OVERVIEW

What is alcoholic hypoglycemia?

Hypoglycemia refers to a condition where blood sugar levels are lower than normal. For non-diabetic individuals, hypoglycemia is diagnosed when blood sugar falls below 2.8 mmol/L.

Hypoglycemia caused by alcohol consumption or alcohol poisoning is termed alcoholic hypoglycemia. It typically occurs after moderate or heavy drinking on an empty stomach, presenting as a comatose or stuporous state with symptoms such as rapid heartbeat, sweating, low body temperature, and alcohol odor on the breath. This condition is often mistaken by family members as "drunkenness."

If hypoglycemia is promptly diagnosed and glucose is administered, recovery can be rapid.

If not detected in time—mistakenly dismissed as "sleeping it off" or "letting them wake up on their own"—and medical treatment is delayed, some patients may suffer irreversible brain damage leading to lifelong disabilities, while severe cases can even result in death.

Is alcoholic hypoglycemia common?

No, it is uncommon.

Non-diabetic alcoholic hypoglycemia is rarely reported, mostly occurring after consuming a large amount of alcohol in a single session (equivalent to 90–450 grams of alcohol).

What are the types of alcoholic hypoglycemia?

Alcoholic hypoglycemia can be divided into two types:

• Postprandial alcoholic hypoglycemia, which occurs approximately 3–4 hours after drinking. This is caused by alcohol-induced excessive insulin secretion.

• Fasting alcoholic hypoglycemia, which develops after heavy drinking without food intake, typically 8–12 hours later when liver glycogen stores are depleted. This results from alcohol's interference with glucose production.

SYMPTOMS

What are the common manifestations of alcoholic hypoglycemia?

The manifestations of alcoholic hypoglycemia are related to the degree of blood sugar drop, the speed of blood sugar decline, and the duration of hypoglycemia. The lower the blood sugar, the more obvious the symptoms; the faster the blood sugar drops, the more severe the symptoms.

Symptoms of sympathetic nervous system excitation usually appear first, followed by manifestations of brain dysfunction.

• Sympathetic nervous system excitation: Mainly includes extreme hunger, profuse sweating, anxiety, agitation, irritability, palpitations, hand and foot tremors, pale complexion, and emotional excitement.

• Brain dysfunction: Mainly includes drowsiness, slurred speech, limb tremors, movement disorders, paralysis, coma, etc.

What serious consequences can alcoholic hypoglycemia cause?

Hypoglycemic episodes can easily induce angina, myocardial infarction, transient ischemic attacks, and cerebral infarction, which are particularly dangerous for the elderly.
If blood sugar drops severely and lasts for a long time, such as severe hypoglycemia persisting for more than 6 hours, it may lead to permanent brain damage or death.

CAUSES

What are the causes of alcoholic hypoglycemia?

The maintenance of normal blood sugar relies on two aspects: food intake (the main source of postprandial blood sugar) and glycogenolysis and gluconeogenesis (the main source of fasting blood sugar). When drinking alcohol, people tend to consume less staple food, and alcohol inhibits gluconeogenesis. Once the stored liver glycogen is depleted, hypoglycemia occurs.

Additionally, alcohol can enhance the blood sugar-lowering effects of certain medications (such as sulfonylureas and insulin). Diabetic patients using these medications while drinking alcohol face a high risk of hypoglycemia.

Who is more prone to alcoholic hypoglycemia?

• Individuals with a long-term history of alcohol consumption and malnutrition are more likely to develop alcoholic hypoglycemia after consuming a large amount of alcohol. This condition may also be accompanied by alcoholic ketoacidosis and lactic acidosis.

• Patients with hyperthyroidism, liver disease, adrenal insufficiency, those experiencing prolonged starvation, or diabetic patients using insulin or oral sulfonylurea hypoglycemic drugs are also at higher risk of alcoholic hypoglycemia after excessive alcohol consumption.

Hypoglycemia typically occurs 6–24 hours after moderate or heavy alcohol consumption but may also manifest shortly after drinking.

Is alcoholic hypoglycemia hereditary?

No, it is not hereditary.

DIAGNOSIS

How to diagnose alcoholic hypoglycemia?

When diagnosing alcoholic hypoglycemia, doctors primarily rely on:

• Patient characteristics: A history of moderate or heavy alcohol consumption before onset, fasting or minimal food intake before drinking; low body mass index; nocturnal onset; typical hypoglycemic symptoms or coma upon admission.

• Blood glucose level below 2.8 mmol/L.

• Significant symptom improvement after glucose infusion.

• Metabolic acidosis, hyperlactatemia, or ketosis further supports the diagnosis.

What tests are needed for suspected alcoholic hypoglycemia?

Generally, blood glucose, ketones, lactate, urinalysis, and blood gas analysis are required.

• Blood glucose: Mainly confirms hypoglycemia.

• Urinalysis and blood ketones: Determine the presence of ketosis.

• Lactate: Assesses hyperlactatemia.

• Blood gas analysis: Identifies metabolic acidosis.

Which conditions can be confused with alcoholic hypoglycemia?

Alcoholic hypoglycemia must be differentiated from other causes of hypoglycemia.

Key features of alcohol-induced hypoglycemia include: a history of alcohol consumption, absence of elevated plasma insulin levels during hypoglycemia, possible hyperlactatemia and metabolic acidosis, and elevated blood ketones or ketonuria.

TREATMENT

Which department should I visit for alcoholic hypoglycemia?

Emergency department or endocrinology department.

Can alcoholic hypoglycemia resolve on its own?

Without timely treatment, it will not resolve on its own. If not detected and treated promptly, delayed treatment may cause irreversible brain damage, leading to lifelong sequelae. In severe cases, it can even be fatal.

How is alcoholic hypoglycemia treated?

• Once diagnosed, immediate administration of glucose solution via intravenous injection or infusion is required.

• For patients with concurrent acute alcohol poisoning, naloxone may be added via intravenous injection or infusion.

• If the patient remains unconscious for an extended period and does not recover after hypertonic glucose treatment, glucocorticoids (e.g., hydrocortisone) may be added, along with neuroprotective therapy and measures to prevent cerebral edema and intracranial hypertension.

Most patients recover quickly after treatment. However, in cases of delayed diagnosis, recovery may take several hours to days. The prognosis is generally good, with no permanent sequelae after treatment. However, complications or death may occur if treatment is delayed.

Do patients with alcoholic hypoglycemia need hospitalization?

Depending on the severity, emergency observation or hospitalization may be required.

Can alcoholic hypoglycemia be cured?

Alcoholic hypoglycemia is caused by excessive alcohol consumption. Avoiding heavy drinking can prevent recurrence.

DIET & LIFESTYLE

What should patients with alcoholic hypoglycemia pay attention to in daily life?

Patients who have experienced alcoholic hypoglycemia should preferably abstain from alcohol. If drinking alcohol, it should be in moderation, and avoid drinking on an empty stomach or when hungry.

PREVENTION

Can Alcoholic Hypoglycemia Be Prevented?

The key to preventing alcoholic hypoglycemia is to avoid excessive or rapid alcohol consumption on an empty stomach or while hungry. Individuals with hyperthyroidism, liver disease, adrenal insufficiency, chronic malnutrition, or diabetes should ideally abstain from alcohol.

Diabetic patients taking sulfonylureas or insulin must never drink alcohol on an empty stomach. If consuming alcohol with dinner, they should eat some staple food and check their blood sugar before bedtime. If blood sugar is low, a snack such as bread, steamed buns, or crackers is recommended to prevent nocturnal hypoglycemia.

How Can Patients with Alcoholic Hypoglycemia Avoid Future Risks?

Early detection, diagnosis, and treatment are crucial to preventing complications.

For unconscious patients with a history of alcohol consumption, alcoholic hypoglycemia or concurrent alcohol poisoning should be strongly suspected. Immediate blood glucose testing is essential for early intervention, reducing the likelihood of complications.