Fed vs Fasting Metabolism | USMLE Step 1
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A 41-year-old woman has recurrent early-morning sweating, tremor, and confusion that improve after she eats. During a symptomatic episode, plasma glucose is 42 mg/dL, insulin is 14 µIU/mL, and C-peptide is 3.1 ng/mL. Insulin and C-peptide should be suppressed at this glucose concentration. A screen for sulfonylureas and meglitinides is negative. Intravenous dextrose promptly resolves her symptoms.