Hypoglycemia in the Non-Diabetic Patient

Feeling shaky, sweaty, hungry, anxious, or light-headed does not by itself diagnose hypoglycemia. These symptoms also occur with panic, dehydration, arrhythmias, infection, and other acute problems. In a patient without diabetes, the diagnostic standard is Whipple’s triad: 1. Symptoms or signs consistent with hypoglycemia 2. A measured plasma glucose of 3.0 mmol/L or less 3. Resolution of symptoms after glucose is given This distinction matters because true hypoglycemia without diabetes is uncommon enough to warrant an explanation. A patient who repeatedly experiences symptoms but has normal plasma glucose during those symptoms may need assessment for another cause. Conversely, a patient with documented Whipple’s triad needs evaluation for the process driving the glucose fall, even when symptoms improve quickly after treatment. A bedside capillary glucose result is useful for rapid triage and treatment decisions. It does not replace a plasma glucose sample obtained during symptoms when diagnostic confirmation is needed.