How can I differentiate between hypoglycaemia due to diabetes medication and other causes of low blood sugar?

To differentiate hypoglycaemia caused by diabetes medication from other causes of low blood sugar, consider the following:

• Medication history: Confirm if the person is on insulin or insulin secretagogues (e.g., sulfonylureas), which are common causes of hypoglycaemia in diabetes management.
• Timing of hypoglycaemia: Hypoglycaemia related to diabetes medication often occurs in relation to insulin administration or oral hypoglycaemic agents, especially if doses are excessive, meals are missed, or physical activity is increased.
• Clinical context and symptoms: Symptoms such as confusion, weakness, or loss of consciousness in a person with diabetes on medication suggest medication-induced hypoglycaemia.
• Rule out other causes: Consider other organic causes such as Addison's disease, coeliac disease, chronic kidney disease, or drug interactions that may enhance hypoglycaemic effects.
• Investigations: If hypoglycaemia occurs in a person not on diabetes medication, or if hypoglycaemia is recurrent and unexplained, further investigations including assessment for other endocrine disorders or non-diabetic causes should be considered.
• Referral: For recurrent severe hypoglycaemia not responding to treatment adjustments, referral to a specialist diabetes team is advised.

These approaches help distinguish medication-induced hypoglycaemia from other causes by integrating clinical history, timing, and appropriate investigations.

References: NICE CKS, NICE CKS, NICE CKS, NICE CKS