Hypoglycemic Agent Screen, Serum (HYPOG)

Test Code: MISC

Overview
Ordering
Specimen
Performing
Clinical/Interpretive
Contacts
Coding

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sensitive to insulin that do not induce hypoglycemia, such as pioglitazone, rosiglitazone, and troglitazone (recently withdrawn from the United States market) are not included in this screen test.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)	14 days
	Ambient	14 days
	Refrigerated	14 days

Rejection Criteria

Gross hemolysis
Gross lipemia
Gross icterus
Serum gel tube

Performing Laboratory Information

Performing Location	Day(s) Test Performed	Analytical Time	Methodology/Instrumentation
Mayo Medical Laboratories	Monday, Wednesday, Friday	2 days	Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Reference Lab

Mayo Clinic Laboratories

Test Information

Drugs detected by this procedure are: 1) First generation sulfonylureas - acetohexamide, chlorpropamide, tolazamide, and tolbutamide; 2) the second-generation sulfonylureas - glimepiride, glipizide, and glyburide; and 3) the miglitinide - repaglinide. Drugs designed to make tissues more sensitive to insulin that do not induce hypoglycemia, such as pioglitazone, rosiglitazone, and troglitazone 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.

Outreach CPTs

CPT	Modifier (if needed)	Quantity	Description	Comments
80307
G0479				(if needed)

Synonyms/Keywords

Ordering Applications

Ordering Application	Description

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