Glucose and Insulin Levels

Currently, the diagnosis of insulinoma is confirmed by demonstrating a circulating insulin level that is inappropriately high for the serum glucose level, measured at the time of hypoglycemia (Fig. 79-3). When a patient presents with symptoms of hypoglycemia (i.e., coma, convulsions, or other neurologic symptoms), blood samples should be taken for the determination of both insulin and glucose levels. Samples should be drawn as early as possible to avoid complications of hypoglycemia and before treatment with glucose. Also, later, epinephrine secretion may cause mobilization of liver glycogen with a compensatory rise in serum glucose, possibly masking the hypoglycemia associated with an insulinoma. Although normal serum glucose levels are 60 to 95 mg/dL, symptoms of hypoglycemia usually do not occur until levels are less than 50 mg/dL. Normal serum insulin levels are typically below 30 pU/mL.

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