EUH Morning Report: How is the Whipple triad utilized when diagnosing non-diabetic hypoglycemia?

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The Bottom Line:

“Hypoglycemia in persons without diabetes is a rare clinical syndrome defined as plasma glucose low enough to cause autonomic and/or neuroglycopenic signs or symptoms, including impaired brain function.” (DynaMed)

Hypoglycemia is confirmed when Whipple triad is present:

  1. symptoms or signs consistent with hypoglycemia
  2. plasma glucose < 55 mg/dL (measured with a precise method such as a venous blood sample)
  3. resolution of symptoms after increasing plasma glucose level

“Hypoglycemia is rare in persons who do not have drug-treated diabetes mellitus (12–15). Furthermore, not requiring Whipple’s triad to initiate a workup will very likely expose patients who do not have a specific pathology causing hypoglycemia to unnecessary evaluations, costs, and potential harms without expectation of benefit.Therefore, we believe it is important to document Whipple’s triad before concluding that a hypoglycemic disorder exists.” (Cryer, et al., 2009, p. 711.)

From: Hypoglycaemia in nondiabetic patients: An evidence based approach.

DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 – . Hypoglycemia in Adults – Approach to the Patient Without Diabetes; [updated 2018 Nov 30, cited 2021 Apr 13].

Cryer PE, Axelrod L, Grossman AB, et al. Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2009 Mar;94(3):709-28. Full-text for Emory users.