The main differential diagnoses of hyperinsulinemic hypoglycemia are non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS), post bariatric hypoglycemia, factitious hypoglycemia, anti-insulin antibodies hypoglycemia, medication related hypoglycemia, paraneoplastic syndromes, sepsis and adrenal insufficiency (Table 3).1,2,40, –42 They are defined by differences in insulin, pro-insulin, and c-peptide levels, characteristics of hypoglycemia and its correlation with food intake, and imaging techniques. The gene discussed is INS; the disease is hyperinsulinemic hypoglycemia.