Best Practice No 173: Clinical and laboratory investigation of adult spontaneous hypoglycaemia

Non-islet cell tumour-induced hypoglycaemia: a review of the literature including two new cases

“…In NICTH, the onset of symptoms is frequently gradual with lethargy, sweating, diminished motor activity and somnolence before a progressive drift into a coma. Recovery may occur spontaneously but is accelerated by the intake of carbohydrates or the administration of parenteral glucose or glucagon , Gama et al 2003. Several studies on NICTH indicate that a major part of the glucose intake is rapidly disposed into peripheral tissues, especially skeletal muscle, rather than consumed by the tumour.…”

“…www.endocrinology-journals.org (Daughaday et al 1988, Zapf 1993, Gama et al 2003. In NICTH, the onset of symptoms is frequently gradual with lethargy, sweating, diminished motor activity and somnolence before a progressive drift into a coma.…”

Insulin & C-peptide levels in sulfonylurea-induced hypoglycemia: A systematic review

“…Older polyclonal insulin assays cross-react with proinsulin and insulin precursors, yielding insulin levels higher than the newer monoclonal assays [4,9,14]. However, there is still a large amount of variability in the sensitivity and cross-reactivity of monoclonal assays, and universally accepted levels for the Comments: Levels were drawn during a 100 g oral glucose tolerance test after an overnight fast.…”

“…We included articles if hypoglycemia was due to sulfonylureas (confirmed by history or laboratory analysis) and if insulin and C-peptide levels were obtained at the time of documented hypoglycemia (blood glucose of Ͻ60 mg/dL (3.3 mmol/L) via bedside glucometer or venous sampling). We excluded articles if cases involved another hypoglycemic agent in addition to a sulfonylurea, as well as patients with hepatic or renal failure because insulin is mainly cleared by the liver and C-peptide by the kidney [9,13,14]. The primary author reviewed, in full, the articles that were unable to be included or excluded based on title or abstract.…”

“…Many medical texts and published algorithms tell us sulfonylurea-induced hypoglycemia yields insulin and C-peptide levels that are "high" or "elevated," but the texts and published algorithms fail to provide details; such as the magnitude of the effect and the effect of hypoglycemic treatment on expected values [3,[7][8][9] Other authors provide suggested cut-off values for insulin and C-peptide without reference to values actually observed [4][5][6]10,11]. The primary purpose of this study was to describe the range of observed values for these variables in sulfonylureainduced hypoglycemia and determine whether these variables differed if levels were obtained before or after hypoglycemic therapy was administered.…”