Causes of hypoglycaemia in type 2 diabetes mellitus Remarks Drugs used for treatment of diabetes Sulphonylureas, insulin, insulin secretagogues (e.g. repaglinide) Drugs potentiating anti-diabetic drugs Incretins, thiazolidinediones Hypoadrenalism and hypopituitarism Short synacthen test and other appropriate endocrine tests Systemic disease Renal and liver failure, sepsis Pancreatic disease Insulinoma, nesidioblastosis Post gastric bypass hypoglycaemia Pancreatic islet hyperplasia due to increased GLP1 and ghrelin secretion Autoimmune hypoglycaemia Autoantibodies to insulin and the insulin receptor IGF II mediated hypoglycaemia Non islet cell, large mesenchymal tumours (These should be considered only if decreased food intake and excessive exercise have been eliminated)

Table 1: The differential diagnosis of hypoglycaemia in a subject with T2DM should include the more rare causes outlined above after drugs have been excluded.