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1. The diagnosis of hypoglycemia is not based on an absolute blood glucose level; it requires fulfillment of the Whipple triad: signs & symptoms of hypoglycemia, BGL < 55 g/dL, releif of symptoms with glucose supplementation.

2. Symptoms are autonomic (palpitations, tremor, sweating, paresthesias) and neuroglycopenic due to CNS glucose deprivation (confusion, impaired consciousness, seizures). Autonomic symptoms happen first.

3. Reactive (postprandial) hypoglycemia develops in response to a nutrient challenge. In some post-GI surgical patients, when gastric contents get dumped into the small intestine too quickly with a brisk release of incretins.

4. Non-reactive/fasting hypoglycemia can be further subdivided into iatrogenic (more common) and fasting/factitious.

5. Fasting/factitious type: patient is unable to maintain glucose levels with fasting. Causes: alcohol abuse, drugs (oral hypoglycemics, pentamidine), sepsis, and renal failure.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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