Evaluation of hypoglycemia can be challenging and frustrating. Patients often report symptoms of hypoglycemia with no documentation, whether by lab or personal glucose meter. With insulinoma so rarely occurring, the most common underlying diagnosis is prediabetes or early Type 2 diabetes, but it could also be liver disease or cancer. The presence of neuroglycopenic symptoms in patients without diabetes are strongly suggestive of a hypoglycemic disorder. Conversely, there is a low likelihood of a hypoglycemic disorder in those with neurogenic symptoms in the absence of a low plasma glucose concentration.