Diagnostic Tests for Hypoglycemia
Hypoglycemia: Diagnostic Tests
The list of diagnostic tests
mentioned in various sources as
used in the diagnosis of Hypoglycemia
includes:
- Blood glucose test
- Successful response to sugar
Hypoglycemia Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Hypoglycemia:
- High Cholesterol: Home Testing:
- High Blood Pressure: Home Testing
- Heart Health: Home Testing:
- Fatigue: Related Home Tests:
- Thyroid: Home Testing:
- Home Anemia Diagnostic Tests
- Diet & Weight Loss: Home Testing:
- Adrenal Gland Health: Home Testing:
- Kidney Health: Home Testing:
- Diabetes: Related Home Testing:
Hypoglycemia Diagnosis: Book Excerpts
Tests and diagnosis discussion for Hypoglycemia:
To diagnose hypoglycemia in people who do not have diabetes, the doctor
looks for the following three conditions:
- The patient complains of symptoms of hypoglycemia
- Blood glucose levels are measured while the person is experiencing
those symptoms and found to be 45 mg/dL or less in a woman or 55 mg/dL
or less in a man
- The symptoms are promptly relieved upon ingestion of sugar.
For many years, the oral glucose tolerance test (OGTT) was used
to diagnose hypoglycemia. Experts now realize that the OGTT can actually
trigger hypoglycemic symptoms in people with no signs of the disorder. For
a more accurate diagnosis, experts now recommend that blood sugar be
tested at the same time a person is experiencing hypoglycemic symptoms.
The doctor will also check the patient for health conditions such as
diabetes, obtain a medication history, and assess the degree and severity
of the patient's symptoms. Laboratory tests to measure insulin production
and levels of C-peptide (a substance that the pancreas releases into the
bloodstream in equal amounts to insulin) may be performed.
(Source: excerpt from Hypoglycemia: NIDDK)
Diagnosis of Hypoglycemia: medical news summaries:
The following medical news items
are relevant to diagnosis of Hypoglycemia:
Diagnostic Tests for Hypoglycemia: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Hypoglycemia.
HYPOGLYCEMIA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The finding of hypoglycemia on routine blood analysis requires nothing in an asymptomatic patient. If there is doubt, a repeat analysis should be done. If the patient is symptomatic, a 5-hr glucose tolerance test or hospitalization for repeated blood sugar during a 72-hr fast should be done. If these are negative, the patient most likely has functional hypoglycemia. Additional tests to order include a T
4
, plasma, cortisol, plasma growth hormone assay, plasma proinsulin, C-peptide, plasma insulin, CT scan of the abdomen, and a tolbutamide tolerance test. Obtain an endocrinology consult.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Low birth weight:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
As soon as possible, evaluate the neonate’s neuromuscular and physical maturity to determine gestational age. (See Ballard Scale for calculating gestational age, pages 382 and 383.) Follow with a routine neonatal examination.
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Source: Handbook of Signs & Symptoms (Third Edition), 2006
Low birth weight:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
As soon as possible, evaluate the neonate’s neuromuscular and physical maturity to determine gestational age. (See Ballard Scale for calculating gestational age, pages 488 and 489.) Follow with a routine neonatal examination.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Low Back Pain:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
Evaluation should be both general and specific. It is prudent to leave the potentially most painful parts of the examination to the end.
A. General. Examination includes auscultation of the heart and assessment of peripheral pulses and blood pressure. Abdominal examination should focus on possible causes of back pain (Table 12.5). Assess gait.
B. Neurologic. The lower extremity examination includes motor strength, deep tendon reflexes, sensation, proprioception, and certain functional maneuvers (Table 12.6). Romberg and Babinski reflexes should also be assessed. Rectal examination should assess sphincter tone, which can be compromised in sacral root dysfunction. In the primary care setting, most clinically significant disc herniations will be detected by the following limited examination: dorsiflexion of the great toe and ankle, Achilles reflex, light touch sensation of the medial (L 4), dorsal (L5), and lateral (S1) aspect of the foot, and the straight leg raise (SLR) test (1).
C. Musculoskeletal. Assess range of motion of the spine and lower extremities. Perform the SLR test passively with the patient supine. Note the angle of leg elevation precipitating pain. A positive test for sciatica is buttock pain radiating to the posterior thigh, and perhaps to the lower leg and foot. Sciatica, with pain and resistance on internal rotation of the hip, can indicate piriformis muscle spasm or strain. The SLR test is usually negative in spinal stenosis (2). Percussion of the spine and upper pelvis helps to identify areas of localized tenderness, as in fracture, metastatic disease, and some rheumatologic conditions. Palpate standard trigger points looking for fibromyalgia. Check for paraspinal muscle spasm. Measure thigh and calf circumferences to look for muscular atrophy.
Testing
A. Clinical laboratory tests. Testing will be guided by the differential diagnosis as determined by the history and physical examination. If the back pain is felt to be of musculoskeletal origin, no test may be indicated. A urinalysis can help rule out hematuria or infection, if the pain is thought to be urologic or as a result of trauma. If the history suggests a medical problem, the considered diagnoses will determine the laboratory work. Extensive medical workup may be needed for a primary or metastatic malignancy. A calcium level should always be measured to identify a potentially lethal hypercalcemia. Rheumatologic studies may be indicated if a connective tissue disease (e.g., ankylosing spondylitis or rheumatoid arthritis) is suspected. If the pain is thought to be secondary to an urgent or life-threatening condition, have pertinent tests done expeditiously.
B. Diagnostic imaging. In the absence of “red flags,” lumbar spine films are not indicated for musculoskeletal sounding low back pain of less than 1 month duration (1). Neurologic emergencies (e.g., major spine trauma, cauda equina syndrome) require magnetic resonance imaging (MRI) studies. It is usually unproductive to order an MRI for straightforward lumbar muscular strain or for initial evaluation of simple disc herniation, as the prevalence rate of nonsignificant abnormal findings is high. A bone scan may be helpful when tumor, infection, or occult fracture is suspected. Electromyography may be useful to assess for nerve root dysfunction when symptoms are questionable.
Diagnostic assessment
The most common cause of low back pain in the outpatient setting is musculoskeletal strain. Although temporarily very debilitating, muscle strain can be conservatively treated and usually has few long-term complications. Variations from this basic presentation must be recognized to identify more structurally significant or medically threatening problems. Clues to these other diagnoses, which are found in the history, are reinforced by abnormalities in the physical examination; they are found less often by diagnostic testing.
The following “red flags” suggest possible urgent diagnoses. A history of recent trauma or motor vehicle accident can signify a vertebral fracture or subluxation. Fever can indicate an infection of the spine or pyelonephritis (Chapter 2.6). Recent genitourinary instrumentation or other invasive procedure can precede this presentation. Weight loss, other constitutional symptoms, or pain at rest (or at night) may suggest cancer (Chapter 2.13). Neurologic abnormalities can signify nerve dysfunction or cord compression. Urinary or fecal incontinence or retention, saddle area perineal numbness, or anal sphincter incompetence suggests cauda equina syndrome. A sudden tearing sensation in the back with associated hypotension can be caused by a rupturing abdominal aortic aneurysm.
References
1. Bigos SJ. Acute low back problems in adults. Clinical Practice Guideline. No. 14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services; December 1994.
2. Alvarez JA, Hardy Jr. RH. Lumbar spine stenosis: a common cause of back and leg pain. Am Fam Physician 1998;57:1825–1834.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Low Back Pain:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Radicular pain has such a high sensitivity for nerve root compression that its absence makes important disc herniation unlikely. Not all radicular pain is due to a herniated disc however. Other causes include spinal stenosis, ligamentous hypertrophy, deep lumbar muscle spasm, and deep trochanteric bursitis.
Back pain at rest or unassociated with posture/movement should increase the suspicion of tumor, fracture, infection, or referred visceral pain. Spinal tenderness is a sensitive but not specific indicator. Clues to metastatic cancer include a history of cancer, unexplained weight loss, and signs of cord compression, such as motor weakness of the legs, urinary or fecal incontinence, and absent anal reflex. Recent bacterial infection, injection drug use, or immune suppression (from steroids, chemotherapy, or HIV) should raise suspicion for infection. Fever occurs in osteomyelitis (50%), epidural abscess (83%), and tuberculosis (27%).
A red flag for fracture in a young adult is major trauma, such as a fall from a height or a motor vehicle accident. In older adults, minor trauma or strenuous lifting can cause a compression fracture.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Low birth weight:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
As soon as possible, evaluate the neonate's neuromuscular and physical maturity to determine gestational age. (See Ballard Scale for calculating gestational age.) Follow with a routine neonatal examination.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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