Ingestion of which of the following drugs may cause hypoglycemia?

• A. Ethanol
• B. Propranolol
• C. Salicylate
• D. All the above

Answer: (D)

Hypoglycemia can result from drugs that either impair liver glucose production or increase glucose use, and some can mask the warning signs as well. Ethanol inhibits gluconeogenesis in the liver, especially during fasting, by altering the cellular redox state and limiting available substrates for glucose synthesis. That drop in hepatic glucose output can precipitate low blood sugar in someone who hasn’t eaten or is fasting.

Beta-blockers like propranolol reduce hepatic glycogenolysis and gluconeogenesis, so the liver’s ability to raise blood glucose in response to fasting is blunted. They also mask the adrenergic symptoms that alert a patient to hypoglycemia, which can delay recognition and treatment.

Salicylates, particularly in higher doses, can stimulate insulin release and promote greater glucose uptake by tissues, tipping the balance toward hypoglycemia. They may also contribute to hepatic dysfunction in severe poisoning, further compromising glucose production.

Because each of these agents can lead to low blood glucose through its own mechanism, ingestion of any of them may cause hypoglycemia.