Reactive hypoglycemia

Abstract

The hypoglycemoses include a large category of distinctly unique entities. Guidelines for a clinical, physiological approach to these disorders is presented. Within this diagnostic spectrum of hypoglycemia lies the reactive hypoglycemic disorders that are characterized by their postprandial onset, adrenergic mediated symptoms, and relatively benign causes. The spectrum of reactive hypoglycemia includes early alimentary-reactive hypoglycemia, late diabetic-reactive hypoglycemia, hormonal deficiency states, and idiopathic hypoglycemia. A new postprandial hypoglycemic disorder, fructose 1-6 diphosphatase, can be added to this list. The frequent sampling of blood-glucose values in the postprandial state will frequently lead to the finding of a biochemically low blood-glucose value of below 50 ml/100 ml, and these individuals show no hypothalamic-pituitary-adrenal stress to the low blood sugar and do not manifest adrenergic symptoms. Their low blood-glucose value simply reflects the transition in intermediary metabolism between the fed and fasting state and provides a biochemical marker of this event. We refer to this asymptomatic biochemical event as transitional low blood-glucose state. It has no clinical implication and may frequently be confused with the bona fide reactive hypoglycemic disorders. Using a symptomatic, counter-regulatory model to define hypoglycemia as a bona fide disorder, findings are presented in patients with the varying types of reactive hypoglycemia, and their results are compared to normal controls and to a weight-matched and disease patient controls. Abnormalities in insulin secretion are discussed as relating to the pathophysiology causal in the hypoglycemia. An approach to therapy is presented based upon the classification of the patient as to the type of hypoglycemia and their abnormalities in insulin secretion.

Frataxin deficiency in pancreatic islets causes diabetes due to loss of β cell mass

“…On the other hand, mice at 6 weeks of age exhibit a somewhat impaired glucose tolerance ( Figure 3c), though the area under the curve for this particular test was not significantly different at that age (P = 0.0647). Furthermore, very young knockout animals exhibit lower postprandial glucose excursions (Figure 2a), suggesting hypersecretion, as observed in early prediabetes in humans (34). Hence we cannot rule out a minor influence of impaired stimulus-secretion coupling following frataxin knockout in pancreatic β cells regardless of the ex vivo experiments.…”

Diagnosis of insulinoma using the ratios of serum concentrations of insulin and C-peptide to glucose during a 5-hour oral glucose tolerance test

“…Reactive hypoglycemia was characterized by postprandial onset, adrenergic mediated symptoms and relatively benign causes. Patients will often fail their 72-hour fast test, never developing hypoglycemia [15].…”

Postprandial Reactive Hypoglycemia in an Oldest-old Patient Effectively Treated with Low-dose Acarbose

“…Dumping syndrome after gastrointestinal surgery is the most frequent cause, but this patient had no history of abdominal surgery. It has been reported that patients with mild diabetes mellitus or impaired glucose tolerance can experience reactive hypoglycemia, because excessive insulin is discharged in the late period, which may cause a severe drop in plasma glucose levels [2]. Although she had never been diagnosed with impaired glucose tolerance before, the OGTT pattern showed moderately high glucose levels, and subsequent extremely high insulin levels at 120 min after the challenge, which may categorize this case as diabetic reactive hypoglycemia.…”

“…The causes of reactive hypoglycemia are various. Hofeldt classified postprandial reactive hypoglycemia into five categories: alimentary hypoglycemia, diabetes mellitus, hormonal, deficient early hepatic gluconeogenesis, and idiopathic [1]. Dumping syndrome after gastrointestinal surgery is the most frequent cause, but this patient had no history of abdominal surgery.…”

“…REACTIVE hypoglycemia is a rare pathophysiological condition in which hypoglycemic symptoms occur postprandially [1,2]. Dumping syndrome after gastrointestinal surgery is the most frequent cause, but some cases can be caused by mild diabetes mellitus, hormone-deficient status, insulinoma, drugs, or other rare mechanisms including fructose intolerance, or may be idiopathic.…”