Hypoglycemia in non diabetics

Etiology and workup of hypoglycemia in non diabetic patients? 

Several conditions that can precipitate hypoglycemia including medications (e.g. insulin, sulfonylurea), ethanol use (inhibits gluconeogenesis), malnutrition (lack of substrate), critical illness (increased glucose utilization), renal failure (decreased clearance of insulin) and adrenal insufficiency (loss of cortisol causes increased insulin sensitivity) must be ruled out based on medical history. Subsequent work-up for hypoglycemia includes plasma glucose, insulin, c-peptide (marker for endogenous insulin production) and urine sulfonylurea screen. Based on findings additional studies including IGF-II levels, insulin antibodies and imaging can be considered.

Hypoglycemia in Nondiabetics

EtiologyMechanismHistoryGlcINSCPOther StudiesCT scan
InsulinomaInsulin producing tumor of pancreasFasting hypoglycemiaPancreatic mass
NesidioblastosisExcessive insulin production by pancreasPostprandial hypoglycemiaNo mass
Insulin overdoseIntentional or unintentional (hospital/pharmacy error)Hypoglycemia duration varies
Sulfonylurea overdoseIntentional or unintentional (hospital/pharmacy error)Prolonged hypoglycemiaPositive Urine Sulfonylurea
Non-islet cell tumorsInsulin like growth factor (IGF-II) secreted by tumors (e.g. liver or colon cancer)Weight loss, fatigue, hypoglycemiaPositive IGF-IISolid tumor
Insulin antibodyAntibodies bind to insulin receptor or insulinErratic blood sugars (highs and lows)Positive Insulin antibodies

CT, Computed tomography; Glc , glucose; INS , insulin; CP , C-Peptide; IGF, insulin-like growth factor.


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