Hypoglycemia - When to Refer
Key points
- The diagnosis and treatment of hypoglycemia that is due to drugs, critical organ failure, or endocrine deficiency is usually straightforward.
- Cryer PE: Glucose counterregulation: prevention and correction of hypoglycemia in humans, Am J Physiol 264:E149-155, 1993.
- Referral of patients to an endocrinologist is warranted if they have documented fasting hypoglycemia and the diagnosis is not clear after a diagnostic fast with measurement of plasma insulin and C-peptide.
- Patients with endogenous hyperinsulinism should be referred to a surgeon with experience in treatment of these disorders.
The diagnosis and treatment of hypoglycemia that is due to drugs, critical organ failure, or endocrine deficiency is usually straightforward. Referral of patients to an endocrinologist is warranted if they have documented fasting hypoglycemia and the diagnosis is not clear after a diagnostic fast with measurement of plasma insulin and C-peptide. Patients with endogenous hyperinsulinism should be referred to a surgeon with experience in treatment of these disorders.
Bibliography
Cryer PE: Glucose counterregulation: prevention and correction of hypoglycemia in humans, Am J Physiol 264:E149-155, 1993.
Daughaday WH: The pathophysiology of IGF-II hypersecretion in non-islet cell tumor hypoglycemia, Diabetes Metab Rev 3:62, 1995.
Doherty GM et al: Results of a prospective strategy to diagnose, localize, and resect insulinomas, Surgery 110:989-997, 1991.
Grunberger G et al: Factitious hypoglycemia due to surreptitious administration of insulin: diagnosis, treatment and long-term follow-up, Ann Intern Med 108:252-257, 1988.
Heerden JA et al: Occult functioning insulinomas: which localizing studies are indicated? Surgery 112: 1010-1015, 1992.
Heller SR, Cryer PE: Reduced neuroendocrine and symptomatic responses to subsequent hypoglycemia after one episode of hypoglycemia in nondiabetic humans, Diabetes 40:223-226, 1991.
Kao PC et al. Proinsulin by immunochemiluminometric assay for the diagnosis of insulinoma, J Clin Endocrinol Metab 78:1048-1051, 1994.
Mitrakou A et al. Reversibility of unawareness of hypoglycemia in patients with insulinomas, N Engl J Med 329:834-839, 1993.
Written and revised by
Gerald Hurowitz, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
health.am provides general information, not medical advice. Always consult a qualified health professional about your own health.
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