Endocrine Society GUIDELINES Bundle

Hypoglycemia

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Key Points Î Whipple's triad consists of symptoms and/or signs consistent with hypoglycemia, a low plasma glucose concentration, and resolution of those symptoms or signs after the plasma glucose concentration is raised. Î Because glucose is an obligate metabolic fuel for the brain, maintenance of brain function requires a virtually continuous supply of glucose from the circulation. Î The Endocrine Society recommends evaluation and management of hypoglycemia only in patients in whom Whipple's triad—symptoms and/or signs consistent with hypoglycemia, a low plasma glucose concentration, and resolution of those symptoms or signs after the plasma glucose concentration is raised—is documented (1 | ⊕⊕⊕⊕). Persons Without Diabetes Mellitus Î The Endocrine Society recommends the following strategy in patients with hypoglycemia without diabetes mellitus (1 | ⊕⊕⊕): > Review the history, physical findings, and all available laboratory data seeking clues to specific disorders—drugs, critical illnesses, hormone deficiencies, nonislet cell tumors. > When the cause of the hypoglycemic disorder is not evidentie, in a seemingly well individualmeasure plasma glucose, insulin, insulin antibodies, C-peptide, proinsulin, and β-hydroxybutyrate concentrations and screen for oral hypoglycemic agents during an episode of spontaneous hypoglycemia and observe the plasma glucose response to IV injection of 1.0 mg glucagon. These steps will distinguish hypoglycemia caused by endogenous (or exogenous) insulin from that caused by other mechanisms. Diagnosis and Assessment

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