[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-detail-504628-en":59,"doc-seo-504628-105":80},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":5,"data":60},{"doc_id":61,"user_id":62,"nickname":63,"user_avatar":64,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":66,"doc_content":67,"file_id":68,"file_url":69,"file_type":70,"file_size":71,"view_count":72,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":73,"language_code":74,"site_id":75,"html_lang":74,"table_of_contents":76,"faqs":77,"seo_title":78,"seo_description":66,"update_tm":79,"read_time":24,"preview_page_count":4},504628,2336478487870,"Jasmine","https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","72 hour Fast for Insulinoma Investigations - Procedure and Interpretation","72-hour prolonged fasting protocol for investigating suspected insulinoma and endogenous hyperinsulinism. The fast aims to provoke fasting hypoglycaemia in patients when it is not seen spontaneously or after an overnight fast, with strict patient preparation, frequent glucose and ketone monitoring, and urgent sampling protocols. Yellow top fluoride EDTA tubes are used for plasma glucose; brown top serum tubes are used for insulin, C-peptide and related screens, with immediate treatment options for hypoglycaemia and defined laboratory thresholds to support interpretation and diagnosis.","72 hour Fast for Insulinoma Investigations  \nProlonged fasting is a sensitive procedure for detection of endogenous hyperinsulinism (sensitivity >90 %) and is routinely employed as the initial test to detect inappropriately elevated insulin secretion as the cause for recurrent hypoglycaemia.  \nIndications  \nUsed to demonstrate fasting hypoglycaemia and diagnosis of insulinoma if not observed spontaneously or after an overnight fast.  \nRequirements  \n• Yellow top fluoride EDTA sample tubes for glucose  \n• Brown top serum sample tubes for insulin and C-peptide  \n• Iced slurry for transportation of samples.  \n• Indwelling cannula  \n• Perform test under close supervision  \n• 10% dextrose (250ml) or glucagon 1mg available for immediate administration for hypoglycaemia.  \n• Orange juice or Gluco juice available for treatment of hypoglycaemia  \nProcedure  \nPATIENT PREPARATION  \n• The onset of the fast is classed as the last intake of calories.  \n• Calorie free, caffeine free beverages only may be consumed.  \n• Prescribed medication can be continued.  \n• Smoking is not permitted during the test.  \n• The patient should remain physically active during waking hours, but not leave the ward.  \nTEST  \n• Cannulate patient and commence prolonged fast.  \n• Bedside capillary blood glucose monitoring must be performed every 4 hours or when clinical symptoms are reported and signs of hypoglycaemia are observed (sweating, palpitations, anxiety, faintness) to assess the degree of hypoglycaemia.  \n• Each time blood glucose is checked a blood ketone level should be measured and recorded in the patient notes.  \n• If the bedside capillary blood glucose result is found to be \u003C3mmol/L or there are symptoms of hypoglycaemia then samples must be taken immediately to send to the laboratory for plasma glucose sample (yellow top fluoride EDTA tube) accompanied by insulin and c-peptide samples (2 x brown top serum tubes on ice) . Send to the laboratory immediately after collection as urgent samples.  \n• If the laboratory glucose level is found to be \u003C2 .2 mmol/L or the patient shows severe symptoms/  \nsigns of hypoglycaemia then carbohydrate should be given or 250ml 10% dextrose IV or 1mg Glucagon IM/IV/SC , see Trust policy on treatment of hypoglycaemia in adults , and the fast should be stopped.  \nNB Insulin and c-peptide samples will only be analysed when laboratory glucose \u003C2 .5mmol/L. Tests set up in EPIC  \n\n| Sample 1 (Admission) | Sample type | Samples 2 – 18 * |\n| --- | --- | --- |\n| Glucose | Yellow top fluoride EDTA tube | Glucose |\n| Insulin | Brown top serum tube | Insulin |\n| C-peptide | Brown top serum tube | C-peptide |\n| FFA | Brown top serum tube Send to laboratory on ice, must be received within 20 mins of collection | FFA |\n| B-OHB | Brown top serum tube | B-OHB |\n| Cortisol | Brown top serum tube |  |\n| Sulfonylurea screen | Brown top serum tube |  |\n| Exogenous Insulin | Brown top serum tube |  |\n\n*Note should the patient become hypoglycaemic (glucose \u003C2 .5 mmol/L) then additional samples for sulfonylurea screen and exogenous insulin at that time point should be taken and requested in EPIC.  \nInterpretation of results  \nORC In normal individuals plasma glucose should not fall below 2.2mmol/L, with serum insulin and c-peptide levels appropriate for glucose level.  \nThe diagnosis of insulinoma rests on the demonstration of hypoglycaemia by laboratory plasma glucose \u003C2.2mmol/L  \nGlucose \u003C2.2 mmol/L:  \nInsulin \u003C3 pmol/L No evidence of inappropriate insulin secretion  \nInsulin 3-12 pmol/L Inappropriate insulin secretion NOT excluded. Interpret results  \nalongside other biochemical and clinical parameters.  \nInsulin >12 pmol/L Results suggestive of insulin secretion  \nSensitivity and specificity  \nBy 24 hrs , 66% insulinomas develop hypoglycaemia and by 48 hrs, >95% insulinomas can be diagnosed. After 72 hrs fast plus exercise, if no hypoglycaemia, insulinoma is very unlikely.","cbCaihlYjqBKSBa1","https://ap.wps.com/l/cbCaihlYjqBKSBa1","pdf",87274,14,"English","en",105,"# Indications\n## Requirements\n## Procedure\n### Patient preparation\n### Test\n### Sample schedule (Admission and 2–18)\n## Interpretation of results\n## Sensitivity and specificity","[{\"question\":\"What is the purpose of the 72-hour fast in insulinoma investigations?\",\"answer\":\"It is used to provoke and demonstrate fasting hypoglycaemia to help diagnose insulinoma and endogenous hyperinsulinism when hypoglycaemia is not observed spontaneously or after an overnight fast.\"},{\"question\":\"What samples and tubes are required during the test?\",\"answer\":\"Use yellow top fluoride EDTA tubes for glucose and brown top serum tubes for insulin and C-peptide. Samples must be transported on ice, with urgent laboratory submission when required.\"},{\"question\":\"How are results interpreted for suspected insulinoma?\",\"answer\":\"A key diagnostic criterion is laboratory plasma glucose \\u003c2.2 mmol/L. Further interpretation uses insulin levels relative to glucose, where insulin \\u003c3 pmol/L suggests no inappropriate secretion, while higher insulin levels support results suggestive of insulin secretion.\"}]","72 hour Fast for Insulinoma Investigations - Procedure and Interpretation | PDF",1791071361,{"code":4,"msg":81,"data":82},"ok",{"site_id":75,"language":74,"slug":83,"title":65,"keywords":84,"description":66,"schema_data":85,"social_meta":139,"head_meta":141,"extra_data":143,"updated_unix":144},"72-hour-fast-for-insulinoma-investigations-procedure-and-interpretation","",{"@graph":86,"@context":138},[87,101,121],{"@type":88,"itemListElement":89},"BreadcrumbList",[90,94,96,99],{"item":91,"name":92,"@type":93,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":95,"name":9,"@type":93,"position":14},"https://docshare.wps.com/document/",{"item":97,"name":35,"@type":93,"position":98},"https://docshare.wps.com/document/healthcare/",3,{"item":100,"name":65,"@type":93,"position":19},"https://docshare.wps.com/document/72-hour-fast-for-insulinoma-investigations-procedure-and-interpretation/504628/",{"url":100,"name":65,"@type":102,"image":103,"author":108,"headline":65,"publisher":110,"fileFormat":113,"inLanguage":74,"description":66,"dateModified":114,"datePublished":115,"encodingFormat":113,"isAccessibleForFree":116,"interactionStatistic":117},"DigitalDocument",{"url":104,"@type":105,"width":106,"height":107},"https://docshare.wps.com/thumbnails/72-hour-fast-for-insulinoma-investigations-procedure-and-interpretation/504628.png","ImageObject",300,407,{"name":63,"@type":109},"Person",{"url":91,"name":111,"@type":112},"DocShare","Organization","application/pdf","2026-11-07","2026-10-03",true,{"@type":118,"interactionType":119,"userInteractionCount":72},"InteractionCounter",{"@type":120},"ViewAction",{"@type":122,"mainEntity":123},"FAQPage",[124,130,134],{"name":125,"@type":126,"acceptedAnswer":127},"What is the purpose of the 72-hour fast in insulinoma investigations?","Question",{"text":128,"@type":129},"It is used to provoke and demonstrate fasting hypoglycaemia to help diagnose insulinoma and endogenous hyperinsulinism when hypoglycaemia is not observed spontaneously or after an overnight fast.","Answer",{"name":131,"@type":126,"acceptedAnswer":132},"What samples and tubes are required during the test?",{"text":133,"@type":129},"Use yellow top fluoride EDTA tubes for glucose and brown top serum tubes for insulin and C-peptide. Samples must be transported on ice, with urgent laboratory submission when required.",{"name":135,"@type":126,"acceptedAnswer":136},"How are results interpreted for suspected insulinoma?",{"text":137,"@type":129},"A key diagnostic criterion is laboratory plasma glucose \u003C2.2 mmol/L. Further interpretation uses insulin levels relative to glucose, where insulin \u003C3 pmol/L suggests no inappropriate secretion, while higher insulin levels support results suggestive of insulin secretion.","https://schema.org",{"og:url":100,"og:type":140,"og:title":65,"og:site_name":111,"og:description":66},"article",{"robots":142,"canonical":100},"index,follow",{"doc_id":61,"site_id":75},1791497163]