Hypoglycemia diagnostic criteria: Difference between revisions
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*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: | |||
{| class="wikitable" | |||
! | |||
!Plasma insulin | |||
![[C-peptide]] | |||
![[proinsulin]] | |||
![[Sulfonylurea]] in plasma | |||
![[insulin]] or [[Insulin receptor|insulin receptor antibodies]] | |||
![[Postprandial]] symptoms | |||
!Fating symptoms | |||
|- | |||
|[[Insulinoma]] | |||
|high | |||
|high | |||
|high | |||
| - | |||
| - | |||
| - | |||
| + | |||
|- | |||
|[[Oral hypoglycemics]]<ref name="pmid9056803">{{cite journal| author=Perros P, Henderson AK, Carter DC, Toft AD| title=Lesson of the week. Are spontaneous hypoglycaemia, raised plasma insulin and C peptide concentrations, and abnormal pancreatic images enough to diagnose insulinoma? | journal=BMJ | year= 1997 | volume= 314 | issue= 7079 | pages= 496-7 | pmid=9056803 | doi= | pmc=2125998 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9056803 }}</ref> | |||
|high | |||
|high | |||
|high | |||
| + | |||
| - | |||
| - | |||
| - | |||
|- | |||
|[[Autoimmune]] hypoglycemia<ref name="pmid19440117">{{cite journal| author=Lupsa BC, Chong AY, Cochran EK, Soos MA, Semple RK, Gorden P| title=Autoimmune forms of hypoglycemia. | journal=Medicine (Baltimore) | year= 2009 | volume= 88 | issue= 3 | pages= 141-53 | pmid=19440117 | doi=10.1097/MD.0b013e3181a5b42e | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19440117 }}</ref> | |||
|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: === | |||
Most of the neonatal hypoglycemias are transient but suspected cases as following should be investigated for metabolic diseases: | |||
* Hypoglycemia that requires prolonged high rates of [[dextrose]] infusion | |||
* [[Persistent hypoglycemia]] | |||
* [[Neurological|Neurologic]] symptoms | |||
* History or physical findings suggestive of metabolic disease | |||
==References== | ==References== |
Revision as of 13:39, 22 September 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
The following 3 characteristics should be present to diagnose hypoglycemia, which is called Whipple's triad and includes:
- 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:
- 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:
Plasma insulin | C-peptide | proinsulin | Sulfonylurea in plasma | insulin or insulin receptor antibodies | Postprandial symptoms | Fating symptoms | |
---|---|---|---|---|---|---|---|
Insulinoma | high | high | high | - | - | - | + |
Oral hypoglycemics[1] | high | high | high | + | - | - | - |
Autoimmune hypoglycemia[2] | 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:
Most of the neonatal hypoglycemias are transient but suspected cases as following should be investigated for metabolic diseases:
- Hypoglycemia that requires prolonged high rates of dextrose infusion
- Persistent hypoglycemia
- Neurologic symptoms
- History or physical findings suggestive of metabolic disease
References
- ↑ Perros P, Henderson AK, Carter DC, Toft AD (1997). "Lesson of the week. Are spontaneous hypoglycaemia, raised plasma insulin and C peptide concentrations, and abnormal pancreatic images enough to diagnose insulinoma?". BMJ. 314 (7079): 496–7. PMC 2125998. PMID 9056803.
- ↑ Lupsa BC, Chong AY, Cochran EK, Soos MA, Semple RK, Gorden P (2009). "Autoimmune forms of hypoglycemia". Medicine (Baltimore). 88 (3): 141–53. doi:10.1097/MD.0b013e3181a5b42e. PMID 19440117.