HYPOGLYCEMIA IN NON-DIABETIC PATIENTS

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HYPOGLYCEMIA IN NON-DIABETIC PATIENTS

Journal Title: Kocatepe Medical Journal - Year 2023, Vol 24, Issue 4

Abstract

Glucose is the main substance used by the brain, and as such, multiple regulatory mechanisms exist to maintain glucose concentrations. The main regulatory mechanisms are cessation of insulin secretion the stimulation of glucagon, cortisol and growth hormone secretion. When these regulatory mechanisms fail or are defective, hypoglycemia occurs. Hypoglycemia is a rare syndrome but can cause significant morbidity, excluding patients on diabetes treatment. Spontaneous hypoglycemia has difficulties in diagnosis and treatment. Therefore, a complete evaluation of the patient's clinical, laboratory and imaging studies is required. The symptoms of hypoglycemia are nonspecific and therefore it is important to confirm hypoglycemia by identifying the presence of the Whipple triad before starting an evaluation for hypoglycemia. The Whipple triad consists of symptoms consistent with hypoglycemia, a plasma glucose level of less than 55 mg/dl, and a resolution of symptoms after raising the plasma glucose level. Evaluation of hypoglycemia should be made as soon as symptoms occur spontaneously. If this is not possible, hypoglycemia is tried to be revealed with a 72-hour prolonged fasting test. If post-prandial hypoglycemiais suspected, the mixed-meal test can also be applied. Causes of endogenous hyperinsulinemic hypoglycemia include insulinoma, post-bariatric hypoglycemia, and non-insulinoma pancreatic hypoglycemia syndrome. Diagnostic imaging studies should also be performed in patients with endogenous hyperinsulinemia. Autoimmune hypoglycemia syndrome is clinically andbiochemically similar to insulinoma, but is associated with high levels of insulin antibodies and plasma insulin. Other important causes of hypoglycemia include; drugs, non-islet cell tumors,hormonal deficiencies, critical illness, and factorial hypoglycemia. In order to prevent hypoglycemia attacks, diagnostic studies should be performed to determine the etiology. Findingthe underlying cause of hypoglycemia also shows us the mechanism and enables the selection of the appropriate treatment. In this review, we provide an overview of the pathogenesis and management of hypoglycemia in non-diabetic patients.

Authors and Affiliations

Nuriye Hale ERBATUR Şerife KUŞKONMAZ

Keywords

Hypoglycemia Hyperinsulinism Insulinoma

EP ID EP722693
DOI https://doi.org/10.18229/kocatepetip.953519
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