Insulin-induced hypoglycemia stimulation test

BOX Sb-3 Protocol for the Insulin-Induced Hypoglycemia Stimulation T t -(Insulin Tolerance Test)... 

Maprotiline, a tetracyclic antidepressant, repeatedly induced hypoglycemia in a 39-year-old woman with type 1 diabetes, even when the insulin dosage was reduced from 20 U/day to 4-10 U/day. Maprotiline seems to prolong the half-life of insulin. A glucagon stimulation test showed a maximum C-peptide concentration of only 0.22 nmol/I (27). 

Measurement of ACTH in blood collected either at baseline or after stimulation with insulin adds httle to the utility of the above tests and is not generally recommended. In fact, in patients who have undergone pituitary surgery, it takes some time before the cortisol negative feedback loop to ACTH secretion is normalized. ACTH and cortisol measurements after administration of CRH are potentially a direct test of pituitary ACTH reserve. However, the insulin-induced hypoglycemia test is currently the definitive test of ACTH and/or cortisol reserve. Tliis test, however, is contraindicated in patients with a history of coronary heart disease, seizure disorder, and general debility. 

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