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
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
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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