The body’s extreme reaction to an infection is a life threatening condition known as sepsis. It can lead to low blood sugars (hypoglycemia) and high blood sugar (hyperglycemia).

Sepsis is a serious complication of a viral, bacterial, or fungal infection. It happens when the chemicals the immune system sends to fight infection cause dangerous inflammation throughout the body.

This condition can affect your blood sugar levels, causing them to spike or crash dangerously low.

Here’s more about how sepsis can cause hypoglycemia, how diabetes plays into the equation, and what treatments may help in an inpatient hospital setting.

Yes. Sepsis can cause both high blood sugar and low blood sugar.

Hyperglycemia (fasting blood sugar higher than 125 mg/dL or above 180 mg/dL post-meal) is common with serious infection and is often referred to as stress-induced hyperglycemia.

Sepsis increases a person’s insulin resistance. When this happens, the body resists the effect of insulin on the blood, and blood sugar rises.

Spontaneous hypoglycemia (blood sugar under 70 mg/dL) is less common.

A 2022 study of 265 people hospitalized with sepsis revealed that around 10% experienced hypoglycemia. Low blood sugar early on in sepsis is significantly related to a person’s outcome and may indicate a higher risk of organ dysfunction and death.

Overall, studies reveal that people with sepsis who develop hypoglycemia have poorer outcomes than those who develop hyperglycemia.

Infections are hard on the body and the immune system. They alter the levels of hormones that regulate blood sugar, among other issues.

Causes of spontaneous hypoglycemia in people with sepsis include:

  • lowered levels of cortisol and adrenaline
  • changes to glucose metabolism
  • increases in the glucose consumption of tissues

Insulin treatment for hyperglycemia-related sepsis may lead to hypoglycemia in some people, as well.

A 2021 study suggests that treating hyperglycemia may not improve the outcome for a person with sepsis. Instead, it may put them at higher risk by causing hypoglycemia and related complications.

Other factors that may increase a person’s risk of developing hypoglycemia related to sepsis include:

  • not eating regular meals
  • organ failure
  • dialysis

Having diabetes is yet another risk factor for developing low blood sugar with sepsis.

First, people with diabetes may be at higher risk — 2 to 6 times higher — of developing sepsis and sepsis-related complications.

The risk of death from sepsis is also higher in people who have diabetes due to kidney failure and respiratory failure.

Researchers in a 2021 review also note that diabetes may protect against poor outcomes related to changes in blood sugar. The risk of death with sepsis-related hyperglycemia is actually lower in people with diabetes than in people who do not have diabetes.

The review also found that people who have diabetes and sepsis-related hypoglycemia also do not experience an increase in the risk of death from this complication.

Still, blood sugar issues do impact people with sepsis who also have diabetes. Individuals with type 1 and advanced type 2 are at the highest risk of developing sepsis-related hypoglycemia, which is likely related to treatments that increase insulin levels in the body.

Without treatment, hypoglycemia can be dangerous. That’s why promptly treating sepsis may help blood sugar levels return to normal.

Treatments include:

Inpatient treatment of hypoglycemia generally involves giving glucose intravenously (IV) in the appropriate concentration.

Consuming rapid-acting carbohydrates (monosaccharides, disaccharides, etc.) is another option for patients who are awake and able to take food by mouth.

After consuming the carbohydrates, staff may check blood sugar every 15 minutes and repeat carb doses as necessary to bring blood sugar into the normal range.

Sepsis can impact a person’s blood glucose levels in various ways. While stress-induced hyperglycemia is more common with sepsis, spontaneous hypoglycemia is an important indicator of how serious the condition is progressing.

Low blood sugar may also directly relate to insulin treatment for infection-induced hyperglycemia. Treating sepsis as soon as possible can help restore blood sugar balance and protect against organ failure and death.