Non-diabetic hypoglycaemia

Non-diabetic hypoglycaemia may commonly present with symptoms such as 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 sulfonylurea use. Another common cause may be physiological reactive hypoglycaemia. However, the most worrisome causes are insulinoma and tumour-related hypoglycaemia.

Preferred treatment for an insulinoma is surgical excision.

Hypoglycaemia is a clinical syndrome present when the blood glucose concentration falls below the normal fasting glucose range, generally <3.3 mmol/L (<60 mg/dL). When glucose values drop below the normal fasting range, glucose meters are not accurate and laboratory serum or plasma testing is useful to confirm the actual blood sugar value.[1]Khan AI, Vasquez Y, Gray J, et al. The variability of results between point-of-care testing glucose meters and the central laboratory analyzer. Arch Pathol Lab Med. 2006 Oct;130(10):1527-32. http://www.ncbi.nlm.nih.gov/pubmed/17090196?tool=bestpractice.com Whipple's triad should be present in cases of true hypoglycaemia: hypoglycaemic symptoms, accompanying low blood glucose concentration, and resolution of symptoms after raising the blood glucose concentration to normal.[2]Whipple AO. The surgical therapy of hyperinsulinoma. J Int Chir. 1938;3:237.

This topic covers non-diabetic hypoglycaemia in adults.