Elghobashy Maiar, Gama Rousseau, Sulaiman Raashda Ainuddin
Clinical Chemistry, Black Country Pathology Services, Royal Wolverhampton Trust, Wolverhampton WV10 0QP, UK.
School of Medicine and Clinical Practice, Wolverhampton University, Wolverhampton WV1 1LY, UK.
Diagnostics (Basel). 2023 Oct 22;13(20):3275. doi: 10.3390/diagnostics13203275.
Although adult spontaneous (non-diabetic) hypoglycaemia is rare, its recognition is important for the preventative or curative treatment of the underlying cause. Establishing Whipple's triad-low blood glucose, neuroglycopaenia and resolution of neuroglycopaenia on increasing blood glucose levels to normal or above-is essential to verify hypoglycaemia. Awareness that hypoglycaemia may occur in severely ill patients is important for its prevention. Further investigation in such cases is unnecessary unless another cause of hypoglycaemia is suspected. Patients are often asymptomatic and normoglycaemic at review. Their history of medication, self-medication, access to hypoglycaemic drugs, alcohol use and comorbidity may provide aetiological clues. The investigation involves obtaining blood samples during symptoms for laboratory glucose measurement or provoking fasting or postprandial hypoglycaemia as directed by symptoms. If confirmed, insulin, c-peptide, proinsulin and beta-hydroxybutyrate are analysed in hypoglycaemic samples. These will classify hypoglycaemia due to non-ketotic hyperinsulinaemia, non-ketotic hypoinsulinaemia and ketotic hypoinsulinaemia, and direct investigations to identify the underlying cause. There are, however, many pitfalls that may mislabel healthy individuals as "hypoglycaemic" or misdiagnose treatable or preventable causes of spontaneous hypoglycaemia. Clinical acumen and appropriate investigations will mostly identify hypoglycaemia and its cause.
尽管成人自发性（非糖尿病性）低血糖很少见，但识别它对于潜在病因的预防性或治愈性治疗很重要。确立惠普尔三联征——低血糖、神经低血糖症以及血糖水平升至正常或以上时神经低血糖症的缓解——对于确诊低血糖至关重要。认识到低血糖可能发生在重症患者中对于预防低血糖很重要。除非怀疑存在其他低血糖病因，否则在此类病例中无需进一步检查。患者在复查时通常无症状且血糖正常。他们的用药史、自我用药情况、获取降糖药物的途径、饮酒情况和合并症可能提供病因线索。检查包括在出现症状时采集血样进行实验室血糖测量，或根据症状诱发空腹或餐后低血糖。如果确诊，对低血糖样本分析胰岛素、C肽、胰岛素原和β-羟丁酸。这些将对非酮症性高胰岛素血症、非酮症性低胰岛素血症和酮症性低胰岛素血症所致的低血糖进行分类，并指导调查以确定潜在病因。然而，存在许多陷阱，可能会将健康个体误标记为“低血糖症患者”，或误诊自发性低血糖的可治疗或可预防病因。临床敏锐度和适当的检查大多能识别低血糖及其病因。
