Evaluation of postprandial hypoglycemia symptoms in adults without diabetes

* For a mixed meal test, the patient consumes a meal of solid composition that usually leads to symptoms and is monitored for the occurrence of symptoms. Venipunctures samples are collected prior to ingestion of the meal and at the time symptoms occur:

• Glucose
• Insulin
• Sulfonylureas and meglitinides (measure only in the symptomatic sample)

After the symptomatic sample is obtained, administer carbohydrates, assess for correction of symptoms, and obtain venipuncture glucose to document normalization.

¶ Causes of noninsulin-mediated hypoglycemia include alcohol, toxins, medications (other than antihyperglycemic agents), and cortisol deficiency.

Δ Causes of insulin-mediated hypoglycemia include factitious hypoglycemia (surreptitious use of insulin, sulfonylurea, or meglitinides), postbariatric surgery hypoglycemia, insulinoma, noninsulinoma pancreatogenous hypoglycemia, and insulin antibodies.