. Glycogenolysis plays an initial role in the defence against alcohol-induced hypoglycaemia and gluconeogenesis takes over later on to prevent profound hypoglycaemia. There are inconstancies in the literature about the role of counter-regulatory hormones in alcohol-induced hypoglycaemia. 16