Hypoglycemia and the postprandial syndrome

Article Abstract:

Significant decreases in blood sugar after a meal (reactive postprandial hypoglycemia) constitute an ill-defined clinical condition, the legitimacy of which is controversial. This condition has been considered a neurotic psychosomatic disorder at certain times in the history of medicine and a legitimate medical problem at other times. Prior studies have assessed the body's response to an oral glucose load by measuring blood levels of glucose (glucose tolerance test). A study reported in this issue of the Journal evaluated this condition in a select population of individuals suspected of being hypoglycemic. This study makes a contribution by measuring the level of blood glucose at the time of an apparent attack. However, despite the attention to detail, the selection of a high-risk subgroup, and measurement of blood sugar at the moment of the episode, few values were found that could be interpreted as indicating hypoglycemia. It is likely that those values which were found to be low were simply an artifact of inadequate collection of blood by the patient. However, the important finding of this paper remains that nearly all measurements of blood glucose in these patients were normal. It must be remembered that hypoglycemic disorder (if it actually exists) is a pathophysiologic symptom, and not a disease. In view of all the evidence, there is little reason to believe that in some individuals hypoglycemia is a cause of symptoms which occur following a meal. At this juncture the physiologic reason for the postprandial syndrome is unknown, but physicians should evaluate the blood glucose levels of their patients at the time of an attack to establish the existence of such a malady, and not use glucose tolerance testing as a method of diagnosis.

Physiological aspects, editorial

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Blood glucose measurements during symptomatic episodes in patients with suspected postprandial hypoglycemia

Article Abstract:

Significant decreases in blood sugar after a meal (reactive postprandial hypoglycemia) constitute an ill-defined clinical condition, the legitimacy of which is controversial. This condition has been considered a neurotic psychosomatic disorder at some times in the history of medicine and a legitimate medical problem at other times. Prior studies have often assessed the body's response to an oral glucose load by measuring blood levels of glucose (glucose tolerance test). This study documents that the glucose tolerance test is not an accurate method for studying this disorder and determines instead that the correlation of patients' spontaneous symptoms to their blood glucose at the time of an episode is a more appropriate measure. Twenty-eight patients suspected of having postprandial hypoglycemia and 17 normal subjects had glucose tolerance tests. The patients were asked to place a small measured sample of capillary (fingertip) blood on a piece of filter paper at the time that they were aware of symptoms such as weakness, palpitations, tremor, sweating, hunger. The normal patients were also asked to take a blood sample several hours after each meal. Of the 132 symptomatic episodes reported, only 5 percent were associated with significant low blood levels of glucose. However, none of the 140 measurements taken on normal individuals were below the normal level. The authors conclude that true postprandial hypoglycemia is rare, and can only be definitively diagnosed when low blood glucose levels can be documented.

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Hyperinsulinemic hypoglycemia with nesidioblastosis after gastric-bypass surgery

Article Abstract:

Six patients with postprandial symptoms of neuroglycopenia are described owing to endogenous hyperinsulinemic hypoglaycemia after Roux-en-Y gastric bypass surgery. It is speculated that hyperfunction of pancreatic islets did not lead to obesity, but that beta-cell trophic factors may be increased as a result of gastric bypass.

United Kingdom, Health aspects, Risk factors, Obesity, Metabolic diseases, Gastric bypass

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