The diagnosis of a hypoglycemic disorder requires a high level of suspicion, careful assessment of the patient for the presence of mediating drugs or a predisposing illness, and, where indicated, methodical evaluation on the basis of well-defined diagnostic criteria.
The diagnostic burden is heaviest for healthy-appearing persons with episodes of confirmed neuroglycopenia. Our criteria for insulin mediation of hypoglycemia are: plasma insulin ≥18 pmol (ICMA immunochemiluminometric assay.), C-peptide ≥200pmol/L (ICMA), proinsulin ≥5pmol/L (ICMA), ≥OH butyrate, ≤2.7mmol/L and generous (1.4mmol/L) response of plasma glucose to IV glucagon administered when the patient is hypoglycemic. Sulfonylureas, meglitinides and insulin antibodies should be sought in the plasma of any hypoglycemic patient.Le texte complet de cet article est disponible en PDF.
Key words : Hypoglycemia, hyperinsulinemia, insulinemia, NIPHS, factitious