Starvation test
Indication | Clarification of hyperinsulinemic hypoglycemia |
Contraindication | Known cerebral spasms in the patient’s history. |
Principle | In case of autonomous production of insulin, there will be hypoglycemic symptoms under starvation. |
Evaluation parameters | Glucose, insulin, C-peptide, proinsulin, possibly beta-hydroxybutyrate |
Material |
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Procedure | The test should be performed under inpatient conditions. All medication should be paused, as far as possible. The patient may drink non-sweetened tea and water during the test (no coffee).
In case of blood glucose levels of ≤ 45 mg/dl or blood glucose levels of ≤ 55 mg/dl and occurrence of neuroglycopenic symptoms, please take insulin, proinsulin, C-peptide and, if necessary, beta-hydroxybutyrate measurements before aborting the test. Should 72 hours be reached without premature termination of test, immediately afterwards, whilst the patient is still empty-stomached, a glucagon stimulation test with bolus-administration of 1 mg glucagon intravenously, should be carried out. After 10, 20 and 30 min, blood glucose (sodium fluoride tube) and, if necessary, beta-hydroxybutyrate should be determined. |
Evaluation | Plasma insulin of ≥ 3 µUl/l with a blood glucose of ≤ 55 mg/dl is considered reliable pathological. The valence of insulin/glucose-ratio of ≥ 0,3 with regard to insulinoma/nesidioblastoma has only little specificity and sensitivity. C-peptide ≥ 0,6 µg/l with blood glucose of ≤ 45 mg/dl is reliable pathological. Proinsulin ≥ 5 pmol/l with blood glucose of ≤ 55 mg/dl is also considered reliable pathological. An increase of the blood glucose of at least 25 mg/dl in the glucagon stimulation test after 72 hours of starvation is considered pathological. A beta-hydroxybutyrate of ≤ 28,1 mg/dl after 72 hours of starvation and/or after glucagon stimulation, is pathological. |
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