Hypoglycemia Workup and Differential Diagnosis
Workup:
• Sulfonylurea Labs
• Anti-lnsulin Ab - Insulin Autoimmune Syndrome
• IGF-2 - Non-islet cell tumor with high tumor burden & metabolic demand causes hypoglycemia
• 72 hr fast to trigger hypoglycemic episode
- Measure glucose q6 hrs until BG < 60: Serum glucose, Insulin, C-peptide & Proinsulin, Beta-Hydroxybutyrate
- Continue until BG <45, symptomatic or 72+hrs
- 1mg IV Glucagon & measure glucose 10, 20 & 30 mins later - Normally, glucose stores in liver should be dried up. In insulinoma, BG can still rise by 25+
Differential Diagnosis:
• Insulinoma
• Sulfonylurea Misuse
• Insulin Misuse
• Insulin Autoimmune Syndrome
• Non-lslet Tumor
SCVMC Internal Medicine @SCVMCMed
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