Non-Diabetes Related Hypoglycaemia

Question 1

What are the criteria for non-diabetes related hypoglycaemia?

Answer 1

• Plasma glucose <2.8mmol/L (some protocols sat 2.2mmol/L)

Question 2

What are the autonomic symptoms of hypoglycaemia?

Answer 2

• Sweating
• Palpitations
• Pallor
• Tremor
• Nausea
• Irratibility
• Hunger

Question 3

What are the neuroglycopenic symptoms of hypoglycaemia?

Answer 3

• Inability to concentrate
• Confusion
• Drowsiness
• Personality change
• Slurred speech
• Incoordination
• Weakness
• Dizziness
• Vision impairment
• Headache
• Seizures
• Coma

Question 4

What is Whipple’s triad of hypoglycaemia?

Answer 4

• Symptoms consistent with hypoglycaemia
• Low plasma glucose concentration
• Relief of those symptoms after the plasma glucose level is raised

Question 5

How is non-diabetes related hypoglycaemia investigated?

Answer 5

• Accertain whether Whipple’s triad exists
• Post-prandial investigaitons
• 72hr fast (provoke homeostatic response to keep glucose level up - glucagon/adrenaline > GH/cortisol are most important)
• Glucose
• Insulin
• C peptide
• SU screen
• (Beta hydroxybutyrate) low in Insulinoma
• (Pro Insulin) low with exogenous Insulin
• Insulin antibodies
• Localising studies (radiology, arterial calcium stimulation)

Question 6

What is the differential diagnosis of non-diabetes related hypoglycaemia?

Answer 6

• Pancreatic (i.e. insulinoma)
• Non-islet cell tumour (i.e. IGF-II secreting tumours, lymphoma, myeloma, leukaemias)
• Autoimmune hypoglycaemia (i.e. autoimmune insulin syndrome)
• Reactive hypoglycaemia (i.e. gastric surgery)
• Drug induced (i.e. DM drugs, heparin, heloperidol)
• Dietary toxins (i.e. alcohol)
• Organ failure (i.e. severe liver failure)
• Endocrine disease (i.e. hypopituitarism)
• Inborn errors of metabolism
• Miscellaneous (i.e. sepsis, starvation)