Non-Diabetic Hypoglycemia

Excerpt

Hypoglycemia is defined as a clinical condition when the venous blood glucose level is <55mg/dl (<3mmol/L), obtained if possible, at the time of the symptoms. Hypoglycemia can be clinically classified according to its timing; it can be fasting, postprandial, or exercise-related. A workup for hypoglycemia should be initiated if the patient fulfills Whipple’s triad; biochemical evidence of hypoglycemia, clinical signs and symptoms consistent with hypoglycemia, and resolution of these features by correcting blood glucose levels. Testing should be performed at the time of spontaneous development of symptoms, with documented low blood glucose levels, if feasible.

Hypoglycemia is frequently observed in patients with diabetes mellitus but is uncommon in patients without diabetes. Hypoglycemia in patients without diabetes may be due to a variety of causes. Therefore, it is important to take a thorough clinical history and examination. Appropriate diagnostic tests should be undertaken to elucidate the cause of hypoglycemia. Treatment is dependent on the cause of hypoglycemia. Hypoglycemia in children will also be briefly reviewed. In children, hypoglycemia is mostly due to inborn errors of metabolism (IEM) and is associated with multisystem involvement.