HYPOGLYCEMIA PRESENTING AS BIZARRE BEHAVIOR. On the day of admission, he was found in his home unresponsive. Emergency medical services were called, and they found his glucose to be 34. Glucose was administered en route to the hospital with an increase in his glucose to 154 and return of consciousness. He had no history of diabetes and denied use of exogenous insulin. Physical exam at the time of admission was normal. Routine labs were all normal except for a glucose of 52. The patient was admitted for a supervised 72-hour fast. Several hours into the fast, the patient's accucheck was < 50, and he again began to exhibit bizarre, child-like behavior. Stat chemistries, serum insulin and C-peptide level were drawn revealing a glucose of 36, insulin 97.1 mU/ml and C-peptide 7.6ng/ml, values consistent with excess endogenous insulin production. A sulfonylurea level was ordered, and a CT scan was scheduled. The CT revealed a 5Â2.5 cm mass in the body of the pancreas and numerous masses throughout the liver. DISCUSSION: This case illustrates the importance of recognizing the signs and symptoms of hypoglycemia in the context of a low glucose value. Low glucose without neuroglycopenia or sympathoadrenal activation may not require further evaluation. However, the presence of these symptoms in an otherwise healthy-appearing, non-diabetic patient with low glucose necessitates a work-up for a hypoglycemic disorder. Careful measurement of insulin, C-peptide, glucose, and sulfonylurea levels can quickly narrow the differential. Whipples Triad (symptoms of hypoglycemia, a glucose of < 50, and relief of symptoms with glucose) is present in the initial presentation of most hypoglycemic disorders.