Simple Reason for Hypoglycemia: ACE Inhibitor-induced Severe Recurrent Hypoglycemia in a Nondiabetic Patient

Elshimy, Ghada; Techathaveewat, Pawarid; Alsayed, Mahmoud; Jyothinagaram, Sathya; Correa, Ricardo

doi:10.7759/cureus.5449

Cited by 7 publications

(8 citation statements)

References 11 publications

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“…Drugs, such as glucoselowering agents like sulphonylureas, insulin, and meglitinides, are the most common cause of hypoglycemia. Hypoglycemia has been linked to nonselective beta-blockers, pentamidine, quinolones, gatifloxacin, and even ACE inhibitors [5], [6]. Our patient was not on any medications.…”

Section: Discussionmentioning

confidence: 79%

Hypoglycemia Caused by Endogenous Hyperinsulinism: A Case Study

Shah

Kothari

Bansode

et al. 2021

EJMED

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Hypoglycemia in the absence of diabetes mellitus in a healthy individual needs’ evaluation. We report a case of 45 years old female who presented with restlessness, anxiety, palpitations, excessive sweating followed by dizziness, and tremors in her hand. Eating sugar or consuming glucose water alleviated symptoms. During one such episode, the patient was taken to a nearby clinic and her capillary blood glucose was 43 mg/dl. The patient was admitted for the 72 hours supervised fast after ruling out other systemic causes of hypoglycemia. Evaluation of critical sample showed elevated levels of insulin, c-peptide, proinsulin, as well as a decreased value of beta-hydroxybutyrate and a negative urine screen for oral anti-diabetic agents, a diagnosis of endogenous hyperinsulinism, was made.

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Section: Discussionmentioning

confidence: 79%

Hypoglycemia Caused by Endogenous Hyperinsulinism: A Case Study

Shah

Kothari

Bansode

et al. 2021

EJMED

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“…ACE-inhibitors are hypothesized to cause hypoglycemia by increasing insulin sensitivity, leading to vasodilation in the muscles with increased muscle uptake of glucose. The combination of ACE-inhibitor with 1 or more oral hypoglycemic agents, including metformin, is thought to increase the risk of hypoglycemia [ 8 – 10 ]. However, the risk does not appear to be significant, as ACE-inhibitors in combination with metformin is commonly prescribed in type 2 diabetes mellitus due the ACE-inhibitors’ protective benefits towards diabetic nephropathy.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Hypoglycemia During Treatment with a Therapeutic Dose of Metformin

Joseph

2021

Am J Case Rep

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Patient: Male, 58-year-old Final Diagnosis: Diabetes mellitus type 2 Symptoms: Confusion • diaphoresis • dizziness • dyspnea • palpitation • weakness Medication: Metformin Clinical Procedure: — Specialty: Endocrinology and Metabolic • General and Internal Medicine • Psychiatry Objective: Unusual clinical course Background: Metformin has a longstanding reputation as the first-line treatment for glycemic control in the setting of diabetes mellitus type 2. A contributing factor to this reputation is metformin having a low risk of inducing hypoglycemia compared to other oral hypoglycemics or insulin. There are no case reports of hypoglycemia while on conventional or therapeutic doses of metformin. This case report is of a patient who developed symptomatic hypoglycemia while being treated with a therapeutic dose of metformin. Case Report: A 58-year-old man with history including diabetes mellitus type 2, hypertension, and schizoaffective disorder was dismissed early from work due to symptoms of severe weakness, confusion, diaphoresis, dizziness, shortness of breath, palpitations, and a sensation of feeling hot. Continuous glucose monitoring revealed hypoglycemic episodes up to 4% of the time. The hypoglycemic events appeared to occur primarily between midnight and 7 A.M., with the second likely time frame being between 7A.M. and noon. Within 2 weeks of discontinuing metformin, there were no further “attacks”, and the chronic daytime fatigue and somnolence significantly improved. Conclusions: This case report suggests that there is a risk of symptomatic hypoglycemia with therapeutic doses of metformin. Although advised to be taken with meals to avoid gastrointestinal upset, patients should also be educated to take metformin with meals to reduce the risk of metformin-associated hypoglycemia.

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“…On the other hand, oral administration of ramipril (10 mg/kg) for five weeks decreased blood glucose levels in male Wistar rats [ 69 ]. However, one report noted that the use of ACEi could lead to a serious risk of hypoglycemia [ 70 ].…”

Section: Acei On Metabolism Of Glucose and Lipidsmentioning

confidence: 99%

“…ACEi also promote insulin-dependent transport of glucose through increasing GLUT4 expression in obese rats. Therefore, glucose utilization becomes more efficient in the muscle [ [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] ].…”

Section: Acei On Metabolism Of Glucose and Lipidsmentioning

confidence: 99%

ACE inhibitors and their interaction with systems and molecules involved in metabolism

Silva-Velasco,

Cervantes-Pérez,

Sánchez-Mendoza

2024

Heliyon

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Simple Reason for Hypoglycemia: ACE Inhibitor-induced Severe Recurrent Hypoglycemia in a Nondiabetic Patient

Cited by 7 publications

References 11 publications

Hypoglycemia Caused by Endogenous Hyperinsulinism: A Case Study

Hypoglycemia Caused by Endogenous Hyperinsulinism: A Case Study

Symptomatic Hypoglycemia During Treatment with a Therapeutic Dose of Metformin

ACE inhibitors and their interaction with systems and molecules involved in metabolism

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