Spontaneous and iatrogenic hypoglycemia in cystic fibrosis

Rebecca Hicks, Brynn E. Marks, Rachael Oxman, Amir Moheet

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Spontaneous episodes of hypoglycemia can occur in people with cystic fibrosis (CF) without diabetes, who are not on glucose lowering medications. Spontaneous hypoglycemia in CF could occur both in the fasting or postprandial state (reactive hypoglycemia). The pathophysiology of fasting hypoglycemia is thought to be related to malnutrition and increased energy expenditure in the setting of inflammation and acute infections. Reactive hypoglycemia is thought to be due to impaired first phase insulin release in response to a glucose load, followed by a delayed and extended second phase insulin secretion; ineffective counterregulatory response to dropping glucose levels may also play a role. The overall prevalence of spontaneous hypoglycemia varies from 7 to 69% as examined with oral glucose tolerance test (OGTT) or with continuous glucose monitoring (CGM) under free living conditions. Spontaneous hypoglycemia in CF is associated with worse lung function, higher hospitalization rates, and worse clinical status. In addition, patients with CF related diabetes on glucose-lowering therapies are at risk for iatrogenic hypoglycemia. In this article, we will review the pathophysiology, prevalence, risk factors, clinical implications, and management of spontaneous and iatrogenic hypoglycemia in patients with CF.

Original languageEnglish (US)
Article number100267
JournalJournal of Clinical and Translational Endocrinology
StatePublished - Dec 2021

Bibliographical note

Funding Information:
This work was supported by the Cystic Fibrosis Foundation EnVision II CF: Emerging Leaders in CF Endocrinology. The sponsor provided support and national faculty mentorship to develop expertise in CF Endocrinology but was not involved in the development of this manuscript.

Publisher Copyright:
© 2021 The Authors


  • Continuous glucose monitor
  • Cystic fibrosis
  • Cystic fibrosis related diabetes
  • Hypoglycemia
  • Oral glucose tolerance test
  • Reactive hypoglycemia


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