Evaluation of a standardized hyperglucidic breakfast test in postprandial reactive hypoglycaemia

Abstract

SummaryThe oral glucose tolerance test is not specific for diagnosing postprandial reactive hypoglycaemia, since it too frequently induces low blood glucose values in subjects who have never complained of symptoms of this. By contrast, the mixed meal tests are deceptive for this purpose because they do not induce hypoglycaemia in subjects who have complained of of hypoglycaemic symptoms. We investigated the frequency of hypoglycaemia after a standardized hyperglucidic breakfast test in three groups of subjects:group A, 43 control subjects; group B, 38 postprandial reactive hypoglycaemic patients; group C, 1193 asymptomatic subjects undergoing assessment of glycoregulation. In the 38 subjects with suspected reactive hypoglycaemia the mean blood glucose nadir was 3.48 + 0.08 mmol/1, i.e. lower than in control subjects (4.83 _+ 0.13 p < 0.0001). Blood glucose levels less than 3.3 mmol/1 were found in 47.3 % of subjects with suspected postprandial reactive hypoglycaemia (group B), i.e more frequently than in control subjects (group A: 2.2% p = 1.6 x 10 -6) and asymptomatic subjects (group C: 1% p = 8 x 10-22). This markedly higher frequency of low blood glucose values in subjects with postprandial symptoms compared with control and asymptomatic subjects suggests that this test detects a tendency to hypoglycaemia after a standardized hyperglucidic breakfast. Since this test mimics average French eating habits, the results suggest that the patients undergo such symptoms in their everyday life, and that the hyperglucidic breakfast test is a simple alternative to ambulatory glucose sampling for diagnosis of postprandial reactive hypoglycaemia. [Diabetologia (1995) 38: 494-501]

Evaluation of insulin sensitivity and glucose effectiveness during a standardized breakfast test: comparison with the minimal model analysis of an intravenous glucose tolerance test

“…Blood samples were taken twice before the meal and at 15,30,60,90,120,150,180,210, and 240 minutes after the start of the meal. This test, which has been designed to detect postprandial reactive hypoglycemia, elicits the same glycemic response as the conventional OGTT [8,17]. For the purpose of the study, we used only the periods 0 to 180 minutes for the calculation of SI.…”

“…Rather than the classic OGTT, we chose to investigate for this purpose the standardized breakfast test (SBT), which is a bphysiologicQ variant of OGTT [16] offering several advantages: (a) lack of artifactual postload hypoglycemia, thus making this test suitable for the study of postprandial hypoglycemia [17], a situation which is frequently due to high values of SI [8,18,19], but also to hyperinsulinism in a context of insulin resistance [8]; (b) use of a physiologic stimulus triggering a cephalic phase proportional to palatability scores [20]; (c) possibility, according to previous reports, to measure SI with a modified algorithm based on the minimal model [21] as well as glucose effectiveness [22] and insulin secretion [23]. Therefore, we aimed at comparing SBT-derived measurements of SI and Sg (expressed in standardized physiologic units) with reference measurement obtained with the minimal model analysis of an IVGTT and to determine which SBT-derived indices correlate the best with those IVGTT-derived measurements.…”

Prevalence of self-reported symptoms attributed to hypoglycaemia within a general female population of the UK

“…Not all researchers have been able to demonstrate hypoglycaemia in their patients using free living blood glucose sampling [2]. However, it is now recognised that true RH exists in a proportion of patients exhibiting symptoms [3][4][5]. Although likely to represent one extreme of normal physiology, rather than a disease state [1], RH appears to have a detrimental effect on the health and well being of sufferers [6,7] and therefore has possible public health implications.…”

Hypoglycemia following pancreas transplantation

“…Evaluating pancreas allograft-associated hypoglycemia may include ambulatory continuous glucose monitoring, a 24-to 48-hour fast, and a standardized meal challenge [ 4 , 5 , 9 , 11 ]. The standardized hyperglucidic breakfast test is preferred over the oral glucose tolerance test for evaluating postprandial hypoglycemia because it is less likely to yield a false-positive result [ 45 ]. Anti-insulin antibody titer should be measured and measurement of free insulin considered in addition to total insulin, as measured in the standard hypoglycemia evaluation.…”