Choice of supervised test for the evaluation of hypoglycemia in adults without diabetes mellitus

* The likelihood of an underlying hypoglycemic disorder is based on the glucose level and presence of concurrent hypoglycemic symptoms. Supervised tests are intended to provoke hypoglycemia and enable etiologic evaluation for insulin- or insulin-like growth factor-mediated causes. This evaluation also may be performed during an observed episode of unprovoked hypoglycemia and should include the same laboratory measurements as those collected during a supervised fast. Refer to other UpToDate content on selection of patients for supervised testing.

¶ The supervised fast may be performed in the inpatient or outpatient setting. The outpatient setting may be preferred for patients in whom hypoglycemia occurs frequently or relatively soon after food withdrawal (eg, within 8 to 12 hours) or if the inpatient setting poses significant logistical challenges.