Diagnostic Approach to a Pt with Suspected Hypoglycemia Based on a History of Symptoms, a Low Plasma Glucose Concentration, or Both

Diagnostic Approach to a Pt with Suspected Hypoglycemia Based on a History of Symptoms, a Low Plasma Glucose Concentration, or Both - Flowchart

«Flowchart»

Suspected/Documented Hypoglycemia

End

Treated with

Insulin
Sulfonylurea
Other secretagogue

Treated with

Insulin
Sulfonylurea
Other secretagogue

Treated with

Insulin
Sulfonylurea
Other secretagogue

Adjust regimen

Document improvement and monitor

Provide adequate glucose; treat underlying cause

Clinical clues

Drugs
Organ failure
Sepsis
Hormone deficiencies
Non–ß cell tumor
Previous gastric surgery

Clinical clues

Drugs
Organ failure
Sepsis
Hormone deficiencies
Non–ß cell tumor
Previous gastric surgery

Drugs
Organ failure
Sepsis
Hormone deficiencies
Non–ß cell tumor
Previous gastric surgery Clinical clues

Apparently healthy

Fasting glucose

<55 mg/dL

55 mg/dL

>=55 mg/dL

Exogenous insulin

!!UpArrow!! Insulin, Whipple’s triad

!!UpArrow!! C-peptide

Increased C-peptide

!!DnArrow!! C-peptide

Decreased C-peptide

Diabetes

No diabetes

Sulfonylurea

Autoimmune

Insulinoma

Ab+

SU+

Likely factitious

Extended fast

Glucose

<55 mg/dL

55 mg/dL

>=55 mg/dL

Reactive hypoglycemia

Hypoglycemia excluded

Mixed meal

Whipple’s triad

No Whipple’s triad

History

Strong

Weak