diagnosis and investigation

Last reviewed 11/2023

• documentation of hypoglycaemia during attack e.g. finger-prick on filter-paper at home for analysis later. In secondary care a laboratory glucose can be undertaken
• exclude known causes e.g. malaria, liver failure
• further investigation of hypoglycaemia is under specialist review and within a secondary care setting e.g. a 72 hour fast and blood glucose, insulin and C-peptide
  • if hypoglycaemia occurs with normal or high insulin and no elevation of ketones then consider:
    • insulinoma, administration of insulin (no C-peptide detectable), insulin autoantibodies, administration of insulin 'sensitiser' e.g. metformin, glitazone
  • if hypoglycaemia occurs and insulin is low or undetectable and there is no elevation of ketones then consider:
    • a non-pancreatic neoplasma e.g. fibroma, hepatoma; anti-insulin receptor antibodies
  • if hypoglycaemia occurs and insulin is low and there is an elevation of ketones then consider:
    • Addison's disease, hypopituitarism, alcohol