Summary

• Common presenting symptoms include nausea, confusion, tremor, sweating, palpitations, or hunger. Patients may present with a non-specific clinical history.
• Documentation of a blood glucose <3.3 mmol/L (<60 mg/dL) with accompanying symptoms is crucial to diagnosing clinically significant hypoglycaemia.
• Important causes to consider are iatrogenic or factitious hypoglycaemia secondary to insulin or sulphonylurea use. Another common cause may be physiological reactive hypoglycaemia. However, the most worrisome causes are insulinoma and tumour-related hypoglycemia.
• Preferred treatment for an insulinoma is surgical excision.