INS and Hypoglycemia: Endocrinology was consulted and diagnostic laboratory testing demonstrated hypoketotic hypoglycemia with an inappropriately high insulin level given hypoglycemia (6.4 μIU/L in the setting of blood glucose < 50 mg/dL), low β-hydroxybutyrate (1.4 mmol/L; reference < 2.0 mmol/L) and a positive response to glucagon stimulation test, consistent with a diagnosis of hyperinsulinism.