Hypoglycemia is probably the most common endocrine emergency seen by primary care physicians. It frequently occurs in patients receiving insulin treatment with tight control and in older patients receiving a sulfonylura. Another common group are patients who have nonspecific symptoms of fatigue, an inability to concentrate, anxiety, and dizziness who are either self-diagnosed as having hypoglycemia by referring to press and lay journals or who have misinterpretation of findings on an oral glucose tolerance test. These patients who are referred to endocrinologists for the evaluation of hypoglycemia often have seen several physicians and have undergone multiple inconclusive laboratory tests. They are often disturbed and frustrated. The most important aspect of their management is a thorough medical history and physical examination by a knowledgeable and understanding physician. In patients who require definitive studies, a meal tolerance test, basal serum proinsulin, and a prolonged fast with frequent determination of glucose, insulin, and C-peptide are generally adequate to clarify the diagnosis.<sup>7 Kitabchi A.E., Goodman R.C. Hypoglycemia pathophysiology and diagnosis Hosp Pract 1987 ;  26 : 45-60

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Clinical hypoglycemia is identified by modified Whipple's criteria consisting of (1) central nervous system symptoms, including confusion, aberrant behavior, or coma; (2) a simultaneous blood glucose level equal to or less than 40 mg/dL; and (3) relief of these symptoms by the administration of glucose. The presence of these criteria for the diagnosis of hypoglycemia has a high specificity (few false-positive findings), but its sensitivity (rate of true-positive findings) has not been evaluated rigorously. Although the most specific criterion for the presence of hypoglycemia is a blood glucose level of 40 mg/dL or less, a blood glucose level less than 50 mg/dL should arouse clinical suspicion.<sup>1 Comi R.J. Approach to acute hypoglycemia Endocrinol Metab Clin North Am 1993 ;  22 : 247-262

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