Hypoglycemia diagnostic criteria
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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.