Test Catalog

Test Id : HYPOG

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Hypoglycemic Agent Screen, Serum

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Evaluation of suspected insulinoma characterized by hypoglycemia and increased serum insulin concentration

 

Detecting drugs that stimulate insulin secretion

 

Drugs detected by this procedure are:

-The first-generation sulfonylureas: chlorpropamide (Diabinese), tolazamide, and tolbutamide (Orinase)

-The second-generation sulfonylureas: glimepiride (Amaryl), glipizide (Glucotrol), and glyburide (Glibenclamide)

-The meglitinides: repaglinide (Prandin) and nateglinide (Starlix)

-The thiazolidinediones: pioglitazone (Actos) and rosiglitazone (Avandia)

 

This test is not intended for therapeutic drug monitoring but could be used to monitor compliance.

Highlights

If hypoglycemia is the result of an insulin-stimulating drug, this test will detect the drug at physiologically significant concentrations during an episode of hypoglycemia.

Method Name
A short description of the method used to perform the test

Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Hypoglycemic Agent Screen, S

Aliases
Lists additional common names for a test, as an aid in searching

Amaryl

Chlorpropamide

Dymelor

Glimepiride

Glipizide

Glucotrol

Glyburide

Meglitinides

Micronase

Prandin

Repaglinide

Sulfonylurea Hypoglycemic Serum

Sulfonylureas

Tolazamide (Tolinase)

Acetohexamide (Dymelor)

Orinase (Tolbutamide)

Diabinese (Chlorpropamide)

HYPOG

Diabinese

Actoplus Met

Actos

Avandamet

Avandia

Glibenclamide

Glubrava

Glucophage

Lobeglitazone

Meglitinide

Nateglinide

Novonorm

Orinase

Pioglitazone

Piomet

Politor

PPAR

Rosiglitazone

Starlix

Surepost

Thiazolidinedione

Tolazamide

Tolbutamide

Tolinase

Troglitazone

Hypoglycemic Agents

Specimen Type
Describes the specimen type validated for testing

Serum Red

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Patient Preparation: Specimen must be collected during an episode of hypoglycemia.

Supplies: Sarstedt Aliquot Tube, 5 mL (T914)

Collection Container/Tube: Red top (serum gel/SST are not acceptable)

Submission Container/Tube: Plastic vial

Specimen Volume:1.5 mL

Collection Instructions: Centrifuge and aliquot serum into a plastic vial.

Forms

If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.

0.5 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Serum Red Frozen (preferred) 28 days
Refrigerated 28 days
Ambient 7 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Evaluation of suspected insulinoma characterized by hypoglycemia and increased serum insulin concentration

 

Detecting drugs that stimulate insulin secretion

 

Drugs detected by this procedure are:

-The first-generation sulfonylureas: chlorpropamide (Diabinese), tolazamide, and tolbutamide (Orinase)

-The second-generation sulfonylureas: glimepiride (Amaryl), glipizide (Glucotrol), and glyburide (Glibenclamide)

-The meglitinides: repaglinide (Prandin) and nateglinide (Starlix)

-The thiazolidinediones: pioglitazone (Actos) and rosiglitazone (Avandia)

 

This test is not intended for therapeutic drug monitoring but could be used to monitor compliance.

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

The metabolic and hormonal profiles of insulinoma and sulfonylurea-induced hypoglycemia are identical. Therefore, in the evaluation of the hypoglycemic patient, the possible use of oral hypoglycemic agents as the cause for low blood glucose and elevated serum insulin must be considered. Absence of hypoglycemic drugs in serum during an episode of low blood glucose should be demonstrated before considering pancreatic exploration for suspected insulinoma.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

Negative

Screening cutoff concentrations

Chlorpropamide: 100 ng/mL

Glimepiride: 20 ng/mL

Glipizide: 5 ng/mL

Glyburide: 5 ng/mL

Nateglinide: 5 ng/mL

Pioglitazone: 20 ng/mL

Repaglinide: 5 ng/mL

Rosiglitazone: 20 ng/mL

Tolazamide: 50 ng/mL

Tolbutamide: 20 ng/mL

 

Note: If a drug is detected at a concentration greater than the cutoff, the report will indicate that specific drug is positive. The test cutoff listed for each drug is lower than the concentration that will cause increased insulin and decreased glucose.

Interpretation
Provides information to assist in interpretation of the test results

Use of hypoglycemic agents outside of the context of treatment of type 2 diabetes is likely to cause hypoglycemia associated with elevated serum insulin. Patients presenting with hypoglycemia due to ingestion of a first-, second-, or third-generation hypoglycemic agents will have drug present in serum greater than the minimum effective concentration (see Reference Values). Presence of drug indicates that the patient has recently ingested a hypoglycemic agent.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Proper interpretation requires that the specimen be collected during or close to the time of a hypoglycemic episode. Drugs will not be detected (and are not likely to be present) if blood is drawn when blood glucose is normal in nondiabetic patients.

 

All drugs that stimulate insulin secretion undergo extensive metabolism before excretion. The parent drug is therefore not present in urine. Blood serum is the specimen of choice for detecting use of the hypoglycemic drugs; urine or plasma is not an acceptable specimen.

 

This screen does not include the first-generation sulfonylurea acetohexamide.

 

Other drugs that do not induce hypoglycemia, thiazolidinediones such as troglitazone and lobeglitazone, and are designed to make tissues more sensitive to insulin are not included in this screen test.

 

Drugs that lower blood glucose through mechanisms not related to stimulation of insulin secretion, such as acarbose, metformin, and miglitol, are not included in this screen test.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Ben-Ami H, Nagachandran P, Mendelson A, Edoute Y. Drug-induced hypoglycemic coma in 102 diabetic patients. Arch Intern Med. 1999;159(3):281-284

2. Milone MC, Shaw LM. Therapeutic drugs and their management. In: Rifai N, Chiu RWK, Young I, Burnham CAD, Wittwer CT, eds. Tietz Textbook of Laboratory Medicine. 7th ed. Elsevier; 2023:420-453

Method Description
Describes how the test is performed and provides a method-specific reference

Serum specimens are subjected to organic extraction. The extract is analyzed by liquid chromatography tandem mass spectrometry.(Unpublished Mayo method)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday, Wednesday, Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

2 to 6 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

14 days

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

80377

G0480-(if appropriate)

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
HYPOG Hypoglycemic Agent Screen, S 68318-5
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
21295 Chlorpropamide 48329-7
21296 Tolazamide 21566-5
21297 Tolbutamide 21567-3
21298 Glimepiride 48325-5
21299 Glipizide 48326-3
21300 Glyburide 48327-1
21301 Repaglinide 48328-9
609767 Nateglinide 49487-2
609768 Pioglitazone 100351-6
609769 Rosiglitazone 100352-4

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports