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Mark Evans

, and Ben Challis

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date: 25 February 2021

Hypoglycaemia is a low blood glucose concentration, clinically important because glucose is the main fuel supporting brain metabolism and function. The commonest causes are as a consequence of insulin or sulphonylurea drugs used to treat diabetes, but there are many rarer causes including insulinoma, toxins (alcohol), organ failure (hepatic), endocrine diseases (adrenal insufficiency, pituitary insufficiency), non-islet cell tumour hypoglycaemia (large mesenchymal tumours and other malignancies), post bariatric surgery (non-insulinoma pancreatogenous hypoglycaemia syndrome), autoimmune insulin syndrome, factitious or felonious administration of insulin/sulphonylureas, and infections (malaria). Typical features include ‘autonomic’ symptoms (e.g. tachycardia, tremor, and sweating), hunger and neuroglycopenic symptoms related to brain glucose deprivation (e.g. impaired cognitive function, blurred vision, drowsiness, and irritation).

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