Hypoglycemia diagnostic criteria: Difference between revisions
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{{CMG}} ; {{AE}} {{MAD}} | {{CMG}} ; {{AE}} {{MAD}} | ||
==Overview== | ==Overview== | ||
Diagnostic criteria of hypoglycemia include symptoms of hypoglycemia, a low [[plasma glucose]] concentration correlated with symptoms, and correction of [[Glucose levels low|glucose level]] relieves symptoms. These criteria called [[Whipple's triad]]. Neonatal hypoglycemia can be diagnosed by measuring multiple [[metabolic]] panels include p[[Insulin|lasma insulin]], plasma [[C-peptide]], [[beta-hydroxybutyrate]], b[[PH|lood pH,]] [[bicarbonate]], [[lactate]], [[Free fatty acids]], [[Acylcarnitine hydrolase|acylcarnitine profile]], plasma free and total [[Carnitine|carnitine levels]]. | |||
The following 3 characteristics should be present to diagnose hypoglycemia, which is called [[Whipple's triad]] and includes: | = Hypoglycemia diagnostic criteria = | ||
The following 3 characteristics should be present to diagnose hypoglycemia, which is called [[Whipple's triad]] and includes:<ref name="pmid17127144">{{cite journal| author=Guettier JM, Gorden P| title=Hypoglycemia. | journal=Endocrinol Metab Clin North Am | year= 2006 | volume= 35 | issue= 4 | pages= 753-66, viii-ix | pmid=17127144 | doi=10.1016/j.ecl.2006.09.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17127144 }}</ref><ref name="pmid8755648">{{cite journal| author=Landau BR, Wahren J, Chandramouli V, Schumann WC, Ekberg K, Kalhan SC| title=Contributions of gluconeogenesis to glucose production in the fasted state. | journal=J Clin Invest | year= 1996 | volume= 98 | issue= 2 | pages= 378-85 | pmid=8755648 | doi=10.1172/JCI118803 | pmc=507441 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8755648 }}</ref> | |||
*Symptoms of hypoglycemia | *Symptoms of hypoglycemia | ||
*A low [[plasma glucose]] concentration correlated with symptoms | *A low [[plasma glucose]] concentration correlated with symptoms | ||
*Correction of [[Glucose levels low|glucose level]] relieves symptoms | *Correction of [[Glucose levels low|glucose level]] relieves symptoms | ||
The strategy is to seek [[Whipple's triad]] under conditions in which hypoglycemia would be expected: | The strategy is to seek [[Whipple's triad]] under conditions in which hypoglycemia would be expected:<ref name="pmid15886243">{{cite journal| author=Service FJ, O'Brien PC| title=Increasing serum betahydroxybutyrate concentrations during the 72-hour fast: evidence against hyperinsulinemic hypoglycemia. | journal=J Clin Endocrinol Metab | year= 2005 | volume= 90 | issue= 8 | pages= 4555-8 | pmid=15886243 | doi=10.1210/jc.2005-0033 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15886243 }}</ref><ref name="pmid6876881">{{cite journal| author=Hogan MJ, Service FJ, Sharbrough FW, Gerich JE| title=Oral glucose tolerance test compared with a mixed meal in the diagnosis of reactive hypoglycemia. A caveat on stimulation. | journal=Mayo Clin Proc | year= 1983 | volume= 58 | issue= 8 | pages= 491-6 | pmid=6876881 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6876881 }}</ref> | ||
*If the symptoms occur in the [[Fasting plasma glucose|fasting state]], that evaluation should be performed during fasting. | *If the symptoms occur in the [[Fasting plasma glucose|fasting state]], that evaluation should be performed during fasting. | ||
*If there is a compelling history of postprandial symptoms, it is reasonable to seek [[Whipple's triad]] with frequent, timed plasma [[Blood glucose monitoring|glucose measurements]] and recording of any symptoms after a mixed meal. | *If there is a compelling history of postprandial symptoms, it is reasonable to seek [[Whipple's triad]] with frequent, timed plasma [[Blood glucose monitoring|glucose measurements]] and recording of any symptoms after a mixed meal. | ||
=== Identifying the cause === | |||
After confirmation of hypoglycemia. Physicians should have history, signs and laboratory results sufficient to help them to identify the cause of hypoglycemia:<ref name="pmid11095416">{{cite journal| author=Service FJ, Natt N| title=The prolonged fast. | journal=J Clin Endocrinol Metab | year= 2000 | volume= 85 | issue= 11 | pages= 3973-4 | pmid=11095416 | doi=10.1210/jcem.85.11.6934 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11095416 }}</ref> | |||
{| class="wikitable" | |||
! | |||
!Plasma [[insulin]]<ref name="pmid19088155">{{cite journal| author=Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER et al.| title=Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. | journal=J Clin Endocrinol Metab | year= 2009 | volume= 94 | issue= 3 | pages= 709-28 | pmid=19088155 | doi=10.1210/jc.2008-1410 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19088155 }}</ref> | |||
![[C-peptide]] | |||
![[proinsulin]] | |||
![[Sulfonylurea]] in plasma | |||
![[insulin]] or [[Insulin receptor|insulin receptor antibodies]] | |||
![[Postprandial]] symptoms | |||
!Fating symptoms | |||
|- | |||
|[[Insulinoma]] | |||
|high | |||
|high | |||
|high | |||
| - | |||
| - | |||
| - | |||
| + | |||
|- | |||
|[[Oral hypoglycemics]] | |||
|high | |||
|high | |||
|high | |||
| + | |||
| - | |||
| - | |||
| - | |||
|- | |||
|[[Autoimmune]] hypoglycemia | |||
|high | |||
|high | |||
|high | |||
| - | |||
| + | |||
| - | |||
| - | |||
|- | |||
|[[NIPHS]]* | |||
|high | |||
|high | |||
|high | |||
| - | |||
| - | |||
| + | |||
| - | |||
|- | |||
|Exogenous [[insulin]] | |||
|high | |||
|low | |||
|low | |||
| - | |||
| - | |||
| - | |||
| - | |||
|- | |||
|[[Non-islet|Non-islet cell tumors]] | |||
|low | |||
|low | |||
|low | |||
| - | |||
| - | |||
| - | |||
| - | |||
|} | |||
<nowiki>*</nowiki>(NIPHS) non-insulinoma pancreatogenous hypoglycemia syndrome | |||
=== Neonatal hypoglycemia: === | |||
* Measure [[Insulin|plasma insulin]], plasma [[C-peptide]] and [[beta-hydroxybutyrate]] | |||
* [[PH|Blood pH,]] [[bicarbonate]], and [[lactate]] | |||
* [[Free fatty acids]], [[Acylcarnitine hydrolase|acylcarnitine profile]], plasma free and total [[Carnitine|carnitine levels]] | |||
* [[Growth hormone]] and [[cortisol]] | |||
* [[Urine organic acids]] and [[Amino acids|serum amino acids]] | |||
==References== | ==References== | ||
{{Reflist|2}} |
Latest revision as of 14:57, 20 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Mohammed Abdelwahed M.D[2]
Overview
Diagnostic criteria of hypoglycemia include symptoms of hypoglycemia, a low plasma glucose concentration correlated with symptoms, and correction of glucose level relieves symptoms. These criteria called Whipple's triad. Neonatal hypoglycemia can be diagnosed by measuring multiple metabolic panels include plasma insulin, plasma C-peptide, beta-hydroxybutyrate, blood pH, bicarbonate, lactate, Free fatty acids, acylcarnitine profile, plasma free and total carnitine levels.
Hypoglycemia diagnostic criteria
The following 3 characteristics should be present to diagnose hypoglycemia, which is called Whipple's triad and includes:[1][2]
- Symptoms of hypoglycemia
- A low plasma glucose concentration correlated with symptoms
- Correction of glucose level relieves symptoms
The strategy is to seek Whipple's triad under conditions in which hypoglycemia would be expected:[3][4]
- If the symptoms occur in the fasting state, that evaluation should be performed during fasting.
- If there is a compelling history of postprandial symptoms, it is reasonable to seek Whipple's triad with frequent, timed plasma glucose measurements and recording of any symptoms after a mixed meal.
Identifying the cause
After confirmation of hypoglycemia. Physicians should have history, signs and laboratory results sufficient to help them to identify the cause of hypoglycemia:[5]
Plasma insulin[6] | C-peptide | proinsulin | Sulfonylurea in plasma | insulin or insulin receptor antibodies | Postprandial symptoms | Fating symptoms | |
---|---|---|---|---|---|---|---|
Insulinoma | high | high | high | - | - | - | + |
Oral hypoglycemics | high | high | high | + | - | - | - |
Autoimmune hypoglycemia | high | high | high | - | + | - | - |
NIPHS* | high | high | high | - | - | + | - |
Exogenous insulin | high | low | low | - | - | - | - |
Non-islet cell tumors | low | low | low | - | - | - | - |
*(NIPHS) non-insulinoma pancreatogenous hypoglycemia syndrome
Neonatal hypoglycemia:
- Measure plasma insulin, plasma C-peptide and beta-hydroxybutyrate
- Blood pH, bicarbonate, and lactate
- Free fatty acids, acylcarnitine profile, plasma free and total carnitine levels
References
- ↑ Guettier JM, Gorden P (2006). "Hypoglycemia". Endocrinol Metab Clin North Am. 35 (4): 753–66, viii–ix. doi:10.1016/j.ecl.2006.09.005. PMID 17127144.
- ↑ Landau BR, Wahren J, Chandramouli V, Schumann WC, Ekberg K, Kalhan SC (1996). "Contributions of gluconeogenesis to glucose production in the fasted state". J Clin Invest. 98 (2): 378–85. doi:10.1172/JCI118803. PMC 507441. PMID 8755648.
- ↑ Service FJ, O'Brien PC (2005). "Increasing serum betahydroxybutyrate concentrations during the 72-hour fast: evidence against hyperinsulinemic hypoglycemia". J Clin Endocrinol Metab. 90 (8): 4555–8. doi:10.1210/jc.2005-0033. PMID 15886243.
- ↑ Hogan MJ, Service FJ, Sharbrough FW, Gerich JE (1983). "Oral glucose tolerance test compared with a mixed meal in the diagnosis of reactive hypoglycemia. A caveat on stimulation". Mayo Clin Proc. 58 (8): 491–6. PMID 6876881.
- ↑ Service FJ, Natt N (2000). "The prolonged fast". J Clin Endocrinol Metab. 85 (11): 3973–4. doi:10.1210/jcem.85.11.6934. PMID 11095416.
- ↑ Cryer PE, Axelrod L, Grossman AB, Heller SR, Montori VM, Seaquist ER; et al. (2009). "Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline". J Clin Endocrinol Metab. 94 (3): 709–28. doi:10.1210/jc.2008-1410. PMID 19088155.