True fasting hypoglycemia is most often seen with diabetes treatment — excess insulin, sulfonylureas, or meglitinides.
A low glucose result can sometimes be false, especially if the blood sample was not processed quickly enough.
Other causes include alcohol intake especially without adequate food, prolonged fasting or malnutrition, critical illness or sepsis, liver, kidney, or severe heart failure, adrenal or pituitary insufficiency, insulin-secreting tumors (insulinoma), and some non-diabetes medications.
High fasting glucose (hyperglycemia) most commonly reflects prediabetes, insulin resistance, or diabetes (type 1, type 2, gestational).
Other causes: pancreatic damage (chronic pancreatitis, hemochromatosis), endocrine disorders that drive insulin resistance (Cushing syndrome, acromegaly, pheochromocytoma), acute physiologic stress or illness, and medications such as glucocorticoids, phenytoin, statins, and estrogens.


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