Question: What's most likely to cause hypoglycemia?
Answer: Well, certainly right up there are medications. In terms of type 2 diabetes, the medications that we see the most hypoglycemia with, outside of insulin, are a class of drugs called sulfonylureas. Now these are pills to treat diabetes that we've had since the 1950s. These are medications such as glyburide, glipizide, glimepiride and we use a lot of these drugs right now because these drugs are very inexpensive because they're all generic and they have been proven over time to be safe. But these drugs do cause hypoglycemia.
And certainly insulin causes hypoglycemia, whether type 1 or type 2 diabetes. I should point out, however, that we see much more hypoglycemia with type 1 diabetes because people with type 2 diabetes are resistant to the effects of insulin -- that's part of their disease and so it is more difficult to get them hypoglycemic.
Now there are other reasons why we see hypoglycemia for people who take insulin or sulfonylureas. The most common one is exercise. With exercise, one does not need as much insulin or sulfonylurea and therefore, patients need to be aware that when they are exercising, even if it's a walk or being on the golf course, even a little exercise potentially can cause hypoglycemia.
Other things that will do it is simply missing a meal, being late for a meal, and I should also point out a very common cause of hypoglycemia is alcohol. In fact, alcohol intake can cause hypoglycemia even in people who don't have diabetes, because it stops glucose production from the liver. And that is the reason why people who have diabetes have to be so careful with their alcohol intake.