Summary
Definition
History and exam
Key diagnostic factors
- diaphoresis
- anxiety
- tremor
- hunger
- generalized tingling
- nausea
- palpitations
- confusion
- irritability
- blurred vision
- drowsiness
Other diagnostic factors
- unexplained weight gain
- unexplained weight loss
- hyperpigmentation
- hypotension
- short stature
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
Diagnostic tests
1st tests 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
Tests 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
Treatment algorithm
reactive hypoglycemia
exposure/overdose medication, toxin, ethanol
bariatric surgery, anorexia, malnutrition, ackee fruit ingestion
insulinoma
IGF-II-secreting tumor
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 (pseudohypoglycemia)
- Insulin autoimmune hypoglycemia
- Diabetic hypoglycemia
More DifferentialsGuidelines
- Society for Endocrinology guidelines for the diagnosis and management of post-bariatric hypoglycaemia
- ENETS consensus guidelines update for the management of patients with functional pancreatic neuroendocrine tumors and non-functional pancreatic neuroendocrine tumors
More GuidelinesPatient information
Diabetes: what is it?
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