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Epic Test Code LAB3873 Hypoglycemic Agent Screen, Serum

Additional Codes

MML Code: HYPOG

NY State Approved

Yes

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Reporting Name

Hypoglycemic Agent Screen, S

Method Name

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

Specimen Stability Information

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


Specimen Required


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.


Specimen Type

Serum Red

Specimen Minimum Volume

0.5 mL

Reference Values

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.

Report Available

2 to 6 days

Day(s) Performed

Monday, Wednesday, Friday

CPT Code Information

80377

G0480-(if appropriate)

Reject Due To

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK

Useful For

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

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.

Interpretation

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

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.

Forms

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

Specimen Retention Time

14 days