Indication
Diagnose adrenal insufficiency and growth hormone deficiency.

Preparation
Patient taking an oral hypoglycemic agent must consult with their physician or nurse practitioner to discuss dosing prior to the insulin tolerance test.

Procedure
1. Measure heart rate, blood pressure and blood glucose levels at 15 minute intervals.
2. Administer 0.15 U/kg human regular insulin.
3. Serum baseline growth hormone and cortisol levels
4. Observe for symptoms of hypoglycemia including pallor, diaphoresis, heart palpations, and anxiety 
     within 30 -45 minutes after administration of insulin.
5. If the patient is not symptomatic and blood glucose is not less than 40, administer the second dose 
    of insulin.
6. Once the blood glucose is less than 40, obtain serum glucose level stat.
7. Serum cortisol levels at 45, 60, 90, minutes
8. Serum glucose levels at 30, 60, 90, 120 minutes after glucose level is less than 40
9. After the completion of the tolerance test, provide orange juice to the patient to elevate the blood 
    glucose level to greater than 60.
10. If the patient demonstrates severe symptoms of hypoglycemia and / or confusion, administer 1 
      ampule of D50 intravenously as a bolus.
11. If the patient becomes hypotensive, in addition to other signs of hypoglycemia, administer 
       Dexamethasone 4mg or Hydrocortisone hemisuccinate intravenously.
12. Document the dosage of insulin, blood pressure, and blood glucose level during tolerance test.
13. A physician or nurse practitioner must be available for immediate assessment and evaluation
       of the patient throughout duration of test.

Interpretation
The administration of insulin should stimulate the adrenal glands to secrete cortisol and the pituitary gland to secrete growth hormone. Failure to respond appropriately to insulin may suggest the need for glucocorticoid and growth hormone replacement.