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22600 Hypoglycemic Agent Screen, Serum (HYPOG)

Hypoglycemic Agent Screen, Serum (HYPOG)
Test Code: MISC
Synonyms/Keywords
Amaryl, Chlorpropamide, Dymelor, Glimepiride, Glipizide, Glucotrol, Glyburide, Meglitinides, Micronase, Prandin, Repaglinide, Sulfonylurea Hypoglycemic Serum, Sulfonylureas, Tolazamid(Tolinase), Acetohexamide (Dymelor), Orinase (Tolbutamide), Diabinese (Chlorpropamide)
Useful For
​Evaluation of suspected insulinoma characterized by hypoglycemia and increased plasma insulin concentration.
 
Detecting drugs that stimulate insulin secretion
 
If hypoglycemia is the result of 1 of these drugs, the test will detect the drug at physiologically significant concentrations in serum during an episode of hypoglycemia.
 
Drugs detected by this procedure are:
-The first-generation sulfonylureas-acetohexamide, chlorpropamide, tolazamide, and tolbutamide
-The second-generation sulfonylureas--glimepiride, glipizide, and glyburide
-The meglitinide-repaglinide
 
Drugs designed to make tissues more sensitive to insulin that do not induce hypoglycemia, such as pioglitazone, rosiglitazone, and troglitazone (recently withdrawn from the United States market) are not included in this screen test.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.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
​Serum Red Top Tube (RTT)​ 3 mL​ 1.1 mL​
Collection Processing Instructions
​Submit sample in a plastic vial.
Specimen Stability Information
Specimen Type Temperature Time
Serum​ ​ ​ Frozen (preferred)​ 28 days​
Ambient ​ 7 days​
Refrigerated ​ 28 days​
Rejection Criteria
​Gross lipemia
​Gross icterus
​Serum gel tube
Interference

​Proper interpretation requires that the blood specimen be drawn 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 test is not intended for therapeutic drug monitoring.

Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Mayo Clinic Laboratories
Monday, Wednesday, Friday​ 2-8 days​
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)​
Reference Lab
Test 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 plasma insulin must be considered. Absence of hypoglycemic drugs in blood serum during an episode of low blood glucose should be demonstrated before considering pancreatic exploration for suspected insulinoma.
Reference Range Information
Interpretive report
Interpretation
​Use of hypoglycemic agents outside of the context of treatment of type 2 diabetes is likely to cause hypoglycemia associated with elevated plasma insulin. Patients presenting with hypoglycemia due to ingestion of a first-, second-, or third-generation hypoglycemic agent 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.
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
​80377
​G0480 ​(if needed)
Synonyms/Keywords
Amaryl, Chlorpropamide, Dymelor, Glimepiride, Glipizide, Glucotrol, Glyburide, Meglitinides, Micronase, Prandin, Repaglinide, Sulfonylurea Hypoglycemic Serum, Sulfonylureas, Tolazamid(Tolinase), Acetohexamide (Dymelor), Orinase (Tolbutamide), Diabinese (Chlorpropamide)
Ordering Applications
Ordering Application Description
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
​Serum Red Top Tube (RTT)​ 3 mL​ 1.1 mL​
Collection Processing
​Submit sample in a plastic vial.
Specimen Stability Information
Specimen Type Temperature Time
Serum​ ​ ​ Frozen (preferred)​ 28 days​
Ambient ​ 7 days​
Refrigerated ​ 28 days​
Rejection Criteria
​Gross lipemia
​Gross icterus
​Serum gel tube
Interference

​Proper interpretation requires that the blood specimen be drawn 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 test is not intended for therapeutic drug monitoring.

Useful For
​Evaluation of suspected insulinoma characterized by hypoglycemia and increased plasma insulin concentration.
 
Detecting drugs that stimulate insulin secretion
 
If hypoglycemia is the result of 1 of these drugs, the test will detect the drug at physiologically significant concentrations in serum during an episode of hypoglycemia.
 
Drugs detected by this procedure are:
-The first-generation sulfonylureas-acetohexamide, chlorpropamide, tolazamide, and tolbutamide
-The second-generation sulfonylureas--glimepiride, glipizide, and glyburide
-The meglitinide-repaglinide
 
Drugs designed to make tissues more sensitive to insulin that do not induce hypoglycemia, such as pioglitazone, rosiglitazone, and troglitazone (recently withdrawn from the United States market) 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.
Reference Range Information
Interpretive report
Interpretation
​Use of hypoglycemic agents outside of the context of treatment of type 2 diabetes is likely to cause hypoglycemia associated with elevated plasma insulin. Patients presenting with hypoglycemia due to ingestion of a first-, second-, or third-generation hypoglycemic agent 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.
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Mayo Clinic Laboratories
Monday, Wednesday, Friday​ 2-8 days​
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)​
Reference Lab
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
​80377
​G0480 ​(if needed)
For most current information refer to the Marshfield Laboratory online reference manual.