Last update:
31-Mar-2011

The issue of hypoglycemia is a common problem in everyday clinical practice and many individuals visit primary health care services with the self-diagnosis of hypoglycemia in need of medical assistance. In most cases this diagnosis is presumptuous and probably mistaken. The clinician initially needs to confirm the diagnosis of true hypoglycemia, based on Whipple's classic triad, after which the differential diagnosis of the hypoglycemic syndrome can be made. The aim of this brief review is to help the clinician overcome the diagnostic difficulties using a proposed algorithm. Various conditions and diseases, and use of drugs related to hypoglycemia must be ruled out. The distinction between the two main types of hypoglycemia, fasting and postprandial, is the key point for further evaluation. After this distinction has been made, the ensuing diagnostic steps to reveal the various causes of each type of hypoglycemia and the underlying pathophysiological mechanisms are described in detail. Special mention is made of pseudohypoglycemia, a condition often presenting no clinical symptoms, although sometimes a subtype of this condition can present with intense hypoglycemia-mimicking symptoms of psychogenic origin. Finally the general principles of individualized therapeutic intervention are discussed.

Key words: Fasting, Hypoglycemia, Postprandial, Pseudohypoglycemia, True.