<p>Identification of Reactive Hypoglycemia with Different Basic BMI and Its Causes by Prolonged Oral Glucose Tolerance Test</p>

Abstract

Purpose: To identify the population susceptible to reactive hypoglycemia and explain the possible reasons for their susceptibility. Methods: Ninety-four patients were divided into normal weight, overweight and obese groups before a 75-gram prolonged oral glucose tolerance test (POGTT). The incidence of reactive hypoglycemia (blood glucose ≤3.1 mmol/L or 55 mg/dL at points of 0-4 hours) was compared among three groups, and blood glucose and insulin levels were monitored simultaneously from 0-4 hours to assess the level of insulin resistance and insulin sensitivity. Furthermore, the degree of insulin resistance among three groups and within each subgroup (whether hypoglycemia events occurred) was compared. Results: Among the three groups, the incidence of hypoglycemia was significantly different at 3 (P=0.033) and 4 hours (P=0.020). At 4 hours, the incidence of reactive hypoglycemia in the obese group was approximately 3 times that in the normal weight group. The insulin level in obese group at 4 hours was nearly 4 times higher than that in normal group, and the same result also exists in the same subgroup of different groups. In addition, the hypoglycemia subgroup of obese group had higher insulin level than non-hypoglycemia (P=0.000). The homeostasis model assessment of insulin resistance index increased with increasing BMI among the three groups (P=0.000), while the Matsuda index decreased (P=0.000). The comparison of the homeostasis model assessment of insulin resistance index between subgroups in each group showed that the P values were 0.021, 0.038 and 0.085, successively, and the P values for the Matsuda index were 0.019, 0.013 and 0.119, respectively. Conclusion: Obese people has higher rate of reactive hypoglycemia than other groups in POGTT, in which insulin resistance may play an important role. But patients who are evaluated for reactive hypoglycemia need to be observed for at least 3 or 4 hours.

Metabolic Parameters in Patients with Suspected Reactive Hypoglycemia

“…Previous studies which have analyzed RH occurrence based on OGTT were conducted in the heterogeneous population. Those investigations involved the following: patients in various age groups and BMI range [ 22 ], healthy subjects [ 12 ], pregnant women [ 23 ], and patients with a variety of medical conditions [ 24 , 25 , 26 ]. The results obtained in those studies are consistent with our results and confirmed relatively low frequency rate of hypoglycemia occurrence during OGTT.…”

Migraine, Brain Glucose Metabolism and the “Neuroenergetic” Hypothesis: A Scoping Review

“…Postprandial hypoglycaemia is not uncommon, both in the general population and in those with diseases that alter the glucose metabolism. Table 1 reports some significant studies on the incidence of postprandial hypoglycaemia and shows that a 2-h OGTT does not suffice to fully understand the real prevalence of those suffering from postprandial hypoglycaemia, but that a 4-or 5-hour (OGTT) may be required [167,132,157].…”

Long‐term incidence of hypoglycaemia‐related events after bariatric surgery or usual care in the Swedish Obese Subjects study: A register‐based analysis

“…It may be speculated that the relatively high risk of hypoglycaemia‐related events in the control group may partly reflect reactive hypoglycaemia due to prediabetes. A recent study, based on prolonged oral glucose tolerance testing, reported such a phenomenon, and also found the association to be stronger in persons with obesity 34 . In comparison, patients with baseline type 2 diabetes (or incident diabetes during follow‐up) will be at higher risk of hypoglycaemia, especially when treated with insulin or insulin secretagogues.…”

“…A recent study, based on prolonged oral glucose tolerance testing, reported such a phenomenon, and also found the association to be stronger in persons with obesity. 34 In comparison, patients with baseline type 2 diabetes (or incident diabetes during follow-up) will be at higher risk of hypoglycaemia, especially when treated with insulin or insulin secretagogues. However, previous reports suggest that risk of hypoglycaemia in patients with diabetes is not increased by bariatric surgery.…”