Symptoms of hypoglycemia, spontaneous hypoglycemia
1. Big picture
Hypoglycemia is an acute energy crisis of the brain. The brain depends mainly on glucose, so falling plasma glucose first activates the sympathetic nervous system, then causes neuroglycopenia: confusion, abnormal behavior, seizures, coma.
For the exam, separate two situations:
| Situation | Most likely cause |
|---|---|
| Diabetic patient | Insulin, sulfonylureas, missed meal, exercise, alcohol, renal failure |
| Non-diabetic patient with spontaneous hypoglycemia | Insulinoma, adrenal insufficiency, liver/renal failure, sepsis, alcohol, drugs, post-bariatric/reactive hypoglycemia, non-islet cell tumor |
The key diagnostic rule is Whipple’s triad: symptoms of hypoglycemia + documented low plasma glucose + relief after glucose correction. The Endocrine Society recommends evaluating non-diabetic hypoglycemia only when Whipple’s triad is present, to avoid overdiagnosis from incidental low readings. ([OUP Academic][1])
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