Avoiding Drug-Induced Hypoglycemia in the Older Adult

Mary Ann E. Zagaria, PharmD, MS, BCGP


US Pharmacist. 2019;44(10):4-10. 

In This Article

Abstract and Introduction


There is much to be learned from those who have examined the unintended effects of medication therapy. As this knowledge base increases, it is important to seek systematic reviews and meta-analyses of these effects and to rely on the evidence these studies provide in order to better serve patients through appropriate medication monitoring and other medication-therapy management (MTM) services. In light of the fact that advancing age is a risk factor for drug-induced (DI) hypoglycemia (Table 1), this brief discussion will provide nuanced guidance and additional resources to help pharmacists better individualize pharmaceutical care to this vulnerable patient population.

A DI disease is the unintended effect of a drug that results in mortality or morbidity with symptoms sufficient to prompt a patient to seek medical attention and/or potentially require hospitalization. Hypoglycemia, or low blood sugar, can be defined by the glucose-alert value of ≤70 mg/dL (3.9 mmol/L).[1,2] Varying blood-glucose levels can cause typical symptoms of hypoglycemia (e.g., shakiness, sweating, fatigue, hunger, headaches, and confusion) in individuals with diabetes mellitus.[3] While DI hypoglycemia typically causes mild-to-moderate transient symptoms (Table 2), a level of discomfort and reduction in quality of life may reach a point that causes a patient to become nonadherent with a medication or regimen in an attempt to avoid repeated episodes.[4] Furthermore, there is a significant economic burden associated with DI glucose and insulin dysregulation, owing to the expense of urgent-care visits and hospitalizations related to treatment of hypoglycemia and hypeglycemia.

Before implicating a drug as the cause of DI hypoglycemia (Table 3, available online), other possible etiologies (e.g., alcohol-use disorder, sepsis, hepatic failure, large non–β-cell tumor) must be ruled out; for the differential diagnoses for DI hypoglycemia, see RESOURCES.