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According to the Society for Endocrinology guidance, patients with suspected PBH should undergo formal assessment, which may include: Mixed-meal tolerance test to document postprandial glucose and insulin responses Continuous glucose monitoring over several days to identify patterns (though diagnosis requires capillary/venous glucose confirmation) Assessment for other causes of hypoglycaemia (insulinoma, adrenal insufficiency, hepatic dysfunction) Review of medications that may contribute to hypoglycaemia Patients should maintain a symptom diary documenting timing, food intake, and blood glucose readings when possible

I look for the predictors that flag those responders: high recurrence, more than three episodes, psychomotor retardation, discrete episodes, and a family history of bipolar disorder or lithium response