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Non-diabetic hypoglycemia

Last reviewed: 5 Oct 2024
Last updated: 20 Sep 2024

Summary

Definition

History and exam

Key diagnostic factors

  • diaphoresis
  • anxiety
  • tremor
  • hunger
  • generalized tingling
  • nausea
  • palpitations
  • confusion
  • irritability
  • blurred vision
  • drowsiness
Full details

Other diagnostic factors

  • unexplained weight gain
  • unexplained weight loss
  • hyperpigmentation
  • hypotension
  • short stature
Full details

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
Full details

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
Full details

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
Full details

Treatment algorithm

ACUTE

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

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  • Guidelines

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  • Patient information

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