Whipple’s triad

Whipple’s Triad is a triad of symptoms suggestive of hypoglycemia.

It includes:

• Spontaneous hypoglycemia with blood sugar levels less than 50mg/100ml
• CNS or vasomotor symptoms that may range from excessive sweating, dizziness, syncope to odd behavior and seizures
• Relief of symptoms by oral or intravenous administration of glucose.

Chronic hypoglycemia leads to attenuated autonomic response. Therefore, it may present with CNS symptoms due to neuroglycopenia (neuro-nerve; glyco- glucose; penia- deficiency).

Symptoms occurring while fasting or following exercise are more likely to be pathological than post-prandial-reactive hypoglycemia.

Reactive hypoglycemia/ postprandial hypoglycemia- recurrent episodes of hypoglycemia occurring within 4 hours post meal. It is thought to be due to an excessive release of insulin after a carbohydrate dense meal, the levels of which remain high even after digestion.

*Always consider hypoglycemia in all comatose patients even in apparently obvious cases like hemiplegic stroke or alcohol intoxication.

Causes that may present as Whipple’s triad: