Hypoglycemia: Interpretation of laboratory tests*

Symptoms, signs, or both	Glucose (mg/dL)/(mmol/L)	Insulin (microU/mL)/(pmol/L)	C-peptide (nmol/L)/(ng/mL)	Proinsulin (pmol/L)	Beta-hydroxybutyrate (mmol/L)	Glucose increase after glucagon (mg/dL)/(mmol/L)	Circulating oral hypoglycemic agent	Antibody to insulin	Diagnostic interpretation
No	<55/3	<3/20.8	<0.2/0.6	<5	>2.7	<25/1.4	No	No	Normal
Yes	<55	>>3	<0.2	<5	≤2.7	>25	No	Neg (Pos)	Exogenous insulin
Yes	<55	≥3	≥0.2	≥5	≤2.7	>25	No	Neg	Insulinoma, NIPHS, PGBH
Yes	<55	≥3	≥0.2	≥5	≤2.7	>25	Yes	Neg	Oral hypoglycemic agent
Yes	<55	>>3	>>0.2^¶	>>5^¶	≤2.7	>25	No	Pos	Insulin autoimmune
Yes	<55	<3	<0.2	<5	≤2.7	>25	No	Neg	IGF^Δ
Yes	<55	<3	<0.2	<5	>2.7	<25	No	Neg	Not insulin (or IGF)-mediated

Neg: negative; Pos: positive; NIPHS: noninsulinoma pancreatogenous hypoglycemia syndrome; PGBH: post-gastric bypass hypoglycemia; IGF: insulin-like growth factor.
* Patterns of findings during fasting or after a mixed meal in healthy individuals with no symptoms or signs despite relatively low plasma glucose concentrations (ie, Whipple's triad not documented) and in individuals with hyperinsulinemic (or IGF-mediated) hypoglycemia or hypoglycemia caused by other mechanisms.
¶ Free C-peptide and proinsulin concentrations are low.
Δ Increased pro-IGF-2, free IGF-2, IGF-2/IGF-1 ratio.

Original table modified for this publication to include mmol/L equivalent data. Reproduced with permission from: Cryer PE, Axelrod L, Grossman AB, et al. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2009; 94:709. Copyright © 2009 The Endocrine Society.

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Hypoglycemia: Interpretation of laboratory tests*