Risk factors for hypoglycemia in diabetes

Absolute or relative therapeutic insulin excess
1. Insulin or insulin secretagogue doses are excessive, ill-timed, or of the wrong type
2. Exogenous glucose delivery is decreased (e.g., following missed meals and during the overnight fast)
3. Glucose utilization is increased (e.g., during and shortly after exercise)
4. Endogenous glucose production is decreased (e.g., following alcohol ingestion)
5. Sensitivity to insulin is increased (e.g., in the middle of the night and following weight loss, improved fitness or improved glycemic control)
6. Insulin clearance is decreased (e.g., with renal failure)
1. Absolute endogenous insulin deficiency
2. A history of severe hypoglycemia, hypoglycemia unawareness, or both as well as recent antecedent hypoglycemia, prior exercise, and sleep
3. Aggressive glycemic therapy per se (lower A1C levels, lower glycemic goals)