In those with a history of diabetes treated with insulin, glinides, or sulfonylurea, who demonstrate Whipple's triad, it is reasonable to assume the cause of hypoglycemia is due to insulin, glinides, or sulfonylurea use. In those without a history of diabetes with hypoglycemia, further diagnostic testing is necessary to identify the cause. Testing, during an episode of hypoglycemia, should include the following: Plasma glucose level, not point-of-care measurement Insulin level C-peptide level Proinsulin level Beta-hydroxybutyrate level Oral hypoglycemic agent screen Response of blood glucose level to glucagon Insulin antibodies If necessary, a diagnostic hypoglycemic episode can be produced in an inpatient or outpatient setting. This is called a diagnostic fast, in which a patient undergoes an observed fast to cause a hypoglycemic episode, allowing for appropriate blood work to be drawn. In some, the hypoglycemic episode may be reproduced simply after a mixed meal, whereas in others a fast may last up to 72 hours.
In those with a history of diabetes treated with insulin glinides or sulfonylurea who demonstrate Whipple's triad it is reasonable to assume the cause of hypoglycemia is due to insulin glinides or sulfonylurea use In those without a history of diabetes with hypoglycemia further diagnostic testing is necessary to identify the cause Testing during an episode of hypoglycemia should include the following Plasma glucose level not point-of-care measurement Insulin level C-peptide level Proinsulin level Beta-hydroxybutyrate level Oral hypoglycemic agent screen Response of blood glucose level to glucagon Insulin antibodies If necessary a diagnostic hypoglycemic episode can be produced in an inpatient or outpatient setting This is called a diagnostic fast in which a patient undergoes an observed fast to cause a hypoglycemic episode allowing for appropriate blood work to be drawn In some the hypoglycemic episode may be reproduced simply after a mixed meal whereas in others a fast may last up to 72 hours