Pseudohypoglycemia Causes and Diagnostic Approaches

Laboratory Interference Causes

High levels of triglycerides, uric acid, or bilirubin can cause falsely low glucose readings on point-of-care meters, according to the Endocrine Society, in patients with metabolic disorders 1, 2
High acetaminophen levels can paradoxically cause falsely high readings, which can mask true hypoglycemia, as noted by the Endocrine Society, in patients taking certain medications 1, 2
Ascorbic acid interferes with electrochemical glucose sensors, as reported by the Endocrine Society, in patients with high vitamin C intake 1, 2
Low hematocrit results in falsely elevated glucose readings on glucose oxidase-based meters, which can mask true hypoglycemia, according to the Endocrine Society, in patients with anemia 1, 2
Hypoxia causes falsely high glucose readings on glucose oxidase-based meters, as noted by the Endocrine Society, in patients with respiratory disorders 1, 2
Oxygen therapy causes falsely low glucose readings on glucose oxidase-based meters, according to the Endocrine Society, in patients receiving oxygen therapy 1, 2

GDH-PQQ-based meters cannot distinguish glucose from other sugars and show falsely elevated readings with icodextrin, maltose, galactose, or xylose, as reported by the Endocrine Society, in patients on peritoneal dialysis or receiving parenteral solutions 1, 2
Certain immunoglobulins and abatacept can cause falsely elevated readings on GDH-PQQ-based meters, according to the Endocrine Society, in patients receiving immunotherapy 1, 2
The Endocrine Society recommends that GDH-PQQ and glucose oxidase-based meters should never be used in patients with end-stage kidney disease on dialysis or those receiving interfering medications, as this can lead to dangerous mismanagement of true hypoglycemia 1, 2

The Endocrine Society suggests using hexokinase, GDH-NAD, or GDH-FAD methods instead of GDH-PQQ or glucose oxidase-based meters in dialysis patients to avoid pseudohypoglycemia 1, 2
Verifying the glucose meter methodology being used and checking for known interfering substances can help diagnose pseudohypoglycemia, as recommended by the Endocrine Society, in patients with suspected measurement errors 1, 2