Hypoglycemia occurs most commonly as a result of treating pts with diabetes mellitus. Additional factors to be considered in any pt with hypoglycemia are listed below.

1. Drugs: insulin, insulin secretagogues (especially chlorpropamide, repaglinide, nateglinide), alcohol, high doses of salicylates, sulfonamides, pentamidine, quinine, quinolones
2. Critical illness: hepatic, renal, or cardiac failure; sepsis; prolonged starvation
3. Hormone deficiencies: adrenal insufficiency, hypopituitarism (particularly in young children)
4. Insulinoma (pancreatic β cell tumor), β cell hyperplasia (nesidioblastosis; congenital or after gastric or bariatric surgery)
5. Other rare etiologies: non-β cell tumors (large mesenchymal or epithelial tumors producing an incompletely processed IGF-II, other nonpancreatic tumors), antibodies to insulin or the insulin receptor, inherited enzymatic defects such as hereditary fructose intolerance and galactosemia