From the FDA Drug Label
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From the Research
The workup for recurrent hypoglycemia in a non-diabetic patient should begin with a thorough history and physical examination, followed by laboratory testing during hypoglycemic episodes, with the most recent guidelines suggesting a 72-hour supervised fast as the gold standard diagnostic test 1. The most important initial test is the Whipple's triad: documented low blood glucose, symptoms of hypoglycemia, and resolution of symptoms after glucose administration. During a hypoglycemic episode, obtain critical samples including plasma glucose, insulin, C-peptide, proinsulin, beta-hydroxybutyrate, and sulfonylurea screen before treatment. Some key points to consider in the workup include:
- Common causes to investigate include insulinoma, medications (especially sulfonylureas), alcohol use, adrenal insufficiency, liver disease, and factitious hypoglycemia.
- Additional testing may include imaging studies like abdominal CT or MRI if an insulinoma is suspected, cortisol levels to assess adrenal function, and liver function tests.
- Management depends on the underlying cause but should include patient education about hypoglycemia symptoms and treatment with fast-acting carbohydrates (15-20g glucose) 2.
- Patients should carry glucose tablets or gel and consider wearing a medical alert bracelet. The workup is essential because recurrent hypoglycemia in non-diabetics often indicates a serious underlying condition that requires specific treatment to prevent potentially dangerous hypoglycemic episodes, as highlighted in recent reviews on insulinomas and hypoglycemia management 3, 1.