Non-diabetic hypoglycaemia

Last reviewed: 21 Apr 2022
Last updated: 28 Jul 2020

Summary

Definition

History and exam

Key diagnostic factors

  • diaphoresis
  • anxiety
  • tremor
  • hunger
  • generalised tingling
  • nausea
  • palpitations
  • confusion
  • irritability
  • blurred vision
  • drowsiness
More key diagnostic factors

Other diagnostic factors

  • unexplained weight gain
  • unexplained weight loss
  • hyperpigmentation
  • hypotension
  • short stature
Other diagnostic factors

Risk factors

  • middle age
  • female sex
  • ethanol consumption
  • bariatric surgery
  • liver failure
  • renal failure
  • intense exercise
  • fibromas
  • sarcomas
  • fibrosarcomas
  • insulinoma
  • adrenal insufficiency
  • growth hormone deficiency
  • hypopituitarism
  • sepsis
  • glycogen storage diseases
  • anorexia nervosa
  • malnutrition
  • exogenous insulin
  • ackee fruit ingestion
  • haloperidol exposure
  • quinine exposure
  • fluoroquinolone exposure
  • sulfonylurea exposure
  • disopyramide exposure
  • beta-adrenergic-blocking agent exposure
  • salicylate exposure
  • tramadol exposure
  • proton pump inhibitor exposure
More risk factors

Diagnostic investigations

1st investigations to order

  • serum glucose
  • liver function testing
  • renal function testing
  • serum insulin
  • serum C-peptide
  • serum beta-hydroxybutyrate
  • serum sulfonylurea
  • thyroid-stimulating hormone levels
  • serum cortisol
More 1st investigations to order

Investigations to consider

  • 48- to 72-hour fast under observation
  • oral glucose tolerance test
  • serum insulin-like growth factor (IGF)-II
  • serum adrenocorticotropic hormone
  • serum human growth factor (HGH)
  • insulin suppression test
  • serum proinsulin
  • CT scan abdomen and pelvis with and without intravenous contrast
  • transabdominal ultrasound
  • endoscopic ultrasound
  • nuclear imaging with octreotide scan
More investigations to consider

Treatment algorithm

ACUTE

reactive hypoglycaemia

exposure/overdose medication, toxin, ethanol

bariatric surgery, anorexia, malnutrition, ackee fruit ingestion

insulinoma

IGF-II-secreting tumour

renal failure, liver failure, sepsis, or other endocrinopathy

Contributors

Authors

Udaya Kabadi, MD

Professor of Medicine

University of Iowa

Des Moines Internal Medicine Residency Training Program

Staff Endocrinologist

Veterans Affairs Medical Center

Des Moines

IA

Disclosures

UK is an author of a number of references cited in this topic.

Acknowledgements

Professor Udaya Kabadi would like to gratefully acknowledge Dr Steven Kunkel, a previous contributor to this topic.

Disclosures

SK declares that he has no competing interests.

Peer reviewers

David J. Leehey, MD

Section Chief

Renal and Hypertension

Professor of Medicine

Division of Nephrology

Department of Medicine

Loyola University School of Medicine and Edward Hines Jr VA Medical Center

Hines

IL

Disclosures

DJL declares that he has no competing interests.

Shehzad Basaria, MD

Assistant Professor

Johns Hopkins University School of Medicine

Baltimore

MD

Disclosures

SB declares that he has no competing interests.

David Hopkins, FRCP

Clinical Director/Clinical Lead for Diabetic Medicine

King’s College Hospital NHS Foundation Trust

London

Disclosures

DH declares that he has no competing interests.

  • Differentials

    • Idiopathic postprandial syndrome (pseudohypoglycaemia)
    • Insulin autoimmune hypoglycaemia
    More Differentials
  • Guidelines

    • ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors
    • Laboratory endocrine testing guidelines: hypoglycemia
    More Guidelines
  • Patient leaflets

    Diabetes: what is it?

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer