November 24, 2019


Presented by Dr Yasser aldabagh

Notes by dr.Majed Fakeeh



  • In diabetic the cut off is 70
  • In non diabetic its 55


Approach for Hypoglycemia:

First thing ask if the patient develop symptoms or not

First thing to correct by simple sugar eg. chocolate

15 gram of any simple sugar

Then wait 15 minutes and check

Repeat for 2 times

Then if not corrected by IV Dextorse


In ER must know if the patient is diabetic or not diabetic

Ask family History of DM

Does the patient look ill or looking well


Ill Well
  • kidney disease ( decrease excretion of insulin)
  • liver failure
  • adrenal failure
  • sepsis
  • mi
  • malnutrition
  • insulinoma, reactive hypoglycemia
  • Medication ( sulfonylurea )
  • Factitious hypoglycemia
  • Patient injecting himself with insulin


Whipple triad:

1- symptomatic hypoglycemia

2- blood sugar level less 55

3- responding to any measurement


Investigations to do: 

  • Fasting 72 hours and send for labs if less than 55:
    • Insulin
    • pro-insulin
    • c- peptide and
    • IGH- 1
    • Antibodies
    • serum glucose and blood glucose
    • Medication screening sulfonylurea
    • blood ketones beta hydroxybutyrate
  • Other tests: TSH , Growth hormone , Synactin test


How to monitor blood sugar during 72h 

72 hours test (only water and some normal saline allowed)

Check every to 2 hours

If dropping below 100 , then check every hour

If below 70 q15 to 30

If below 55 glucagon or d50


How to interpret investigations reading? 


Dx Serum insulin C-Peptide Pro-insulin Serum 


Insulin antibodies Medications 
insulinoma high high high low -ve -ve
Medications high high high low -ve +ve
Use of insulin high low low low -ve -ve
Insulin- AID  high high high low +ve -ve
IGH-1 low low low low -ve -ve