Abstract
Hypoglycemia in the absence of diabetes mellitus in a healthy individual needs’ evaluation. We report a case of 45 years old female who presented with restlessness, anxiety, palpitations, excessive sweating followed by dizziness, and tremors in her hand. Eating sugar or consuming glucose water alleviated symptoms. During one such episode, the patient was taken to a nearby clinic and her capillary blood glucose was 43 mg/dl. The patient was admitted for the 72 hours supervised fast after ruling out other systemic causes of hypoglycemia. Evaluation of critical sample showed elevated levels of insulin, c-peptide, proinsulin, as well as a decreased value of beta-hydroxybutyrate and a negative urine screen for oral anti-diabetic agents, a diagnosis of endogenous hyperinsulinism, was made.
Highlights
INTRODUCTIONHypoglycemia (glucose < 55 mg/dl) is rare in otherwise healthy adults, as well as in people who are not being treated for diabetes
Hypoglycemia is rare in otherwise healthy adults, as well as in people who are not being treated for diabetes
We report a case of hypoglycemia due to endogenous hyperinsulinism in a patient with no other systemic illness or medications as a known cause of hypoglycemia
Summary
Hypoglycemia (glucose < 55 mg/dl) is rare in otherwise healthy adults, as well as in people who are not being treated for diabetes. Before beginning a hypoglycemia assessment, the Whipple's triad, which includes low plasma glucose concentration, clinical signs or symptoms associated with hypoglycemia, and resolution of signs and symptoms as plasma glucose concentration rises, should be recorded [1][3]. When signs appear, testing should be performed as soon as possible, aided by blood tests at the time of hypoglycemia to determine the etiology in cases where there is no illness or medication as a cause. A prolonged supervised fast test or mixed meal test can be performed to determine etiology. Hypoglycemia treatment should be specific to the underlying cause and may include nutritional, medical, and/or surgical interventions. We report a case of hypoglycemia due to endogenous hyperinsulinism in a patient with no other systemic illness or medications as a known cause of hypoglycemia
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