Reactive hypoglycemia
Encyclopedia
Reactive hypoglycemia, or postprandial hypoglycemia, is a medical term describing recurrent episodes of symptomatic hypoglycemia
occurring within 4 hours after a high carbohydrate
meal (or oral glucose load) in people who do not have diabetes. It is thought to represent a consequence of excessive insulin
release triggered by the carbohydrate meal but continuing past the digestion
and disposal of the glucose
derived from the meal.
The prevalence of this condition is difficult to ascertain and controversial, because a number of stricter or looser definitions have been used, and because many healthy, asymptomatic people can have glucose tolerance test
patterns said to be characteristic of reactive hypoglycemia. It has been proposed that the term reactive hypoglycemia be reserved for the pattern of postprandial hypoglycemia which meets the Whipple criteria (symptoms correspond to measurably low glucose and are relieved by raising the glucose), and that the term idiopathic postprandial syndrome
be used for similar patterns of symptoms where abnormally low glucose levels at the time of symptoms cannot be documented.
For diagnosis, a doctor can administer an HbA1c test to measure the blood sugar average over the past 2-3 months. Additionally, a 6-hour glucose tolerance test will chart blood sugar during the past six hours.
According to the U.S. National Institute of Health (NIH), a blood glucose level below 70mg/dL at the time of symptoms followed by relief after eating confirms a diagnosis for reactive hypoglycemia.
symptoms include:
Stomach surgery or hereditary fructose intolerance are both believed to be causes, albeit uncommon, of reactive hypoglycemia.
"Idiopathic Reactive Hypoglycemia" is a term no longer used because researchers now know the underlying causes of reactive hypoglycemia and have both the tools to perform the diagnosis
and the pathophysiological data explaining the mechanisms.
To check if there is real hypoglycemia when symptoms occur, neither an oral glucose tolerance test
nor a breakfast test is effective; instead, a hyperglucidic breakfast test or ambulatory glucose testing is the current standard.
Low-carbohydrate diet and/or frequent small split meals is the first treatment of this disorder. The first important point is to add small meals at the middle of the morning and of the afternoon, when glycemia would start to decrease. If adequate composition of the meal is found, the fall in blood glucose is thus prevented. Patients should avoid rapidly absorbable sugars and thus avoid popular soft drinks rich in glucose or sucrose. They should also be cautious with drinks associating sugar and alcohol, mainly in the fasting state.
Hypoglycemia
Hypoglycemia or hypoglycæmia is the medical term for a state produced by a lower than normal level of blood glucose. The term literally means "under-sweet blood"...
occurring within 4 hours after a high carbohydrate
Carbohydrate
A carbohydrate is an organic compound with the empirical formula ; that is, consists only of carbon, hydrogen, and oxygen, with a hydrogen:oxygen atom ratio of 2:1 . However, there are exceptions to this. One common example would be deoxyribose, a component of DNA, which has the empirical...
meal (or oral glucose load) in people who do not have diabetes. It is thought to represent a consequence of excessive insulin
Insulin
Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....
release triggered by the carbohydrate meal but continuing past the digestion
Digestion
Digestion is the mechanical and chemical breakdown of food into smaller components that are more easily absorbed into a blood stream, for instance. Digestion is a form of catabolism: a breakdown of large food molecules to smaller ones....
and disposal of the glucose
Glucose
Glucose is a simple sugar and an important carbohydrate in biology. Cells use it as the primary source of energy and a metabolic intermediate...
derived from the meal.
The prevalence of this condition is difficult to ascertain and controversial, because a number of stricter or looser definitions have been used, and because many healthy, asymptomatic people can have glucose tolerance test
Glucose tolerance test
A glucose tolerance test is a medical test in which glucose is given and blood samples taken afterward to determine how quickly it is cleared from the blood. The test is usually used to test for diabetes, insulin resistance, and sometimes reactive hypoglycemia and acromegaly, or rarer disorders of...
patterns said to be characteristic of reactive hypoglycemia. It has been proposed that the term reactive hypoglycemia be reserved for the pattern of postprandial hypoglycemia which meets the Whipple criteria (symptoms correspond to measurably low glucose and are relieved by raising the glucose), and that the term idiopathic postprandial syndrome
Idiopathic postprandial syndrome
Idiopathic postprandial syndrome is a medical term describing a collection of symptoms popularly attributed to hypoglycemia but without demonstrably low blood glucose levels.People with this condition suffer from recurrent episodes of altered mood and cognitive...
be used for similar patterns of symptoms where abnormally low glucose levels at the time of symptoms cannot be documented.
For diagnosis, a doctor can administer an HbA1c test to measure the blood sugar average over the past 2-3 months. Additionally, a 6-hour glucose tolerance test will chart blood sugar during the past six hours.
According to the U.S. National Institute of Health (NIH), a blood glucose level below 70mg/dL at the time of symptoms followed by relief after eating confirms a diagnosis for reactive hypoglycemia.
Common symptoms
Symptoms vary according to individuals' hydration level and sensitivity to the rate and/or magnitude of decline of their blood glucose concentration. Some of the food-induced hypoglycemiaHypoglycemia
Hypoglycemia or hypoglycæmia is the medical term for a state produced by a lower than normal level of blood glucose. The term literally means "under-sweet blood"...
symptoms include:
- heartHeartThe heart is a myogenic muscular organ found in all animals with a circulatory system , that is responsible for pumping blood throughout the blood vessels by repeated, rhythmic contractions...
palpitationPalpitationA palpitation is an abnormality of heartbeat that causes a conscious awareness of its beating, whether it is too slow, too fast, irregular, or at its normal frequency. The word may also refer to this sensation itself...
or fibrillationFibrillationFibrillation is the rapid, irregular, and unsynchronized contraction of muscle fibers. An important occurrence is with regards to the heart.-Cardiology:There are two major classes of cardiac fibrillation: atrial fibrillation and ventricular fibrillation.... - fatigue
- dizziness
- light-headedness
- sweating
- headaches
- depression
- nervousness
- irritability
- tremors
- flushingFlushing (physiology)For a person to flush is to become markedly red in the face and often other areas of the skin, from various physiological conditions. Flushing is generally distinguished, despite a close physiological relation between them, from blushing, which is milder, generally restricted to the face, cheeks or...
- craving sweets
- increased appetite
- rhinitisRhinitisRhinitis , commonly known as a stuffy nose, is the medical term describing irritation and inflammation of some internal areas of the nose. The primary symptom of rhinitis is nasal dripping. It is caused by chronic or acute inflammation of the mucous membrane of the nose due to viruses, bacteria or...
- nausea, vomiting
- panic attackPanic attackPanic attacks are periods of intense fear or apprehension that are of sudden onset and of relatively brief duration. Panic attacks usually begin abruptly, reach a peak within 10 minutes, and subside over the next several hours...
- numbness/coldness in the extremities
- confusion
- comaComaIn medicine, a coma is a state of unconsciousness, lasting more than 6 hours in which a person cannot be awakened, fails to respond normally to painful stimuli, light or sound, lacks a normal sleep-wake cycle and does not initiate voluntary actions. A person in a state of coma is described as...
can be a result in severe untreated episodes
Causes
The NIH states: "The causes of most cases of reactive hypoglycemia are still open to debate. Some researchers suggest that certain people may be more sensitive to the body’s normal release of the hormone epinephrine, which causes many of the symptoms of hypoglycemia. Others believe deficiencies in glucagon secretion might lead to reactive hypoglycemia .Stomach surgery or hereditary fructose intolerance are both believed to be causes, albeit uncommon, of reactive hypoglycemia.
Types of reactive hypoglycemia
There are different kinds of reactive hypoglycemia:- Alimentary Hypoglycemia (consequence of dumping syndrome; it occurs in about 15% of people who have had stomach surgery)
- Hormonal Hypoglycemia (e.g., hypothyroidismHypothyroidismHypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone.Iodine deficiency is the most common cause of hypothyroidism worldwide but it can be caused by other causes such as several conditions of the thyroid gland or, less commonly, the pituitary gland or...
) - Helicobacter pyloriHelicobacter pyloriHelicobacter pylori , previously named Campylobacter pyloridis, is a Gram-negative, microaerophilic bacterium found in the stomach. It was identified in 1982 by Barry Marshall and Robin Warren, who found that it was present in patients with chronic gastritis and gastric ulcers, conditions that were...
-induced gastritis (some reports suggest this bacteria may contribute to the occurrence of reactive hypoglycemia) - Congenital enzyme deficiencies (hereditary fructose intolerance, galactosemiaGalactosemiaGalactosemia is a rare genetic metabolic disorder that affects an individual's ability to metabolize the sugar galactose properly. Although the sugar lactose can metabolize to galactose, galactosemia is not related to and should not be confused with lactose intolerance...
, and leucine sensitivity of childhood) - Late Hypoglycemia (Occult Diabetes; characterized by a delay in early insulin release from pancreatic β-cells, resulting in initial exaggeration of hyperglycemia during a glucose tolerance testGlucose tolerance testA glucose tolerance test is a medical test in which glucose is given and blood samples taken afterward to determine how quickly it is cleared from the blood. The test is usually used to test for diabetes, insulin resistance, and sometimes reactive hypoglycemia and acromegaly, or rarer disorders of...
)
"Idiopathic Reactive Hypoglycemia" is a term no longer used because researchers now know the underlying causes of reactive hypoglycemia and have both the tools to perform the diagnosis
and the pathophysiological data explaining the mechanisms.
To check if there is real hypoglycemia when symptoms occur, neither an oral glucose tolerance test
Glucose tolerance test
A glucose tolerance test is a medical test in which glucose is given and blood samples taken afterward to determine how quickly it is cleared from the blood. The test is usually used to test for diabetes, insulin resistance, and sometimes reactive hypoglycemia and acromegaly, or rarer disorders of...
nor a breakfast test is effective; instead, a hyperglucidic breakfast test or ambulatory glucose testing is the current standard.
Treatment
To relieve reactive hypoglycemia, the NIH recommends taking the following steps- Eating small meals and snacks about every 3 hours;
- Avoiding or limiting sugar intake;
- Exercising regularly;
- Eating a variety of foods, including meat, poultry, fish, or nonmeat sources of protein, foods such as whole-grains, fruits, vegetables, and dairy products;
- Choosing high-fiber foods.
Low-carbohydrate diet and/or frequent small split meals is the first treatment of this disorder. The first important point is to add small meals at the middle of the morning and of the afternoon, when glycemia would start to decrease. If adequate composition of the meal is found, the fall in blood glucose is thus prevented. Patients should avoid rapidly absorbable sugars and thus avoid popular soft drinks rich in glucose or sucrose. They should also be cautious with drinks associating sugar and alcohol, mainly in the fasting state.
Postprandial syndrome and adrenergic postprandial syndrome
If there is no hypoglycemia at the time of the symptoms, this condition is called "postprandial syndrome." It might be an "adrenergic postprandial syndrome" — the glycemia is normal, but the symptoms are caused through autonomic adrenergic counterregulation Often, this syndrome is associated with emotional distress and anxious behaviour of the patient. Dietary recommendations for reactive hypoglycemia can help to relieve symptoms of postprandial syndrome.External links
- Overview at Mayo ClinicMayo ClinicMayo Clinic is a not-for-profit medical practice and medical research group specializing in treating difficult patients . Patients are referred to Mayo Clinic from across the U.S. and the world, and it is known for innovative and effective treatments. Mayo Clinic is known for being at the top of...
- How to Get Diagnosed
- Dumping Syndrome Overview at Mayo ClinicMayo ClinicMayo Clinic is a not-for-profit medical practice and medical research group specializing in treating difficult patients . Patients are referred to Mayo Clinic from across the U.S. and the world, and it is known for innovative and effective treatments. Mayo Clinic is known for being at the top of...
- Article about hypoglycemia at eMedicineEMedicineeMedicine is an online clinical medical knowledge base that was founded in 1996 by Scott Plantz and Richard Lavely, two medical doctors. The website is searchable by keyword and consists of approximately 6,800 articles, each of which is associated with one of 62 clinical subspecialty textbooks...
- Research about reactive hypoglycemia
- Overview about the causes of reactive hypoglycemia
- Research about suspected reactive hypoglycemia associated with B-adrenergic hypersensivity and emotional distress
- Classification and possible causes of reactive hypoglycemia (article of 1972; may not be in accord with current medical practice)