Fasting Hypoglycemia

Aka: Fasting Hypoglycemia

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II. Causes: Underproduction of Glucose

  1. Hormone Deficiency
    1. Hypopituitarism
    2. Adrenal Insufficiency
    3. Catecholamine deficiency
    4. Glucagon deficiency
  2. Enzyme Defect
    1. Glucose 6 Phosphate Dehydrogenase deficiency (G6PD)
  3. Substrate deficiency
    1. Ketotic Hypoglycemia of infancy
    2. Severe Malnutrition or wasting
    3. Late pregnancy
  4. Acquired Liver disease
    1. Hepatic congestion
    2. Severe hepatitis
    3. Cirrhosis
    4. Uremia
    5. Hypothermia
  5. Drugs
    1. Alcohol
    2. Propranolol
    3. Salicylates

III. Causes: Overutilization of Glucose

  1. Hyperinsulinism
    1. Insulinoma
    2. Insulin Autoimmunity
    3. Medications
      1. Exogenous Insulin
      2. Sulfonylureas
      3. Quinine
      4. Disopyramide
      5. Pentamidine
    4. Endotoxic shock
  2. Appropriate Insulin Level
    1. Extrapancreatic tumor
    2. Systemic carnitine deficiency
    3. Deficiency in enzymes of fat oxidation
    4. Cachexia with fat depletion

IV. Symptoms and Signs

  1. See Hypoglycemia

V. Labs

  1. Plasma Insulin
    1. Plasma Insulin >7175 pmol/L
      1. Exogenous Insulin injection
    2. Plasma Insulin <1435 pmol/L
      1. Insulinoma
      2. Sulfonylurea
  2. Proinsulin
    1. Increased in Insulinoma
  3. C-Peptide
    1. Increased in Insulinoma and Sulfonylurea use
  4. Sulfonylurea assay

VI. Management

  1. See Hypoglycemia Management

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