Long lasting episodes of low blood sugar that do not respond to standard treatment are known as refractory hypoglycemia. Causes may include excess insulin or pancreatic tumors.

Refractory hypoglycemia is an episode of prolonged low blood sugar that doesn’t respond to standard treatment. Episodes can last hours or days.

Although hypoglycemia is often linked to diabetes, it’s not the only condition that can cause refractory hypoglycemia. Pancreatic tumors and conditions that cause high insulin levels in the blood can also cause refractory hypoglycemia.

Treatment of refractory hypoglycemia depends on the underlying cause but can involve high doses of dextrose or prolonged infusions of glucose.

Typical episodes of hypoglycemia can be treated quickly. Refractory hypoglycemia lasts longer. The exact length of time an episode lasts depends on the underlying cause and the person.

For instance, refractory hypoglycemia can happen after an overly large dose of insulin. When this occurs, a person can experience several episodes of hypoglycemia that are difficult to predict and manage. Their blood sugar can dip dangerously low, and stabilizing it can be challenging.

However, refractory hypoglycemia isn’t always caused by diabetes and diabetes medication.

It can also be the result of pancreatic tumors or rare conditions such as type B insulin resistance. Type B insulin resistance is sometimes initially misdiagnosed as type 1 diabetes.

But, unlike type 1 diabetes, it cannot be treated with insulin. It’s one of a few conditions that can lead to what’s known as hyperinsulinemia, or too much insulin in your blood.

Refractory hypoglycemia is sometimes known by other names. You might hear it referred to as:

  • resistant hypoglycemia
  • unresponsive hypoglycemia
  • intractable hypoglycemia

These terms all generally mean the same thing: hypoglycemia that isn’t resolving after treatment.

Just like the length of time of refractory hypoglycemia can vary depending on the underlying cause, the reason it lasts so long can also vary. Hypoglycemia might be refectory because:

  • a very high dose of insulin taken as a treatment holds blood sugar low
  • tumors cause your pancreas to make extra insulin, keeping your blood sugar too low
  • a condition doesn’t allow your body to process insulin correctly, leading to high levels of it in your blood and low blood sugar

Refectory hypoglycemia is rare. Typically, hypoglycemia can be treated through standard measures. It’s uncommon for it to be resistant to treatment.

The risk for refractory hypoglycemia can vary because there are multiple possible underlying causes. For instance, people with diabetes are at risk of taking too much insulin if they:

These risk factors do not mean someone will always experience refractory hypoglycemia, but they are linked to a higher risk of severely low blood sugar. A severe episode of low blood sugar could become refectory hypoglycemia.

Pancreatic tumors can also lead to refractory hypotension. The type of pancreatic tumor linked to refractory hypotension is called insulinoma. Risk factors for this tumor include:

Because refractory hypoglycemia is rare and has multiple underlying causes, there isn’t a standard treatment. Still, common options include a prolonged IV infusion of glucose and high doses of dextrose.

Follow-up monitoring is often required.

Differing underlying causes can change the treatment options. For instance, someone who takes a too-high dosage of insulin medication will likely need a different treatment than someone with refractory hypoglycemia caused by a tumor.

Refectory hypoglycemia caused by too much insulin is a side effect of a single medication dose, but refectory hypoglycemia caused by a pancreatic tumor is a complication of an ongoing medical condition.


Responding to severe hypoglycemia

Addressing severe hypoglycemia

Clinical guidelines define severe hypoglycemia as a glucose reading below 54 mg/dL. This is considered a medical emergency. If this happens, a person experiencing severe hypoglycemia may need assistance being treated with fasting-acting glucagon or possibly by emergency medical professionals.

Read more about responding to a diabetic emergency.

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Refractory hypoglycemia means that a low blood sugar episode is long lasting and does not respond to standard treatments.

There are multiple causes of refractory hypoglycemia, including too-high doses of insulin medication, pancreatic tumors, and health conditions that make insulin levels in the blood too high.

Treatment of refractory hypoglycemia depends on the underlying condition. Possible options include IV infusions of glucose, high doses of dextrose, and continuous monitoring.