Factitious Hypoglycemia:

S. Insulin C Peptide Diagnosis

High Low Exogenous Insulin
High High Exogenous Sulfonylureas
High High Insulinoma

S. Insulin Level:
<1500 pmol/l: Insulinoma
1500-7000: Sulfonylurea
>7000: Exogenous Insulin

C Peptide: (Connecting Peptide)

 Formed by: (Pre-proinsulin) >> (Pro-insulin) >> (Insulin + C peptide)
 Better indicator for B cell function than peripheral insulin.
 Type 1 DM: Low C-peptide
Type 2 DM: High C-peptide
 Normal Value: (0.5-2.7) ng/ml

High C-Peptide Low C-peptide

 Insulinoma  Exogenous Insulin
 Sulfonylurea intoxication  Type 1 DM
 Insulin resistance
(Obesity, Cushings), CKD

Recurrent Hypoglycemia:
 Endocrine: Adrenal Insufficiency, Pan-hypopituitarism
 Islet Cell tumors: Insulinoma
 Alcohol, Drugs: Gatifloxacilin, Quinine
 Critical Illness: Hepatic failure, Renal Failure, Sepsis
 Glycogen Storage Disease