Thank you Dr. Jarod DuVall on a very interesting case in a non-diabetic patient presenting with hypoglycemia
Learning Points:
- True hypoglycemia in a patient without underlying diabetes must fulfill the Whipple’s triad:
- Presence of symptoms suggestive of hypoglycemia (e.g. diaphoresis, palpitations, tremors)
- Document that glucose is low when the symptoms are present
- Demonstrate that symptoms are relieved by correction of the hypoglycemia by administration of glucose or glucagon
- In a patient with asymptomatic hypoglycemia, worry about hypoglycemic unawareness from shifted glycemic thresholds secondary to repeated episodes of hypoglycemia
- Ddx: Meds (Insulin, sulfonyureas); ETOH abuse in setting of depleted glycogen stores; critical illness; malnourishmend; cortisol deficiency; nonislet cell tumor; endogenous hyperinsulinism (e.g. insulinoma); insulin autoimune hypoglycemia (will often present as post-prandial hypoglycemia)
- Consider chronic opiate use as a cause for secondary adrenal insufficiency resulting in cortisol deficiency and ultimately hypoglycemia.
- Here is a case-report on a patient presenting with AMS and seizures from hypoglycemia secondary to an insulinoma