Test Id : HYPOG
Hypoglycemic Agent Screen, Serum
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.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
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 | |
| Ambient | 7 days | ||
| Refrigerated | 28 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
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.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
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.
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 |