Hypoglycaemia following a mixed meal in eating disorder patients

Abstract

OBJECTIVE To describe the incidence of hypoglycaemia, and variables associated with hypoglycaemia, in eating disorder patients following a mixed meal stimulus. METHODS Postprandial blood glucose values of patients admitted to a specialist eating disorder hospital for treatment of an eating disorder between 2000 and 2006 were reviewed and compared to body mass index (BMI), electrolytes, and weight losing behaviours. Analysis of variance (ANOVA) and stepwise logistic regression were undertaken. RESULTS 22% of patients had postprandial glucose values ≤3.5 mmol/l (63 mg/dl). Only low BMI significantly predicted postprandial hypoglycaemia. CONCLUSION Clinicians should be aware that postprandial hypoglycaemia is a common finding in eating disorders patients receiving inpatient treatment. As hypoglycaemia is predicted by low BMI, weight restoration is a priority for treatment in patients experiencing hypoglycaemia. Future research should investigate the nutrient composition of refeeding regimens and whether altering the macronutrient composition attenuates the presence of hypoglycaemia. Investigation is warranted in a community sample of eating disorder patients to see if this finding is replicated in non-hospitalised patients.

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders

“… a Cardiac arrhythmia is a common cause of death. b Hypoglycaemia in the first weeks is generally post prandial and occurs several hours after refeeding, hence some units preferentially use nasogastric feeding (Hart et al, 2011a). c Complications caused by purging behaviours as well as starvation (Bahia et al, 2012).…”

“… b Hypoglycaemia in the first weeks is generally post prandial and occurs several hours after refeeding, hence some units preferentially use nasogastric feeding (Hart et al, 2011a). …”

Effects of starvation and short-term refeeding on gastric emptying and postprandial blood glucose regulation in adolescent girls with anorexia nervosa

“…AUC and iAUC values were divided by the time of last measurement to obtain a final weighted average to account for samples that could not be collected in n ϭ 3 participants because of cannula failure at t ϭ 120 min. The number of patients with a blood glucose concentration of Ͻ3.9 mmol/l at any postprandial time-point was also recorded (25,42).…”

“…Anorexia nervosa (AN) is characterized by a marked restriction of energy intake leading to malnutrition, serious medical complications (36), and high mortality (46). Hypoglycemia, defined as episodes of abnormally low plasma glucose concentrations exposing individuals to potential harm (55a), which occurs in up to 30% of hospitalized patients (25), may lead to coma, cardiogenic shock (43), or cardiac arrest (38), and is associated with an increased risk of death (19a). Moreover, disturbances in glycemic regulation may be responsible for clinical symptoms (e.g., fatigue, dizziness, collapsing, etc.)…”

The application of continuous glucose monitoring technology to eating disorders research: An idea worth researching

“…Eating disorder behaviors (EDBs), including fasting, objectively large binge episodes, and purging, impact momentary blood glucose levels. Over time, these repeated fluctuations in blood glucose levels likely contribute to broader dysregulations in glucose control including increased risk for type 2 diabetes (Raevuori et al, 2015) or other glucose control abnormalities like postprandial hypoglycemia (i.e., low glucose levels following meal consumption; Hart, Abraham, Franklin, Twigg, & Russell, 2011).…”