Hypoglycemia

- In a patient with diabetes, hypoglycemia is defined as bs < 4

- In a patient without diabetes, the diagnosis should be based on Whipple's triad:
1) Symptoms consistent with hypoglycemia
2) A low plasma glucose when symptoms are present (often bs < 2.5 used)
3) Improvement of symptoms when glucose normalizes

- Does the patient look sick? Secondary causes of hypoglycemia include sepsis, adrenal insufficiency, liver or kidney failure

- No obvious cause? Specialized investigations to determine exogenous versus endogenous insulin production should only be tested when hypoglycemia is present

- C-peptide is a byproduct created when insulin is made in the body, so levels will only be elevated with endogenous insulin production. Don't forget that medications like sulfonylureas will cause an elevated C-peptide because they stimulate endogenous insulin production