Differential Diagnosis

Reactive hypoglycemia is usually observed in diabetics but also is found in nondiabetics following ingestion of a high-carbohydrate meal.

Pts w/ hypoglycemia caused by an insulin-producing tumor may have signs & symptoms associated w/ malignancy.

For surreptitious insulin injection, seek a history of insulin use or access to insulin.

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For excess administration of sulfonylurea drugs, seek a history of use of or access to these drugs.

For impaired liver function, seek clinical evidence of impaired liver function.

Suggested Additional Lab Testing

Blood glucose level <50 mg/dL, coincident w/ symptoms that are reversible within 15 to 45 min of the administration of glucose in the absence of cerebral edema

C-peptide level. Pts have high levels of insulin synthesis & secretion of this portion of the pro-insulin molecule should be detectable in the blood at high levels

Elevated blood insulin Surreptitious insulin administration: insulin is elevated but C-peptide level is not because the insulin in the blood was not synthesized from proinsulin in the pt’s pancreas.