Hypoglycaemia

Last updated: Tuesday, 14, December, 2010
Key InformationAppropriate Tests
NeonatalHypoglycaemia may be asymptomatic in neonates.

Diabetic mother

Transient neonatal hypoglycaemia, especially

  • Low birth weight 
  • Haemolysis
See Haemolysis – neonatal.

Nesidioblastosis

Paediatric

Specimens must be collected during hypoglycaemia.

If necessary, this may be done with a supervised fast, as an inpatient.

During an attack: glucose with simultaneous insulin measurements; collect sufficient blood for other tests which may be indicated (refer to laboratory for correct storage conditions) - cortisol, growth hormone, C-peptide, lactate, hydroxybutyrate; organic acids – urine.

Treatment with IV glucose, if necessary, must not be delayed. 

Insulinoma

Glucocorticoid deficiency

Hypopituitarism

Hypothyroidism

Growth hormone deficiency

Glycogen storage disease, especially

  • type I, type III

Galactosaemia

Organic acidaemias

Ketotic hypoglycaemia

Reye syndrome

Insulin overdose

Carnitine deficiency

Hereditary fructose intolerance

Adult

Symptoms suggestive of hypoglycaemia after a meal are experienced by many normal people, and are not necessarily an indication for further investigation.

The severity of symptoms due to hypoglycaemia is determined by the rate of decrease in blood glucose and the degree of hypoglycaemia.

If hypoglycaemia is suspected, this must be confirmed by glucose measurement prior to further investigation.

Further investigation is indicated when there are symptoms of hypoglycaemia, confirmed by plasma glucose measurement, and relieved by administration of glucose (Whipple’s triad).

An inpatient supervised fast of up to 3 days duration may be required to precipitate hypoglycaemia in a controlled setting.

Alternatively, a C-peptide suppression test may be done.

During an attack: glucose with simultaneous insulin measurements; collect sufficient blood for other tests which may be indicated (refer to laboratory for correct storage conditions) - cortisol, growth hormone, C-peptide, lactate, hydroxybutyrate, oral hypoglycaemic agents.

Treatment with IV glucose, if necessary, must not be delayed.

Functional

Insulin overdose, including

  • Accidental
  • Surreptitious
Insulin, C-peptide, if appropriate.

Oral hypoglycaemic overdose

Measurement of drug or metabolite in urine or plasma if surreptitious ingestion is suspected.

Post-gastrectomy syndrome

Insulinoma

Glucocorticoid deficiency

Alcoholism

Hepatic failure

Drug-induced, especially

  • Propranolol

Hypopituitarism

IGF-II producing tumours, especially

  • Hepatocellular carcinoma
  • Retroperitoneal sarcoma