Metabolic Parameters in Patients with Suspected Reactive Hypoglycemia

Abstract

Background: It remains unclear whether reactive hypoglycemia (RH) is a disorder caused by improper insulin secretion, result of eating habits that are not nutritionally balanced or whether it is a psychosomatic disorder. The aim of this study was to investigate metabolic parameters in patients admitted to the hospital with suspected RH. Methods: The study group (SG) included non-diabetic individuals with symptoms consistent with RH. The control group (CG) included individuals without hypoglycemic symptoms and any documented medical history of metabolic disorders. In both groups the following investigations were performed: fasting glucose and insulin levels, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), 75 g five-hour Oral Glucose Tolerance Test (OGTT) with an assessment of glucose and insulin and lipid profile evaluation. Additionally, Mixed Meal Tolerance Test (MMTT) was performed in SG. Results from OGTT and MMTT were analyzed in line with the non-standardized RH diagnostic criteria. Results: Forty subjects have been enrolled into SG. Twelve (30%) of those patients had hypoglycemic symptoms and glucose level ≤55 mg/dL during five-hour OGTT and have been diagnosed with RH. Ten (25%) subjects manifested hypoglycemic like symptoms without significant glucose decline. Patients with diagnosed RH had statistically significantly lower mean glucose at first (92.1 ± 37.9 mg/dL vs. 126.4 ± 32.5 mg/dL; LSD test: p < 0.001) and second (65.6 ± 19.3 mg/dL vs. 92.6 ± 19.3 mg/dL; LSD test: p < 0.001) hour of OGTT and insulin value (22.7 ± 10.9 lU/mL vs. 43.4 ± 35.0 lU/mL; LSD test: p < 0.001) at second hour of OGTT compared to the patients who did not meet the criteria of RH. Seventeen (43%) subjects from SG reported symptoms suggesting hypoglycemia during MMTT but none of them had glucose value lower than ≤55 mg/dL (68.7 ± 4.7 mg/dL). From the entire lipid profile, only mean total cholesterol value was significantly higher (p = 0.024) in SG in comparison with CG but did not exceed standard reference range. Conclusions: No metabolic disturbances have been observed in patients with diagnosed reactive hypoglycemia. Hyperinsulinemia has not been associated with glycemic declines in patients with this condition. Occurrence of pseudohypoglicemic symptoms and lower glucose value was more common after ingestion of glucose itself rather than after ingestion of a balanced meal. This could suggest an important role that nutritionally balanced diet may play in maintaining correct glucose and insulin levels in the postprandial period.

Atherosclerosis Risk Factors in Patients with Reactive Hypoglycemia

“…The RH subgroup had significantly better results regarding HDL-cholesterol and TG levels (Table 3). Similar observations on glucose and lipid metabolism in patients with RH were made by Hall M. et al (2021), who reported no significant abnormalities in insulin response or alterations in the lipid profile in individuals with RH. 34 On the other hand, Lv X et al (2020) found that at hours 3 and 4 of an OGTT, the incidence of RH was higher in obese subjects than in patients with BMI<30 kg/m 2 .…”

“…33 Depending on the time after which plasma glucose levels fall below 70 mg/dL, RH can be categorized as: idiopathic -occurring approximately 3 hours after a meal, postprandial -occurring within 0.5-2 hours, and lateoccurring 4-5 hours after a meal. 34 The last category may be related to impaired insulin sensitivity, and thus, late RH can be regarded as a predictor of type 2 DM. 31,32 To our knowledge, no large clinical studies have been conducted on the epidemiology of RH.…”

“…Furthermore, there are no standardized guidelines on how to diagnose RH, and there are various diagnostic glucose cut-off values suggested in literature. 34,35 Hypoglycemia can be considered as a major distress to the human body and in some cases can be life-threatening. 10 In order to maintain glucose homeostasis, a vast array of counter-regulatory mechanisms evolved to prevent tissues from the negative consequences associated with hypoglycemia.…”

Assessing Long-Term Impact of Dietary Interventions on Occurrence of Symptoms Consistent with Hypoglycemia in Patients without Diabetes: A One-Year Follow-Up Study

“…The subjects were referred to the hospital in order to perform a detailed diagnosis toward suspected reactive hypoglycemia. Subjects underwent diagnostic procedures to screen for RH and other metabolic disturbances, which have been described in detail in the previous study [ 6 ]. The diagnostic tool to confirm RH was a five-hour oral glucose tolerance test that required administering orally seventy-five grams of glucose.…”

“…Their symptoms may occur in the postprandial period, but the frequency of those warning signs does not have a fully interpretable pattern. Due to the fact that hypoglycemic-like symptoms are not always associated with low glycemia, it is even more unclear how to interpret the occurrence of the abnormal symptoms attributed to hypoglycemia [ 6 ]. There is no standardized diagnostic procedure to determine the factors that contribute to and/or cause the symptoms in the postprandial period.…”