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June 2010


Hypoglycaemia in nondiabetic patients

An evidence

Volume 39, No.6, June 2010 Pages 399-404

Ching Luen Ng


Hypoglycaemia can have serious consequences for patients. Hypoglycaemia in nondiabetic patients is not a common condition, and is often a diagnostic challenge for general practitioners.


To search for evidence based guidelines on diagnosis and management of hypoglycaemia in nondiabetic adult patients and to see how these guidelines can be applied in general practice.


The Endocrine Society clinical practice guideline 2009 recommends evaluation and management of hypoglycaemia only in patients in whom Whipple’s triad is documented: symptoms and/or signs of hypoglycaemia; low plasma glucose; and resolution of symptoms and/or signs after plasma glucose returns to normal. The first step in evaluation is to pursue clinical clues to specific aetiologies, ie. drugs, critical illnesses, hormone deficiencies and nonislet cell tumours. In a seemingly well individual, the differential diagnosis of hypoglycaemic disorder narrows to drug induced hypoglycaemia; accidental, surreptitious, or malicious hypoglycaemia; endogenous hyperinsulinism; and idiopathic postprandial hypoglycaemia. When a spontaneous hypoglycaemic episode cannot be observed, patients should be referred for a prolonged fasting test or a mixed meal test.

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