Hypoglycaemia

Question 1

What are the causes of hypoglycaemia in a diabetic?

Answer 1

1. Insulin or sulphonylurea

2. Increased activity, missed meal, overdose.

Question 2

What are the causes of hypoglycaemia in a non-diabetic?

Answer 2

1. Exogenous drugs (insulin, sulphonylurea), alcohol binge with no food.
2. Pituitary insufficiency
3. Liver failure
4. Addison’s
5. Islet cell tumours (insulinoma) and immune hypoglycaemia (anti-insulin receptor antibodies in Hodgkin’s disease)
6. Non-pancreatic neoplasms

Question 3

What could the cause of hypoglycaemic hyperinsulinaemia be?

Answer 3

Insulinoma, sulphonylureas, insulin injection (no detectable c-peptide)

Question 4

What could the cause be of low/undetectable insulin and no ketones in hypoglycaemia?

Answer 4

Anti-insulin receptor antibodies

Question 5

What could the cause be of low insulin and high ketones in hypoglycaemia?

Answer 5

Alcohol, pituitary insufficiency, Addison’s

Question 6

What is insulinoma and how is it diagnosed?

Answer 6

1. Hypoglycaemia and increased plasma insulin during a long fast.
2. Give IV insulin and measure c-peptide, normally exogenous insulin suppresses c-peptide, this does not occur in insulinoma.