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.

Keywords: hyperinsulinemia; insulin resistance; reactive hypoglycemia.

Figure 1

Performed procedures. BMI—Body Mass Index; OGTT—Oral Glucose Tolerance Test; HOMA-IR—Homeostatic Model Assessment for Insulin Resistance; IFG—Impaired Fasting Glycemia; IGT—Impaired Glucose Tolerance; RH—Reactive Hypoglycemia; MMTT—Mixed Meal Tolerance Test.

Figure 2

Mean glucose value during 5-h OGTT (three-way ANOVA: F_{(10, 360)} = 3.598, p < 0.001) [mean glucose value with a 95% confidence interval]. SG—Study Group; CG—Control Group; RH—Reactive Hypoglycemia.

Figure 3

Mean insulin values during 5-h OGTT (three-way ANOVA: F_{(10, 360)} = 1.290, p = 0.234) [mean insulin value with a 95% confidence interval]. SG—Study Group; CG—Control Group; RH—Reactive Hypoglycemia.

Figure 4

ROC graph for patients with reactive hypoglycemia. OGTT—Oral Glucose Tolerance Test; T0—measurement taken in fasting state; T1—first hour of measurement, T2—second hour of measurement; T3—third hour of measurement; T4—fourth hour of measurement; T5—fifth hour of measurement.