Reactive hypoglycemia
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2008-06-23T09:32:16Z
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'''Reactive hypoglycemia''' is a medical term describing recurrent episodes of symptomatic [[hypoglycemia]] occurring 2-4 hours after a high [[carbohydrate]] meal (or oral glucose load). 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.
== Common symptoms ==
Although symptoms vary according to individuals' sensitivity to the elevation and decline of glucose levels, some of the more common symptoms are:
*fatigue
*dizziness
*light-headedness
*sweating
*headaches
*palpitations
*depression
*nervousness
*irritability
*tremors
*flushing
*craving sweets
*increased appetite
*[[rhinitis]]
*epileptic-type response to rapidly flashing bright lights
*nausea, vomiting
== Causes ==
There are different kinds of reactive hypoglycemia: [http://www.alfediam.org/media/pdf/RevueBrunD&M5-2000.pdf]
1) '''Alimentary Hypoglycemia''' (consequence of [[dumping syndrome]]; it occurs in about 15% of people who have had stomach surgery)
2) '''Pre-diabetes'''
3) '''Hormonal Hypoglycemia''' (due to lack of some hormones; i.e., hypothyroidism)
4) '''[[Helicobacter pylori]]-induced gastritis''' (some reports suggest this bacteria may contribute to the occurrence of reactive hypoglycemia)<ref>{{cite journal |author=Açbay O, Celik AF, Kadioğlu P, Göksel S, Gündoğdu S |title=Helicobacter pylori-induced gastritis may contribute to occurrence of postprandial symptomatic hypoglycemia |journal=Dig. Dis. Sci. |volume=44 |issue=9 |pages=1837–42 |year=1999 |pmid=10505722 |doi=10.1023/A:1018842606388}}</ref>
5) '''Congenital enzyme deficiencies''' (hereditary fructose intolerance, galactosemia, and leucine sensitivity of childhood)<ref>{{cite web |url=http://www.emedicine.com/med/topic1123.htm |title=eMedicine - Hypoglycemia : Article by Vasudevan A Raghavan |accessdate=2007-07-06 |format= |work=}}</ref>
6) '''Idiopathic reactive hypoglycemia'''
7) '''Late Hypoglycemia '''(Occult Diabetes; characterized by a delay in early insulin release from pancreatic B cells, resulting in initial exaggeration of hyperglycemia during a glucose tolerance test)<ref name=health.am>{{cite web | Umesh Masharani, MB, BS, MRCP(UK) | title =Postprandial Hypoglycemia (Reactive Hypoglycemia) |
publisher=Armenian Medical Network | work =The Hypoglycemic states - Hypoglycemia | url=http://www.health.am/db/more/postprandial-hypoglycemia-reactive-hypoglycemia/ | year = 2007 }}</ref>
To check if there is real hypoglycemia when symptoms occur, you can have an [[OGTT]], or even more accurate for this kind of diagnosis, a "breakfast test". [http://www.alfediam.org/media/pdf/RevueBrunD&M5-2000.pdf] Then, additional tests may be applied to see if there is another disease (i.e. hypothyroidism) causing the reactive hypoglycemia.
== Treatment ==
To relieve reactive hypoglycemia, some health professionals recommend taking the following steps:
* Eat small meals and snacks about every 3 hours.
* Exercise regularly.
* Eat a variety of foods, including meat, poultry, fish, or non-meat sources of protein, foods such as whole-grain bread, fruits, vegetables, and dairy products.
* Choose high-fiber foods and food with a moderate-to-low [[glycemic index]].
* Avoid or limit foods high in sugar, especially on an empty stomach.
* Avoid alcohol, caffeine, and highly starchy foods such as white rice, potatoes, corn, and popcorn (all very high on the glycemic index).
* Adding soluble fibers (e.g., 5 to 10 grams of [[hemicellulose]], [[pectin]], or [[guar gum]]) to a meal may help to relieve symptoms, especially in [[dumping syndrome]]. [http://www.alfediam.org/media/pdf/RevueBrunD&M5-2000.pdf]
* Limiting total intake of carbohydrate to 130 grams/day can reduce the severity of symptoms.
Your doctor can refer you to a registered dietitian for personalized meal planning advice. Although some health professionals recommend a diet high in protein and low in carbohydrates, studies have not proven the effectiveness of this kind of diet for reactive hypoglycemia. If the diet does not provide a relief in symptoms, there are some medications which can be useful in reactive hypoglycemia, and that should be administrated only by a physician.
== 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.<ref>{{cite web |url=http://www.uni-duesseldorf.de/MedFak/insulinoma/english%20homepage/mainpage/subpage/Epostpran_hypo.htm#APS |title=postprandiale Hypoglyk�mie |accessdate=2007-07-06 |format= |work=}}</ref> Often, this syndrome is associated with emotional distress and anxious-behaviour of the patient [http://www.alfediam.org/media/pdf/RevueBrunD&M5-2000.pdf] [http://jcem.endojournals.org/cgi/content/abstract/79/5/1428].
Dietary recommendations for reactive hypoglycemia can help to relieve symptoms of postprandial syndrome.
==References==
<references/>
==External links==
* [http://www.mayoclinic.com/health/reactive-hypoglycemia/AN00934 Overview] at [[Mayo Clinic]]
* [http://www.mayoclinic.com/health/dumping-syndrome/DS00715 Dumping Syndrome Overview] at [[Mayo Clinic]]
* [http://www.emedicine.com/med/topic1123.htm Article about hypoglycemia] at [[eMedicine]]
* [http://www.alfediam.org/media/pdf/RevueBrunD&M5-2000.pdf Research about reactive hypoglycemia]
* [http://www.uni-duesseldorf.de/MedFak/insulinoma/english%20homepage/mainpage/Ehypo_cause.htm Overview about the causes of reactive hypoglycemia]
* [http://jcem.endojournals.org/cgi/reprint/79/5/1428.pdf Research about suspected reactive hypoglycemia associated with B-adrenergic hypersensivity and emotional distress]
* {{cite journal |author=Açbay O, Celik AF, Kadioğlu P, Göksel S, Gündoğdu S |title=Helicobacter pylori-induced gastritis may contribute to occurrence of postprandial symptomatic hypoglycemia |journal=Dig. Dis. Sci. |volume=44 |issue=9 |pages=1837–42 |year=1999 |pmid=10505722 |doi=10.1023/A:1018842606388}}
* [http://www.ajcn.org/cgi/reprint/25/11/1193.pdf Classification and possible causes of reactive hypoglycemia (article of 1972; may not be in accord with current medical practice)]
[[Category:Diseases]]
[[de:Postprandiale Hypoglykämie]]
[[pt:Hipoglicemia reativa]]