Hypoglycaemia

Key Information

Appropriate Tests

Neonatal

Hypoglycaemia 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, L-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's 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 laboratory 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, L-Lactate, Hydroxybutyrate, Proinsulin, 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

 

References

See also Pathology Decision Support Tool: Hypoglycaemia (recurrent or severe) in a child