Hypoglycemic Agent Screen

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General Information

Lab Name
Lab Code
146
External Test Id
HYPOG
Description

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: 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.
Synonyms
Acetohexamide (Dymelor), Actoplus Met, Actos, Amaryl, Avandamet, Avandia, Chlorpropamide, Diabinese, Diabinese (Chlorpropamide), Dymelor, Glibenclamide, Glimepiride, Glipizide, Glubrava, Glucophage, Glucotrol, Glyburide, HYPOG, Hypoglycemic Agents, Lobeglitazone, Meglitinide, Meglitinides, Micronase, Nateglinide, Novonorm, Orinase, Orinase (Tolbutamide), Pioglitazone, Piomet, Politor, PPAR, Prandin, Repaglinide, Rosiglitazone, Starlix, Sulfonylurea Hypoglycemic Serum, Sulfonylureas, Surepost, Thiazolidinedione, Tolazamide, Tolazamide (Tolinase), Tolbutamide, Tolinase, Troglitazone
Components

Interpretation

Method

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

Reference Range
Ref. Range Notes
Component Reference Value Cutoff
Chlorpropamide Negative 100 ng/mL
Glimepiride Negative 20 ng/mL
Glipizide Negative 5 ng/mL
Nateglinide Negative 5 ng/mL
Pioglitazone Negative 20 ng/mL
Repaglinide Negative 5 ng/mL
Rosiglitazone Negative 20 ng/mL
Tolazamide Negative 50 ng/mL
Tolbutamide Negative 20 ng/mL

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

Interferences and Limitations

Cautions:

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 screen does not include the first-generation sulfonylurea acetohexamide.

Other drugs designed to make tissues more sensitive to insulin that do not induce hypoglycemia, thiazolidinediones such as troglitazone and lobeglitazone, 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.

Ordering & Collection

Specimen Type
Blood
Collection

9 mL blood in RED TOP tube

Unacceptable: any other tube type.

Handling Instructions

Outside Laboratories: Centrifuge specimen and transfer serum to a separate plastic vial. Freeze serum at -20°C.

Stability: Frozen (preferred): 28 days; Refrigerated: 28 days; Ambient 7 days.

Reject Due To: Gross lipemia, gross icterus, gross hemolysis are okay.

Quantity
Requested: 3 mL serum
Minimum: 1.1 mL serum

Processing

Receiving Instructions

Centrifuge specimen and transfer serum to a separate plastic vial. Freeze serum at -20°C.

Login: SEND1-;FREEZE

  • RSNDT1: MAYO
  • RSTYP1: SERUM
  • RTSRQ1: ;Hypoglycemic Agent Screen (Mayo test HYPOG)

Sendouts: order Mayo Test: HYPOG.

Stability: Frozen (preferred): 28 days; Refrigerated: 28 days; Ambient 7 days.

Reject Due To: Gross lipemia, gross icterus, gross hemolysis are okay.

Misc Sendout

Performance

Lab Department
Frequency
Performed: Monday, Wednesday, Friday. Report Available: 2-8 days.
Available STAT?
No
Performing Location(s)
Sendout Mayo Clinic Laboratories (Superior Drive)
800-533-1710

3050 Superior Drive NW
Rochester, MN 55901

Billing & Coding

Billing Comments

CPT: G0481