Hypoglycemia
 National Diabetes Information Clearinghouse 

U.S. Department 

of Health and 

Human Services 

NATIONAL 

INSTITUTES 

OF HEALTH 

What is hypoglycemia? 

Hypoglycemia, also called low blood glucose or low blood sugar, occurs when blood 

glucose drops below normal levels. Glucose, an important source of energy for the 

body, comes from food. Carbohydrates are 

the main dietary source of glucose. Rice, 

potatoes, bread, tortillas, cereal, milk, fruit, 

and sweets are all carbohydrate-rich foods. 

After a meal, glucose is absorbed into the 

bloodstream and carried to the body’s cells. 

Insulin, a hormone made by the pancreas, 

helps the cells use glucose for energy. If a 

person takes in more glucose than the body 

needs at the time, the body stores the extra 

glucose in the liver and muscles in a form 

called glycogen. The body can use glycogen 

for energy between meals. Extra glucose 

can also be changed to fat and stored in fat 

cells. Fat can also be used for energy. 

When blood glucose begins to fall, 

glucagon—another hormone made by 

the pancreas—signals the liver to break 

down glycogen and release glucose into 

the bloodstream. Blood glucose will then 

rise toward a normal level. In some people 

with diabetes, this glucagon response 

to hypoglycemia is impaired and other 

hormones such as epinephrine, also called 

adrenaline, may raise the blood glucose 

level. But with diabetes treated with insulin 

or pills that increase insulin production, 

glucose levels can’t easily return to the 

normal range. 

Hypoglycemia can happen suddenly. It is 

usually mild and can be treated quickly and 

easily by eating or drinking a small amount 

of glucose-rich food. If left untreated, 

hypoglycemia can get worse and cause 

confusion, clumsiness, or fainting. Severe 

hypoglycemia can lead to seizures, coma, 

and even death. 

In adults and children older than 10 years, 

hypoglycemia is uncommon except as a side 

effect of diabetes treatment. Hypoglycemia 

can also result, however, from other medications or diseases, hormone or enzyme 

deficiencies, or tumors. 

What are the symptoms of 

hypoglycemia? 

Hypoglycemia causes symptoms such as 

•	 hunger

•	 shakiness

•	 nervousness

•	 sweating

•	 dizziness	or	light-headedness

•	 sleepiness

•	 confusion

•	 difficulty	speaking

•	 anxiety	

•	 weakness
 

Hypoglycemia can also happen during 

sleep. Some signs of hypoglycemia during 

sleep include 

•	 crying	out	or	having	nightmares

•	 finding	pajamas	or	sheets	damp	from	

perspiration 

•	 feeling	tired,	irritable,	or	confused	

after waking up 

What causes hypoglycemia 

in people with diabetes? 

Diabetes Medications 

Hypoglycemia can occur as a side effect of 

some diabetes medications, including insulin and oral diabetes medications—pills— 

that increase insulin production, such as 

•	 chlorpropamide	(Diabinese)

•	 glimepiride	(Amaryl)

•	 glipizide	(Glucotrol,	Glucotrol	XL)

•	 glyburide	(DiaBeta,	Glynase,	
 

Micronase)
 

•	 nateglinide	(Starlix)

•	 repaglinide	(Prandin)

•	 sitagliptin	(Januvia)	

•	 tolazamide	

•	 tolbutamide

Certain combination pills can also cause 

hypoglycemia, including 

•	 glipizide	+	metformin	(Metaglip)

•	 glyburide	+	metformin	(Glucovance)

•	 pioglitazone	+	glimepiride	(Duetact)

•	 rosiglitazone	+	glimepiride	(Avandaryl)

•	 sitagliptin	+	metformin	(Janumet)

Other types of diabetes pills, when taken 

alone, do not cause hypoglycemia. Examples of these medications are 

•	 acarbose	(Precose)

•	 metformin	(Glucophage)

•	 miglitol	(Glyset)

•	 pioglitazone	(Actos)

•	 rosiglitazone	(Avandia)

However, taking these pills along with 

other diabetes medications—insulin, pills 

that increase insulin production, or both— 

increases the risk of hypoglycemia. 

In	addition,	use	of	the	following	injectable	

medications can cause hypoglycemia: 

•	 Pramlintide	(Symlin),	which	is	used	

along with insulin 

•	 Exenatide	(Byetta),	which	can	cause	

hypoglycemia when used in combination with chlorpropamide, glimepiride, 

glipizide, glyburide, tolazamide, and 

tolbutamide 

For more information about diabetes 

medications,	see	the	National	Diabetes	

Information Clearinghouse’s booklet What 

I need to know about Diabetes Medicines, 

available at www.diabetes.niddk.nih.gov/ 

dm/pubs/medicines_ez or by calling 

1–800–860–8747. 

Other Causes of Hypoglycemia 

In people on insulin or pills that increase 

insulin production, low blood glucose can 

be due to 

•	 meals	or	snacks	that	are	too	small,	

delayed, or skipped 

•	 increased	physical	activity	

•	 alcoholic	beverages

2 Hypoglycemia 
 

How can hypoglycemia be 

prevented? 

Diabetes	treatment	plans	are	designed	to	

match the dose and timing of medication 

to a person’s usual schedule of meals and 

activities. Mismatches could result in hypoglycemia. For example, taking a dose of 

insulin—or other medication that increases 

insulin levels—but then skipping a meal 

could result in hypoglycemia. 

To help prevent hypoglycemia, people 

with diabetes should always consider the 

following: 

•	 Their diabetes medications. A health 

care provider can explain which diabetes medications can cause hypoglycemia and explain how and when to take 

medications. For good diabetes management, people with diabetes should 

take diabetes medications in the recommended doses at the recommended 

times. In some cases, health care providers may suggest that patients learn 

how	to	adjust	medications	to	match	

changes in their schedule or routine. 

•	 Their meal plan. A registered dietitian can help design a meal plan that 

fits one’s personal preferences and 

lifestyle. Following one’s meal plan is 

important	for	managing	diabetes.		People with diabetes should eat regular 

meals, have enough food at each meal, 

and try not to skip meals or snacks. 

Snacks are particularly important for 

some people before going to sleep or 

exercising. Some snacks may be more 

effective than others in preventing 

hypoglycemia overnight. The dietitian 

can make recommendations for snacks. 

What to Ask the 

Doctor about Diabetes 

Medications 

People	who	take	diabetes	medications	

should ask their doctor or health care 

provider 

•	 whether	their	diabetes	medications	

could cause hypoglycemia 

•	 when	they	should	take	their	diabetes medications 

•	 how	much	medication	they	should	

take 

•	 whether	they	should	keep	taking	

their diabetes medications when 

they are sick 

•	 whether	they	should	adjust	their	

medications before physical activity 

•	 whether	they	should	adjust	their	

medications if they skip a meal 

•	 Their daily activity. To help prevent 

hypoglycemia caused by physical activity, health care providers may advise 

–	 checking blood glucose before 

sports, exercise, or other physical 

activity and having a snack if the 

level is below 100 milligrams per 

deciliter	(mg/dL)

–	 adjusting	medication	before	physical activity 

–	 checking blood glucose at regular 

intervals during extended periods of 

physical activity and having snacks 

as needed 

–	 checking blood glucose periodically 

after physical activity 

3	 Hypoglycemia 
 

 

 

•	 Their use of alcoholic beverages. 

Drinking	alcoholic	beverages,	especially on an empty stomach, can cause 

hypoglycemia, even a day or two later. 

Heavy drinking can be particularly 

dangerous for people taking insulin or 

medications that increase insulin production. Alcoholic beverages should 

always be consumed with a snack or 

meal at the same time. A health care 

provider can suggest how to safely 

include alcohol in a meal plan. 

•	 Their diabetes management plan. 

Intensive diabetes management— 

keeping blood glucose as close to the 

normal range as possible to prevent 

long-term complications—can increase 

the risk of hypoglycemia. Those whose 

goal is tight control should talk with 

a health care provider about ways to 

prevent hypoglycemia and how best to 

treat it if it occurs. 

How is hypoglycemia 

treated? 

Signs and symptoms of hypoglycemia vary 

from	person	to	person.		People	with	diabetes should get to know their signs and symptoms and describe them to their friends and 

family so they can help if needed. School 

staff should be told how to recognize a 

child’s signs and symptoms of hypoglycemia 

and how to treat it. 

People	who	experience	hypoglycemia	several times in a week should call their health 

care provider. They may need a change in 

their treatment plan: less medication or a 

different medication, a new schedule for 

insulin or medication, a different meal plan, 

or a new physical activity plan. 

Prompt Treatment for 

Hypoglycemia 

When people think their blood glucose is 

too low, they should check the blood glucose level of a blood sample using a meter. 

If	the	level	is	below	70	mg/dL,	one	of	these	

quick-fix foods should be consumed right 

away to raise blood glucose: 

•	 3	or	4	glucose	tablets

•	 1	serving	of	glucose	gel—the	amount	

equal to 15 grams of carbohydrate 

•	 1/2	cup,	or	4	ounces,	of	any	fruit	juice

•	 1/2	cup,	or	4	ounces,	of	a	regular—

not diet—soft drink 

•	 1	cup,	or	8	ounces,	of	milk

•	 5	or	6	pieces	of	hard	candy

•	 1	tablespoon	of	sugar	or	honey

Recommended amounts may be less for 

small children. The child’s doctor can 

advise about the right amount to give a 

child. 

The next step is to recheck blood glucose 

in	15	minutes	to	make	sure	it	is	70	mg/dL	

or above. If it’s still too low, another serving of a quick-fix food should be eaten. 

These steps should be repeated until the 

blood	glucose	level	is	70	mg/dL	or	above.		

If the next meal is an hour or more away, 

a snack should be eaten once the quick-fix 

foods have raised the blood glucose level 

to	70	mg/dL	or	above.

4 Hypoglycemia 
 

For People Who Take 

Acarbose (Precose) or 

Miglitol (Glyset) 

People	who	take	either	of	these	diabetes medications should know that only 

pure glucose, also called dextrose— 

available in tablet or gel form—will 

raise their blood glucose level during 

a low blood glucose episode. Other 

quick-fix foods and drinks won’t raise 

the level quickly enough because acarbose and miglitol slow the digestion of 

other forms of carbohydrate. 

Help from Others for Severe 

Hypoglycemia 

Severe hypoglycemia—very low blood 

glucose—can cause a person to pass out 

and can even be life threatening. Severe 

hypoglycemia is more likely to occur in 

people	with	type	1	diabetes.		People	should	

ask a health care provider what to do about 

severe hypoglycemia. Another person 

can help someone who has passed out by 

giving	an	injection	of	glucagon.		Glucagon	

will rapidly bring the blood glucose level 

back to normal and help the person regain 

consciousness. A health care provider 

can prescribe a glucagon emergency kit. 

Family, friends, or coworkers—the people 

who will be around the person at risk of 

hypoglycemia—can learn how to give a 

glucagon	injection	and	when	to	call	911	or	

get medical help. 

Physical Activity and Blood 

Glucose Levels 

Physical	activity	has	many	benefits	for	

people with diabetes, including lowering 

blood glucose levels. However, physical 

activity can make levels too low and 

can cause hypoglycemia up to 24 hours 

afterward. A health care provider can 

advise about checking the blood glucose 

level before exercise. For those who take 

insulin or one of the oral medications that 

increase insulin production, the health 

care provider may suggest having a snack 

if	the	glucose	level	is	below	100	mg/dL	or	

adjusting	medication	doses	before	physical	

activity to help avoid hypoglycemia. A 

snack can prevent hypoglycemia. The 

health care provider may suggest extra 

blood glucose checks, especially after 

strenuous exercise. 

Hypoglycemia When Driving 

Hypoglycemia is particularly dangerous 

if it happens to someone who is driving. 

People	with	hypoglycemia	may	have	trouble concentrating or seeing clearly behind 

the wheel and may not be able to react 

quickly to road hazards or to the actions 

of other drivers. To prevent problems, 

people at risk for hypoglycemia should 

check their blood glucose level before 

driving.		During	longer	trips,	they	should	

check their blood glucose level frequently 

and eat snacks as needed to keep the level 

at	70	mg/dL	or	above.		If	necessary,	they	

should stop for treatment and then make 

sure	their	blood	glucose	level	is	70	mg/dL	

or above before starting to drive again. 

5 Hypoglycemia 
 

Hypoglycemia Unawareness 

Some people with diabetes do not have 

early warning signs of low blood glucose, 

a condition called hypoglycemia unawareness. This condition occurs most often 

in people with type 1 diabetes, but it can 

also occur in people with type 2 diabetes. 

People	with	hypoglycemia	unawareness	

may need to check their blood glucose level 

more often so they know when hypoglycemia is about to occur. They also may need 

a change in their medications, meal plan, or 

physical activity routine. 

Hypoglycemia unawareness develops when 

frequent episodes of hypoglycemia lead to 

changes in how the body reacts to low blood 

glucose levels. The body stops releasing 

the hormone epinephrine and other stress 

hormones when blood glucose drops too 

low. The loss of the body’s ability to release 

stress hormones after repeated episodes 

of hypoglycemia is called hypoglycemiaassociated autonomic failure, or HAAF. 

Epinephrine causes early warning symptoms of hypoglycemia such as shakiness, 

sweating, anxiety, and hunger. Without 

the release of epinephrine and the symptoms it causes, a person may not realize 

that hypoglycemia is occurring and may not 

take action to treat it. A vicious cycle can 

occur in which frequent hypoglycemia leads 

to hypoglycemia unawareness and HAAF, 

which in turn leads to even more severe 

and dangerous hypoglycemia. Studies have 

shown that preventing hypoglycemia for a 

period as short as several weeks can sometimes break this cycle and restore awareness of symptoms. Health care providers 

may therefore advise people who have had 

severe hypoglycemia to aim for higherthan-usual blood glucose targets for shortterm periods. 

Being Prepared for 

Hypoglycemia 

People	who	use	insulin	or	take	an	oral	

diabetes medication that can cause low 

blood glucose should always be prepared to prevent and treat low blood 

glucose by 

•	 learning	what	can	trigger	low	blood	

glucose levels 

•	 having	their	blood	glucose	meter	

available to test glucose levels; 

frequent testing may be critical for 

those with hypoglycemia unawareness, particularly before driving a 

car or engaging in any hazardous 

activity 

•	 always	having	several	servings	of	

quick-fix foods or drinks handy 

•	 wearing	a	medical	identification	

bracelet or necklace 

•	 planning	what	to	do	if	they	develop	

severe hypoglycemia 

•	 telling	their	family,	friends,	and	

coworkers about the symptoms of 

hypoglycemia and how they can 

help if needed 

6 Hypoglycemia 
 

Normal and Target 

Blood Glucose Ranges 

Normal Blood Glucose Levels in 

People Who Do Not Have Diabetes 

Upon waking— 

fasting 70	to	99	mg/dL

After meals 70 to 140 mg/dL

Target Blood Glucose Levels in 

People Who Have Diabetes 

Before meals 70 to 130 mg/dL

1 to 2 hours after 

the start of a meal below	180	mg/dL

Source:		American	Diabetes	Association.		

Standards	of	Medical	Care	in	Diabetes—2008.		

Diabetes Care. 2008;31:S12–S54. 

For people with diabetes, a blood glucose 

level	below	70	mg/dL	is	considered	

hypoglycemia. 

Hypoglycemia in People 

Who Do Not Have Diabetes 

Two types of hypoglycemia can occur in 

people who do not have diabetes: 

•	 Reactive	hypoglycemia,	also	called	

postprandial hypoglycemia, occurs 

within 4 hours after meals. 

•	 Fasting	hypoglycemia,	also	called	

postabsorptive hypoglycemia, is often 

related to an underlying disease. 

Symptoms of both reactive and fasting 

hypoglycemia are similar to diabetesrelated hypoglycemia. Symptoms may 

include hunger, sweating, shakiness, 

dizziness, light-headedness, sleepiness, 

confusion, difficulty speaking, anxiety, and 

weakness. 

To find the cause of a patient’s hypoglycemia, the doctor will use laboratory tests to 

measure blood glucose, insulin, and other 

chemicals that play a part in the body’s use 

of energy. 

7 Hypoglycemia 
 

Reactive Hypoglycemia 

Diagnosis 

To diagnose reactive hypoglycemia, the 

doctor may 

•	 ask	about	signs	and	symptoms

•	 test	blood	glucose	while	the	patient	

is having symptoms by taking a blood 

sample from the arm and sending it to 

a laboratory for analysis* 

•	 check	to	see	whether	the	symptoms	

ease after the patient’s blood glucose 

returns	to	70	mg/dL	or	above	after	eating or drinking 

A	blood	glucose	level	below	70	mg/dL	at	

the time of symptoms and relief after eating 

will confirm the diagnosis. The oral glucose 

tolerance test is no longer used to diagnose 

reactive hypoglycemia because experts now 

know the test can actually trigger hypoglycemic symptoms. 

Causes and Treatment 

The causes of most cases of reactive hypoglycemia are still open to debate. Some 

researchers suggest that certain people 

may be more sensitive to the body’s normal release of the hormone epinephrine, 

which causes many of the symptoms of 

hypoglycemia. Others believe deficiencies 

in glucagon secretion might lead to reactive 

hypoglycemia. 

A few causes of reactive hypoglycemia are 

certain, but they are uncommon. Gastric— 

or stomach—surgery can cause reactive 

hypoglycemia because of the rapid passage of food into the small intestine. Rare 

enzyme deficiencies diagnosed early in life, 

such as hereditary fructose intolerance, also 

may cause reactive hypoglycemia. 

To relieve reactive hypoglycemia, some 

health professionals recommend 

•	 eating	small	meals	and	snacks	about	

every 3 hours 

•	 being	physically	active

•	 eating	a	variety	of	foods,	including	

meat, poultry, fish, or nonmeat sources 

of protein; starchy foods such as 

whole-grain bread, rice, and potatoes; 

fruits; vegetables; and dairy products 

•	 eating	foods	high	in	fiber

•	 avoiding	or	limiting	foods	high	in	

sugar, especially on an empty stomach 

The doctor can refer patients to a registered dietitian for personalized meal 

planning advice. Although some health 

professionals recommend a diet high in protein and low in carbohydrates, studies have 

not proven the effectiveness of this kind of 

diet to treat reactive hypoglycemia. 

*A personal blood glucose monitor cannot be used to 

diagnose reactive hypoglycemia. 

8 Hypoglycemia 
 

Fasting Hypoglycemia 

Diagnosis 

Fasting hypoglycemia is diagnosed from a 

blood sample that shows a blood glucose 

level	below	50	mg/dL	after	an	overnight	

fast, between meals, or after physical 

activity. 

Causes and Treatment 

Causes of fasting hypoglycemia include certain medications, alcoholic beverages, critical illnesses, hormonal deficiencies, some 

kinds of tumors, and certain conditions 

occurring in infancy and childhood. 

Medications. Medications, including some 

used to treat diabetes, are the most common cause of hypoglycemia. Other medications that can cause hypoglycemia include 

•	 salicylates, including aspirin, when 


taken in large doses
 

•	 sulfa medications, which are used to 

treat bacterial infections 

•	 pentamidine, which treats a serious 

kind of pneumonia 

•	 quinine, which is used to treat malaria 

If using any of these medications causes a 

person’s blood glucose level to fall, the doctor may advise stopping the medication or 

changing the dose. 

Alcoholic beverages.		Drinking	alcoholic	

beverages, especially binge drinking, can 

cause hypoglycemia. The body’s breakdown of alcohol interferes with the liver’s 

efforts to raise blood glucose. Hypoglycemia caused by excessive drinking can be 

serious and even fatal. 

Critical illnesses. Some illnesses that affect 

the liver, heart, or kidneys can cause hypoglycemia. Sepsis, which is an overwhelming 

infection, and starvation are other causes of 

hypoglycemia. In these cases, treating the 

illness or other underlying cause will correct 

the hypoglycemia. 

Hormonal deficiencies. Hormonal deficiencies may cause hypoglycemia in very young 

children, but rarely in adults. Shortages of 

cortisol, growth hormone, glucagon, or epinephrine can lead to fasting hypoglycemia. 

Laboratory	tests	for	hormone	levels	will	

determine a diagnosis and treatment. Hormone replacement therapy may be advised. 

Tumors. Insulinomas are insulin-producing 

tumors in the pancreas. Insulinomas can 

cause hypoglycemia by raising insulin levels 

too high in relation to the blood glucose 

level. These tumors are rare and do not 

normally spread to other parts of the body. 

Laboratory	tests	can	pinpoint	the	exact	

cause. Treatment involves both shortterm steps to correct the hypoglycemia and 

medical or surgical measures to remove the 

tumor. 

9	 Hypoglycemia
 
 

Conditions occurring in infancy and childhood. Children rarely develop hypoglycemia. If they do, causes may include the 

following: 

•	 Brief intolerance to fasting, often during an illness that disturbs regular eating patterns. Children usually outgrow 

this tendency by age 10. 

•	 Hyperinsulinism, which is the overproduction of insulin. This condition can 

result in temporary hypoglycemia in 

newborns, which is common in infants 

of	mothers	with	diabetes.		Persistent	

hyperinsulinism in infants or children 

is a complex disorder that requires 

prompt evaluation and treatment by a 

specialist. 

•	 Enzyme deficiencies that affect carbohydrate metabolism. These deficiencies can interfere with the body’s 

ability to process natural sugars, such 

as fructose and galactose, glycogen, or 

other metabolites. 

•	 Hormonal deficiencies such as lack of 

pituitary or adrenal hormones. 

Points to Remember 

Diabetes-related Hypoglycemia 

•	 When	people	with	diabetes	think	

their blood glucose level is low, 

they should check it and treat the 

problem right away. 

•	 To	treat	hypoglycemia,	people	

should have a serving of a quick-fix 

food, wait 15 minutes, and check 

their blood glucose again. They 

should repeat the treatment until 

their	blood	glucose	is	70	mg/dL	or	

above. 

•	 People	at	risk	for	hypoglycemia	

should keep quick-fix foods in the 

car, at work—anywhere they spend 

time. 

•	 People	at	risk	for	hypoglycemia	

should be careful when driving. 

They should check their blood 

glucose frequently and snack as 

needed to keep their level 

70	mg/dL	or	above.

Hypoglycemia Unrelated to Diabetes 

•	 In	reactive	hypoglycemia,	symptoms occur within 4 hours of 

eating.		People	with	reactive	hypoglycemia are usually advised to 

follow a healthy eating plan recommended by a registered dietitian. 

•	 Fasting	hypoglycemia	can	be	

caused by certain medications, critical illnesses, hereditary enzyme or 

hormonal deficiencies, and some 

kinds of tumors. Treatment targets 

the underlying problem. 

10 Hypoglycemia 
11 Hypoglycemia

Hope through Research

The National Institute of Diabetes and

Digestive and Kidney Diseases (NIDDK)

was established by Congress in 1950 as one

of the National Institutes of Health of the 

U.S. Department of Health and Human

Services. The NIDDK conducts and supports research in diabetes, glucose metabolism, and related conditions. Researchers 

supported by the NIDDK are investigating

topics such as the causes of hypoglycemia and whether use of continuous glucose monitoring devices can help prevent 

hypoglycemia.

Participants in clinical trials can play a

more active role in their own health care, 

gain access to new research treatments 

before they are widely available, and help 

others by contributing to medical research. 

For information about current studies, visit 

www.ClinicalTrials.gov.

For More Information

National Diabetes Education Program 

1 Diabetes Way

Bethesda, MD 20814–9692

Phone: 1–888–693–NDEP (6337)

TTY: 1–866–569–1162

Fax: 703–738–4929

Email: ndep@mail.nih.gov 

Internet: www.ndep.nih.gov

American Diabetes Association 

1701 North Beauregard Street 

Alexandria, VA 22311 

Phone: 1–800–DIABETES (342–2383)

Email: AskADA@diabetes.org

Internet: www.diabetes.org

Juvenile Diabetes Research Foundation 

International 

26 Broadway, 14th Floor 

New York, NY 10004 

Phone:		1–800–533–CURE (2873)

Fax:		212–785–9595

Email:		info@jdrf.org

Internet:		www.jdrf.org

You may also find additional information about this 

topic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain information about medications. When prepared, this publication included 

the most current information available. For updates 

or for questions about any medications, contact 

the U.S. Food and Drug Administration toll-free at

1–888–INFO–FDA (463–6332) or visit www.fda.gov. 

Consult your doctor for more information.

The U.S. Government does not endorse or favor any 

specific commercial product or company. Trade, 

proprietary, or company names appearing in this 

document are used only because they are considered 

necessary in the context of the information provided. 

If a product is not mentioned, the omission does not 

mean or imply that the product is unsatisfactory.
National Diabetes 

Information Clearinghouse

1 Information Way 

Bethesda,	MD		20892–3560

Phone:		1–800–860–8747

TTY:		1–866–569–1162

Fax:		703–738–4929

Email: ndic@info.niddk.nih.gov 

Internet: www.diabetes.niddk.nih.gov

The	National	Diabetes	Information	Clearinghouse	(NDIC)	is	a	service	of	the	National	

Institute	of	Diabetes	and	Digestive	and	Kidney	

Diseases	(NIDDK).		The	NIDDK	is	part	of	

the National Institutes of Health of the U.S. 

Department	of	Health	and	Human	Services.		

Established	in	1978,	the	Clearinghouse	provides	

information about diabetes to people with diabetes and to their families, health care professionals,	and	the	public.		The	NDIC	answers	

inquiries, develops and distributes publications, 

and works closely with professional and patient 

organizations and Government agencies to 

coordinate resources about diabetes.

Publications	produced	by	the	Clearinghouse	

are	carefully	reviewed	by	both	NIDDK	scientists and outside experts. This fact sheet was 

reviewed	by	Vivian	A.	Fonseca,	M.D.,	F.R.C.P.,	

Tulane University Health Sciences Center, 

New	Orleans,	LA;	Catherine	L.	Martin,	M.S.,	

A.P.R.N.,	B.C.-A.D.M.,	C.D.E.,	University	of	

Michigan Health System, Ann Arbor, MI; and 

Neil	H.	White,	M.D.,	C.D.E.,	Department	of	

Pediatrics,	Washington	University	School	of	

Medicine	and	St.	Louis	Children’s	Hospital,	

St.	Louis,	MO.

This publication is not copyrighted. The Clearinghouse encourages users of this fact sheet to duplicate 

and distribute as many copies as desired.

This fact sheet is also available at 

www.diabetes.niddk.nih.gov.

U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES

National Institutes of Health

NIH	Publication	No.	09–3926

October 2008