Nondiabetic hypoglycemia

Nondiabetic hypoglycemia may commonly present with symptoms such as nausea, confusion, tremor, sweating, palpitations, or hunger. Patients may present with a nonspecific clinical history.

Documentation of a blood glucose ≤70 mg/dL (≤3.9 mmol/L) with accompanying symptoms is crucial to diagnosing clinically significant hypoglycemia.

Important causes to consider are iatrogenic or factitious hypoglycemia secondary to insulin or insulin secretagogue (sulfonylurea or meglitinide) use. Another common cause may be physiological reactive hypoglycemia. However, the most worrisome causes are insulinoma and tumor-related hypoglycemia.

Preferred treatment for an insulinoma is surgical excision.

Hypoglycemia is a clinical syndrome present when the blood glucose concentration falls below the normal fasting glucose range, generally ≤70 mg/dL (≤3.9 mmol/L).[1]Workgroup on Hypoglycemia, American Diabetes Association. Defining and reporting hypoglycemia in diabetes: a report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care. 2005 May;28(5):1245-9. https://diabetesjournals.org/care/article/28/5/1245/27763/Defining-and-Reporting-Hypoglycemia-in-DiabetesA [2]Association of British Clinical Diabetologists.​ JBDS 01 the hospital management of hypoglycaemia in adults with diabetes mellitus. Jan 2023 [internet publication]. https://abcd.care/resource/current/jbds-01-hospital-management-hypoglycaemia-adults-diabetes-mellitus ​​​ 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 glucose value.[3]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 triad should be present in cases of true hypoglycemia: hypoglycemic symptoms, accompanying low blood glucose concentration, and resolution of symptoms after raising the blood glucose concentration to normal.[4]Whipple AO. The surgical therapy of hyperinsulinoma. J Int Chir. 1938;3:237.

This topic covers non-diabetic hypoglycemia in adults.