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.