Hypoglycemia is the term for low levels of sugar in the blood. Refractory hypoglycemia occurs when hypoglycemia lasts for a prolonged period of time, such as a few hours to a few days.

Refractory hypoglycemia can occur when a person takes high doses of long-lasting insulin. It may also occur due to certain tumors that release proteins that can affect a person’s blood sugar levels.

A person can usually treat regular hypoglycemia on their own by consuming foods containing sugar or carbohydrates. However, refractory hypoglycemia may require treatment with intravenous glucose to help increase blood sugar levels.

This article explains what refractory hypoglycemia is and what can cause it. It also looks at risk factors and treatments for the condition.

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Currently, there is no universal definition of refractory hypoglycemia. However, medical professionals often define it as hypoglycemia that:

  • lasts for hours or days
  • requires a high dose of dextrose to normalize sugar levels
  • requires a prolonged infusion of glucose to normalize sugar levels

A person with refractory hypoglycemia may experience the following symptoms:

Severe symptoms of refractory hypoglycemia include seizures and coma.

Generally, a person can treat hypoglycemia quickly and easily by consuming foods containing sugars. Their blood sugar may return to a normal range within 15 minutes.

However, with refractory hypoglycemia, the condition lasts longer. Evidence suggests that refractory hypoglycemia can last anywhere from hours to days.

Taking a very high dose of long-acting insulin may cause a person to experience refractory hypoglycemia.

Insulin is a hormone that regulates blood sugar. People with diabetes may take insulin to help manage their blood sugar levels. This is often done after eating to lower blood sugar levels to within a target range.

If a person takes a very high dose of long-lasting insulin, it can cause their blood sugar levels to drop for a long period of time. This can lead to refractory hypoglycemia.

Read on to learn more about insulin therapy.

Certain tumors may also cause a person to develop refractory hypoglycemia. This is because they can lead to the development of a condition known as non-islet cell hypoglycemia (NICH).

NICH is a rare condition that occurs when a tumor secretes a protein called insulin-like growth factor-2 (IGF-2). This protein can lower a person’s blood sugar levels, causing them to develop refractory hypoglycemia.

One cause of refractory hypoglycemia is a very large dose of long-acting insulin. People with diabetes who take insulin may be at risk of taking too much. This can lead to refractory hypoglycemia.

NICH can also cause a person to develop refractory hypoglycemia. Studies show that NICH is most commonly present in people with mesenchymal and epithelial tumors.

Mesenchymal tumors are tumors that develop in the body’s soft tissue, such as the connective tissue.

Epithelial tumors are types of tumors that develop in the body’s epithelial tissue. The epithelial tissue consists of a compact layer of cells and forms the covering of body surfaces and the hollow organs. It is also the major tissue present in the body’s glands. This tissue performs a number of functions, including protection and absorption.

NICH is most often associated with hepatocellular carcinoma, the most common type of liver cancer.

A person can usually treat hypoglycemia by eating or drinking 15–20 grams (g) of glucose or carbohydrates. They can then repeat this step every 15 minutes until blood glucose levels return to their target range.

Learn more about the rule of 15 for treating hypoglycemia.

However, if a person has refractory hypoglycemia, their symptoms may not respond to this standard treatment.

Treatment for refractory hypoglycemia may require a high dose of dextrose and a prolonged infusion of glucose

Dextrose is a type of sugar that medical professionals often use to treat people with severe hypoglycemia. A doctor may administer a high dose of dextrose intravenously.

In some cases, a medical professional will then administer a prolonged IV infusion of glucose. This ensures a person’s blood sugar levels remain within their target range after they receive dextrose.

Refractory hypoglycemia occurs when a person experiences hypoglycemia that lasts for a prolonged period of time.

There is no universal definition of refractory hypoglycemia. Medical professionals often define it as hypoglycemia that lasts for hours or days. It may also require high doses or prolonged infusions of glucose to normalize sugar levels.

Refractory hypoglycemia can occur when a person takes very high doses of long-lasting insulin. It may also occur due to certain tumors that release proteins that can affect blood sugar levels.

If a person has refractory hypoglycemia, they may require treatment with glucose to help increase their blood sugar levels.