Interpretation of laboratory results during an episode of hypoglycemia (serum glucose < 3.0 mmol/L) (4)*
| Diagnosis | Insulin (pmol/L) | C-peptide (nmol/L) | β-OH butyrate (mmol/L) | Insulin antibody | Circulating oral antihyperglycemic |
|---|---|---|---|---|---|
| Normal | < 20.8 | < 0.2 | > 2.7 | Negative | No |
| Exogenous insulin | >> 20.8 | < 0.2 | < 2.7 | Positive or negative | No |
| Insulinoma, NIPHS, PGBH | ≥ 20.8 | ≥ 0.2 | < 2.7 | Negative | No |
| Sulfonylurea overdose | >> 20.8 | ≥ 0.2 | < 2.7 | Negative | Yes |
| Insulin autoimmune | >> 20.8 | >> 0.2 | < 2.7 | Positive | No |
| IGF mediated | < 20.8 | < 0.2 | < 2.7 | Negative | No |
| Non-insulin mediated | < 20.8 | < 0.2 | > 2.7 | Negative | No |
NIPHS = non-insulinoma pancreatogenous hypoglycemia syndrome, PGBH = postgastric bypass hypoglycemia.
↵* Reprinted from European Journal of Medicine, Vol. 25(5), Pieter Martens, Jos Tits, Approach to the patient with spontaneous hypoglycemia, p. 415–421, Copyright (2014), with permission from Elsevier.