Hypoglycemia is common in daily clinical practice and often occurs during the treatment of
diabetes mellitus. However, a small minority of
hypoglycemia encountered in clinical practice is spontaneous and thus not induced by glycemic lowering agents. These spontaneous
hypoglycemic events confront the clinician with a diagnostic enigma. Although the trained clinician can recognize the autonomic and neuroglycopenic symptoms of
hypoglycemia even in a patient not on
insulin, it remains challenging to decipher the etiology of a spontaneous
hypoglycemic event. A logical and stepwise approach to the spontaneous
hypoglycemic event allows for a conclusive diagnosis. This diagnostic process consists of adequately diagnosing
hypoglycemia by fulfilling Whipple's triad, stratifying patients according to their clinical status and analyzing a full
hypoglycemic blood panel. A complete
hypoglycemic blood panel should include the analysis of
glucose,
insulin,
C-peptide, pro-
insulin,
insulin antibodies and the presence of oral
hypoglycemic agents. For patients with episodes of
hypoglycemia induced by excessive endogenous
insulin, additional imaging is often required to detect the presence of an underlying
insulinoma. By diagnosing the underlying cause of the spontaneous
hypoglycemia, the physician also diagnosis the mechanism by which the
hypoglycemic event occurs. Allowing for a problem orientated therapeutic approach.
METHODOLOGY: