American Board of Family Medicine (ABFM) Practice Exam 2026 - Free ABFM Practice Questions and Study Guide

In previously stable diabetic patients who have not changed their diet or insulin dosage, the most common cause of hypoglycemia is often related to increased physical activity. When patients increase their levels of physical activity without adjusting their insulin regimens, they may utilize more glucose for energy, which can lead to hypoglycemic episodes if their insulin dosage remains unchanged.

During physical activity, the body uses glucose at a higher rate, which, in turn, can lower blood sugar levels more rapidly than anticipated. Since the patients have not made changes to their diet or medication, the unanticipated increase in glucose consumption through exercise becomes a significant factor leading to low blood glucose levels.

Renal disease, while it can affect glucose metabolism and insulin clearance, is not as commonly associated with acute episodes of hypoglycemia as changes in physical activity levels are. Additionally, medication non-compliance typically leads to poorly controlled diabetes and potential hyperglycemia, rather than hypoglycemia, unless it involves insufficient dosing of insulin or medications that lower blood sugar. Dietary changes are also ruled out since the scenario specifies that there have been no alterations in diet.

Hence, increased physical activity is the most straightforward and common reason for experiencing hypoglycemia in this patient population under the specified conditions.