The affirmation of an organic origin of hypoglycemia is difficult because of the non-specific nature of the symptoms.
In any case, before considering a fasting test, it is essential to eliminate the obvious causes of hypoglycemia that are:
> Drug causes
- Most often in people with diabetes (Type 1 or Type 2) after too much insulin, or after taking other oral diabetes medications (which stimulate the release of too much pancreatic insulin) ), taking into account the level of activity and the diet.
- Some high blood pressure medications (eg, atenolol, metoprolol, propranolol), some antidepressants (eg phenelzine, tranylcypromine), quinine, haloperidol, and trimethoprim-sulfamethoxazole may also be used. to promote hypoglycaemia.
Acute or massive alcohol intoxication, often on an empty stomach or in the absence of a meal, is a common cause.
> Severe renal and hepatic insufficiency
The liver can not properly store carbohydrates or turn them into glucose.
> Prolonged and intense physical activity
> Dieting low calorie too severe
If none of these causes are found:
The stage of the etiological diagnosis is dominated by the search for an insulinoma, the most common cause of adult hypoglycemic tumors, but rare (<5 cases per million and per year) and usually benign (the malignancy can not be affirmed only by the occurrence of metastases 10%).
It is most often a small tumor (90% is less than 2 cm and 30% less than 1 cm), which can cause problems to locate it with the available radiological means.
Insulinoma gives episodes of hypoglycemia, sometimes very episodic, in often young and healthy adults. The diagnosis is thus frequently delayed, even in patients with regular episodes, which occur more readily on an empty stomach, or on exercise. Repetition of episodes can sometimes be accompanied by weight gain.
Diagnosis is often easy with the fasting test, with hypoglycaemia occurring in 99% of cases (70% within 24 hours) and accompanied by a measurable concentration of insulin and C-peptide (precursor to insulin) on the blood test.Hypoglycemia can also be caused by a problem with the pituitary gland, or the adrenal glands.
The pituitary gland controls the production of certain hormones needed in the body to raise blood sugar levels too low. These hormones include cortisol and adrenaline, released by the adrenal glands and have the property of increasing glucose levels too low. When they are deficient, hypoglycaemia may occur (called adrenal insufficiency or adrenocorticotropic insufficiency).
Reaction hypoglycemia remains a controversial topic and could be linked to several factors that are sometimes difficult to determine.Hypoglycaemia appears to occur after food intake, usually a high carbohydrate meal. Ingesting it causes the blood sugar to rise too rapidly, which in some cases stimulates excessive insulin secretion.
Hypoglycaemia may also be favored after certain types of gastric surgery (sleeve gastrectomy, bypass, etc.), with the sugars being absorbed more rapidly and causing an early insulin spike.
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