Diagnosis and definition of RH can be difficult since it requires first ruling out other conditions (e.g., diabetes, hormonal dysregulation, peptic ulcer disease, alcoholism).[1][2][3] Currently, there are no standardized biochemical tests or procedures that can definitively diagnose RH.[1][4][5]
The timing and presentation of hypoglycemia relative to meals is a key feature of RH, so a comprehensive symptom and medical history are requisite steps in diagnosis.[1][6][2] Blood glucose assessment helps to confirm hypoglycemia, though there is still some debate as to which test is most suitable for the diagnosis of RH.[1][2] While the presence of hypoglycemia may be established by tests such as continuous glucose monitoring, mixed-meal tolerance tests, oral glucose tolerance tests, and ambulatory glucose testing,[2][3][7][5][8] no specific level of blood glucose has been established as a cutoff for the diagnosis of RH.[1][4][5]